ust your lower legs, but now includes your upper legs and you need help to go the bathroom. The next day the weakness and heaviness isn't only confined to your legs, but now has worked it's way up to your arms. You spend most of your day in bed which concerns your family, so they bring you to the hospital Friday evening.I was on call when Susan arrived. I listened to the history, and then did an exam. I found a 19 year old female who could barely move her legs or arms, had no reflexes, but could feel my hands when
I touched her. When I sat her up to listen to her lungs, she almost fell back except her brothers and sister held her up. I diagnosed her with Guillian Barre Syndrome and was worried she was only going to get worse.
Guillain Barre is an acute ascending paralysis that usually starts in the legs and works it's way up. After the legs, it goes to the arms, and then can get the muscles used for breathing. This is the most feared complication for us, and puts our patients at risk of dying because we don't have a machine, ventilator, that can breathe for them. Many pts, if they aren't already in the hospital when this paralysis occurs, won't make it to us in time to help. When we are faced with a patient who is paralyzed and can't breathe, our options include intubating the patien
t and bagging them until the paralysis recovers (2-4 wks later), or transferring them to a hospital with a ventilator.
So at 6pm on Friday night, I was talking to the family about transferring the pt to Mt. Hagen, where they have a ventilator and an ICU, so that when she stops breathing, she would be in a hospital that could care for her. The family agreed, so off she went to Hagen, only to return to us on Sunday, as their ventilator doesn't work. When she returned, she wasn't moving her
her arms or her legs, could barely talk, but was still breathing. Within 8 hours, she stopped being able to breathe on her own and Dr. Scott, who was on call, intubated her. He explained to the family, the need for them to continuously squeeze the bag which would breathe for her. If they stopped she would die. All night long, they faithfully squeezed the bag over and over about 20-30 times a minute breathing for Susan.
I had no idea that Susan had returned to us when I started my rounds on Monday am. It didn't take me long to find Susan and a faithful wasmeri sitting at
her bedside squeezing life into Susan's lungs. I knew the situation in front of us wasn't good. We can only keep breathing for someone for so long, because eventually the tube will come dislodged, someone will fall asleep and quit squeezing the back and she will die. As I talked to Bill about the case, he said to try and see if the pt can be transferred to Port Moresby General Hospital. So I start making phone calls, many phone calls. After 2 hours and having hurdled many obstacles, I find myself along with Grace (an anesthesia training officer), and 3 of Susan's brothers in the back of our ambulance on the way to the Mt. Hagen airport to get on a MAF (Mission Aviation Fellowship) airplane to go to Port Moresby General Hospital.
The trip wasn't easy, with numerous tube readjustments we made when her sats dropped, got low on oxygen and had to change bottles, and she almost fell off the backboard as we put her into the plane, but God was with us. We prayed numerous times along the way, but specifically with Susan as we started to make our way to the runway. Grace and I got to talk to her about Christ. She has gone to church, but isn't a Christian and so we got to share with her about Jesus's love for her. 2.5 hours later we landed in Port Moresby at the airport waiting for the ambulance to pick her up and take her to the hospital where doctors were waiting to put her on a ventilator and breathe for her.
On the 2.5 hr trip home, I couldn't help but pray for Susan and I ask that you would too. Pray for her to know the one who died for her. Pray for the doctors in Port Moresby to know how best to care for her. Pray that the ventilator would be able to sustain her until she is able to breathe on her own again (2-4 wks from now). Pray for her family as they look after her and care for her while she is there.
