Saturday, March 10, 2007

How far do you go?

One of the things I've been learning is which limitations I should try
to tackle and change, and what I should just allow to be. This past
week gave a good example. We had a sick man sent to us from one of our
referral hospitals who had clearly not done well with the trip. He
arrived on our doorstep acutely short of breath, with an oxygen
saturation of 52% (normal is above 90%). We placed him on a bed on male
ward and hooked up our oxygen concentrator to him. Unfortunately, we
only have one working oxygen concentrator for each ward (the one for
male ward has since made an awful noise, emitted sparks, and started
smoking, but that's another story) and there was a man who was already
using it, so we had to hook up a Y connector and split our maximum of 5L
of oxygen between the two of them. The power to the hospital then went
out, and we started the generator. We were told that the power company
didn't know where the fault was, however, so they were projecting that
it could take several days to fix (remember when I arrived in December
the power to everywhere went out for three days). We, in the meantime,
only had fuel to run the larger generator for around 16 hours (80L of
fuel). The local filling station has shut down, since it doesn't get
regular shipments of gas from the city, so all we can buy is black
market petrol, when it is available, which it wasn't at the time. We
could, however, run the smaller generator much more efficiently which
powers a few electrical outlets on pediatrics, maternity, the OR, and
the lab. So I made the decision that we should move this man to
maternity, fire up the smaller generator, and put him on the oxygen
machine from labor and delivery. This process consumed most of my lunch
hour, and his oxygen levels got very low while moving him. However, we
did get him on to maternity, at which point his IV pulled out during the
transfer to the other bed. After we got a new IV placed, the power came
back on. We wanted to give him a rest on maternity, but he started to
deteriorate and the nurses were uncomfortable having him pass away in
the middle of a bunch of pregnant women, so we moved him back to the
male ward, where he died in about 30 minutes.
You can go through these sort of lengths for almost every patient,
trying to maximize your limited resources and using your staff's energy
on what are likely hopeless cases (O2 saturations of 50% need to be
intubated and on a ventilator, which we don't have available here). Or
you can give them up for lost, but have to live with the thought that
maybe you could have done a bit more for that patient. There's no easy
answers, and you do what you think you have to in order to look at
yourself in the mirror the next morning.

2 comments:

Anonymous said...

Matt,
It is so refreshing to read your blog. This is coming from someone who doesn't read blogs. The challenges you face are both interesting to read about and sobering to consider in light of our relative abundance in the states. Many people are praying for you and all those with whom you come in contact. Thanks for doing what you're doing.

Jonathan

Anonymous said...

Hi dear Matt-
We are so blessed by your blog stories and emails. Thank you for being so honest with all that is happening for you. This gentleman with low O2 who passed on, it sounds like you all did famously moving as quickly as possible to meet his needs. The Lord must be smiling continuously. I know I am.
Love and prayers, Ruthie