Mar. 27

Yesterday was a nightmare.  I was too emotionally exhausted to write before bed.  It was 2 am when Nikki and I made it to bed.

The morning began with me doing rounds in the female ward.  I completed rounds with very little interruptions. 

One interruption was the 19 year old with seizures.  She was sitting comfortably in bed when I spoke to her.  The girl later went outside to visit friends and she collapsed on the ground screaming.  A few men carried her inside and I walked over to assess the situation.  The girls said that her back hurt.  She had her hand over the left lower back.  In just a couple of minutes the girl stopped crying and lay calmly in bed.  I had given her no medication but simply stood next to her bed and watched.  A nurse standing next to me said the girl had problems at home.  I don’t know what to do with this information.  I still haven’t figured out what is causing this.

Since Tuesday a day with sickle cell anemia has been in the ward.  She was admitted with severe abdominal pain and we originally thought that she had a perforated bowel due to typhoid.  The lady was started on antibiotics and fluids and Dr. Jean was notified.  By the time the patient was in the OR, her pain was significantly improved so the surgery was canceled.  We assumed that she had had a sickle cell crisis and it could be managed with fluids.  The key to these patients’s is to keep them well hydrated.  Dr. Jean placed her on 4 liters of fluids that day.  During rounds on Wednesday and Thursday the lady was complaining of abdominal pain and she had no appetite.  I kept her on 2 liters of fluid per day and started the treatment for Typhoid.  On Friday morning rounds the lady reported that she felt better and was able to eat without a problem.  So I didn’t place her on fluids and just continued the antibiotics.  I finished rounds and left the hospital.  That evening Nikki and I were visiting Pastor Jido.  While at his house I received a phone call from Dr. Jean.  She informs me that the patient’s abdomen is now distended and painful.  That the patient was not kept on enough fluids to flush out the sickled cells and she has probably clotted off part of her intestine.  The woman needed surgery but had no insurance so the family would be in financial crisis.  And I was told the woman would probably die in surgery because she wasn’t kept on enough fluids.  As you can imagine I felt terrible.  I felt as if I had just killed this patient.

Nikki and I left Pastor Jido’s house to go to the hospital and see if we could help.  We arrived at the hospital to find out there was no blood to give her.  Since I’m O negative I walked with Emery, a lab tech, to see if I could give a pint.  In order to safely give blood, a person needs hemoglobin of 12…mine was 10.4.  I’m a chronic anemia, which I knew before coming to Africa but I wanted to still try to give.  We decided that I would be able to give a pint IF there was no other option.  Finding a person with O negative is rare, that person is considered the universal donor.  The patient had B positive blood type.  Thankfully she had 2 relatives, who were matches, but her hemoglobin was 2.2 and she needed at least 4 pints of blood in order to survive the surgery.

Nikki and I went to the nurses at the hospital to find more donors.  I found 2 male nurses who were willing to donate but no one else was a match or was willing to give.  Several nurses said no even though we were begging for this lady’s life.  Nikki called Emery and said we found donors and he needed to return to the lab right away.  Emery said he had to eat first and would be there in 30 minutes.  I couldn’t believe it!  We waited outside the lab for Emery to arrive.  Meanwhile Dr. Jean is performing surgery and the patient desperately needs blood to survive.  I’m sitting on a bench outside the lab blaming myself for this patient’s surgery because if I had kept her on enough fluids it could have been avoided.

While we were waiting for Emery, the electricity went out.  There are no backup generators at the hospital and the only lights in the OR were flashlights and Dr. Jean’s headlamp.  I just couldn’t believe all of this was happening! Thankfully the electricity came back on in a few minutes.  I continue to sit on the bench begging God to be merciful and save this lady’s life because I don’t want her life on my conscience.  After about an hour of praying silently I’m so emotionally exhausted that I finally just say “God, do as You will”.

I walk back into the OR and Dr. Jean tells me the lady had a ruptured ectopic pregnancy.  She just finished draining 2 pints of blood out of the patient’s abdomen.  There was no way I could have known this lady had an ectopic pregnancy.  So keeping her on the fluids wouldn’t have made a difference.  The lady survived the surgery.  Afterward I went and thanked the male nurses for donating.  Without their blood the woman would have died.  I lay in bed last night thanking God for showing mercy.  The odds of finding 3 donors in a matter of minutes were extremely slim.  The electricity was only off for a couple of minutes during surgery but after we finished surgery the electricity shut off for a full hour and continued to come off and on for the rest of the night.  This night was just completely unbelievable.

4:30 pm

I was planning to visit Pastor Jido’s church this morning, but Dr. Jean came into my room and said there was a patient with cholera at the hospital.  Cholera is the result of dirty drinking water.  The symptoms are rice water stool (milky white fluid) and severe vomiting.  The patient will die in a matter of hours from dehydration if not treated appropriately.  This news truly made me afraid because this could indicate a cholera epidemic.  Dr. Jean sent me to the hospital to evaluate the patient.  We had placed the patient in an isolated room.  By the time he reached the hospital his diarrhea and vomiting had slowed.  We started fluids, gave Promethazine, and Doxycylcine.  This patient should be fine.  Please God let this be the only case of cholera.

While I’m sitting in the men’s ward a nurse requested that I see another patient.  The 75 year old man was sitting on the edge of the bed breathing very shallow and fast.  I could look from across the room and tell that he was extremely ill.  I called Dr. Young and told her I thought he had pneumonia, after receiving the orders I moved on to the next patient.  Dr. Jean came to the hospital and we completed rounds on the female ward then returned to check on this man.  He had deteriorated in just 2 hours.  He was now gasping for breath and using his accessory muscles.  Dr. Jean called for an ambulance to take him to Yendi.  We don’t have Oxygen at this hospital and he needed Oxygen.  He was loaded into the ambulance and was taken only 50 feet before he died.

Female Ward

God is great and he performed a miracle.  The woman with the ruptured ectopic pregnancy is still alive.  Not only is she alive but when I looked at the inner lining of her eyelid (easy way to assess patient’s hemoglobin level) it was a healthy pink.  Last night her inner eyelid was pure white.  The woman was able to sit on the edge of the bed for a few minutes.  God is good!

The 19 year old with seizures was discharged today.  She is back to normal.  I will never know what caused all of this.  She has a referral to a neurologist in Tamale but the girl said that she didn’t want to go.  I just hope this doesn’t happen again.

Ghana fact…

Pastor Jido has promised that he will cook a dog for Nikki and me.  He will throw a big party and kill a dog.  The family now has two dogs.  The new dog is called “God’s timing”.   He will be kept for awhile to fatten up.  So I think that Pastor Jido will feed us the dog Faith.  This family also has a cat that will be eaten soon.  I asked if Pastor Jido ate rats…his response was “Oh no, I do NOT eat rats!  Who could eat a rat?”