Black Cloud

Buenos Dias, Amigas. NH aqui:

It has been a few days since my last post and so much as happened. So remember when I mentioned the great missionary Exodus? Well, Thursday night, the missionaries leave the compound. I am left with another family practice doc and Abby, the ER doc, to man the entire hospital. The missionaries have been joking with me in the week leading up. They'd be like, "It will be FINE. Most likely, nothing will happen. Remember that year though during retreat when there was an 11 person MVC and only 2 docs with so many injured patients? Remember that?" Very comforting. Well, anyways, Thursday night and Friday were not that bad. I got a 6am call to come help with a delivery. The family doc had been on call but since they like to have a doc for the baby and a doc for the momma since the nurses are not NALS certified, I went. The delivery went fine but the baby came out depressed. Since I am house sitting all of the way up the hill, I do not make it until the baby was already out. I walk in and the baby is not crying, and they say to me, "Do you know how to tracheal suction." "Yes," I say. But I'm thinking to myself, "Well, in theory at least." But I do tracheal suction and eventually the baby starts crying. I rounded on all of my patients and then was actually able to steal a couple of hours to go snorkeling for my first time EVER. We swam way off the beach to find this beautiful reef, and I could not believe the diversity of wildlife and the colors of all of the coral.

Josh and I are up the hill around maybe 5pm, and I hear over the radio the ER doctor. There's a delivery, and she needs some more help. I get down there pretty much in time to gown, glove, and catch baby. Baby is a little depressed but looks pretty good. Mom has a small lac that i get to repair. Fun stuff. Everybody who is reading this knows this is right up my alley. However, then we start having trouble keeping the baby's saturations up even though the baby actually looks pretty good. We decided this is an urgent but not emergent need for transportation to Ceiba, a city about 1.5-2 hours drive from here. Oh, and there are no ambulances running tonight so if we want them to be transported, we will have to do it ourself. As Abby is arranging this and sorting throught he mountain of paperwork (birth certificates, etc.), I see a man in the ER for her. At this point,we are busy, but it is under control. We get a call saying there has been a motorcycle accident. As soon as Abby walked into the ER and saw the chaos, she sent out a radio call. "Everyone who has hands and/or a car, COME!" A husband, wife, and 2 year old boy had been on a motorcycle (in the dark, mind you) and hit a horse. The wife had some minor lacerations but otherwise looked ok. The husband has a pumping scalp laceration and is covered in blood and his eyes are both swollen almost shut indicating further head injuries. We are putting him a C collar when I look over and say, "Who's the kid?" Abby said, "He must have been a part of the accident too," and we quickly turn our attention to him. The 2 year old has complete left hemineglect: eyes are looking off to one side and he is only using one side of his body. Abby, being the ER doc she is, decides he is the most urgent (as we are almost certain he has a head bleed) and starts preparing a car to take him to La Ceiba. She decides, since I am most up-t0-date on my pediatric life support certification, to send me with the intubation kit, a monitor, and a suction kit with the reassuring words, "He has a good chance of seizing, coding, or dying on the way there. Be ready." Thanks very much.

As she is putting the child in the back seat of the car, he starts seizing. I have already drawn up Phenobarbital and push a dose as we take off with mom, grandma, and our driver, Brad. He does not stop seizing with the first dose of phenobarbital so I give him a second dose. He finally stops seizing and remains pretty stable the rest of the trip with an occasional desaturation that goes away with suction. The whole trip, he only responds to painful stimuli and when he does respond, it is only with his right side. We get to the government hospital, which Brad says is a great improvement on the previous facility and walk immediately into the ER bay. I have been told to BE FORCEFUL, because if I am not, this child could have to wait hours to even be seen. I meet a doctor who I know at once is a resident, probably an intern, by the fatigue and panic in his eyes. I tell him the story and tell him that the patient needs a CT scan STAT. He is very kind and seems to know what he is doing and understand the urgency of the situation. But they don't do CT scans anymore here and would have to take the patient 20 minutes down the road to another hospital. Ok, let's do that. Now. The little boy now starts waking up and to all of our amazement and relief, he starts moving all of his extremities and crying. YAY! Perhaps his paralysis is not an expanding head bleed but a smaller one causing seizure activity. He still needs a CT scan, but we are thankful that he's showing improvement. Anyways, we leave the little boy once the attending comes down. The family, of course, does not have the cash in their pockets for the CT scan, because they came straight from the sight of the accident to the hospital. Brad give the money (about $150) to the hospital so they can take the child. I know this is not "When-Helping-Hurts"-Savvy but who cares? What are you supposed to do? The rest of our transports have arrive: the post-partum lady, her baby, and the husband. The husband apparently had an arterial pumper from his scalp lac that they were unable to repair at Loma de Luz. Instead, they put a large pressure dressing around his head that seems to have stopped the bleeding for now. I get back to the hospital around 1am.

I am actually on call Sat., and I am busy with ER consults but its nothing too bad. A vomiting child, a foreign body in the eye, a miscarraige, you know. I had one nighttime consult but was in bed by midnight and did not get any other calls. This morning is Sunday and there is no ride for me to go to Honduran church and the missionary church is not going on so Josh and I are taking a true Sabbath this morning. (Well, besides me going in to round.) There is more, but I am tired of writing, and you are probably tired of reading. I know I keep promising pictures, but they will come. Thank you all for your continued prayers. They are much needed.

Oh, and as far as the "black cloud" title goes, I believe that mine has followed me here to Honduras. Its kind of a big joke back in Greenwood, but I forgot to warn Loma de Luz in my application process that I draw in chaos. Kindly though one missionary said that she has been praying for this. She has been trying to train nurses, but their census has been low. Since I have come, they have gotten lots of learning. That's one way to look at it.

Philippians 4:19 "My God will supply all my needs according to his riches and glory."