life on the edge

We've had a lot of deaths on pediatrics this week after a few quiet
weeks in the hospital. We've also been stretched a little thin with
various docs going away to get customs cleared, visas approved, go to
clinics in the rural villages, and caught up in the OR. So I often get
an abrupt "We need you in peds" or "we need you in maternity" and have
to shift from laughing with my colleagues to walk in on a situation
where someone is dying in the space of a few steps. The nurses would
like to let us know sooner but we don't have a centralized paging system
or radio so they often waste a lot of time looking for someone to help.
This Friday I got the summons to go to pediatrics when I stepped in the
doors after lunch. When I got there the pediatric charge nurse,
Michelle, was in the resuscitation room with a 3 year old child. He'd
gotten there around 30 minutes before, didn't look very good, and she'd
moved him in to try to do a lumbar puncture. He'd stopped breathing.
When I arrived he had thick white vomit on his face, and there were two
nursing students in the room trying to get the suction machine to work
without really knowing how. He was bradycardic, we gave some atropine,
and his heart stopped and so did we.
I asked the mom if she wanted us to pray with her, and she said okay. I
started to pray, but all I could really think to say was to ask
forgiveness, for my lack of pediatrics training, for the lack of medical
services for her child, for giving up so quickly instead of doing the
full PALS protocol because I didn't have the right drugs, or help, and
knew it was likely to be futile without ICU care, for the negligence of
the folks in America and elsewhere to keep allowing things like that to
happen. She didn't speak English, and I didn't say all that aloud, but
managed to mumble something and left the room to call the chaplains to
come and spend more time while I moved on to the next crisis in maternity.
I don't like giving up on patients. I don't like it even after I've
exhausted the resources of a modern US hospital. I like it less here,
when I feel that I often give up quickly, perhaps too quickly at times.
You tell yourself you're being practical, or pragmatic, but the honest
truth is that you're tired, and stretched thin, and worried about what's
coming in the next few minutes, and trying to save your drugs for the
patients you estimate that you think you can save. It's a curious poker
game where you're trying to call the disease's bluff, you sometimes
don't get it right, and it's hard to meet that mom's eye after you're
finished, even if her expectations were not that high for what you could
do. So she ties that body on her back and starts the journey back home,
and you move on to the other wards, to a lumbar puncture or an
amputation or an I&D, and watch American movies and try not to think
about it that much, and make promises to yourself that you'll figure it
out the next time. And God willing, maybe you will.