Saturday, August 16, 2014

A very close call

A few months ago, I was sitting at the bedside of one of our missionary kids, praying the medicines we were giving him for his asthma exacerbation would work and I wouldn't have to intubate him to continue to breathe for him.  Thankfully, the medicine worked for Levi, and we didn't have to intubate and he is now on regular medicine and doing really well.  That night was scary to many of us. As the doctor, I hoped and prayed that I wouldn't have to be in that situation again.  I didn't want to have to decide at what point do I make the call that we need to consider putting a tube down a kid's throat to breathe for him because his body can't do it any longer.

Unfortunately, that situation arose recently.  I had just come back from lunch and was met in the ER by Imelda, one of our docs.  She had been working with a medical student trying to get this little girl's breathing under control.  We weren't winning, so she asked for more help.  We discussed some other medications that we could give the child, and proceeded to do so.  The kid was sick, really sick, but I was hopeful, that the medicines were going to work.  However, 30 minutes later the medical student came to get me, saying the kid was doing worse, despite our meds.  I knew this was bad.  I had just given this girl every medicine we had to try and help her breathe, the only option left was to intubate.

In the ER, I see this kid who is barely able to raise her chest, her head is down, she is no longer fighting the breathing treatments, she is just laying in her mom's arms, and I knew we were in trouble.  She didn't have much time.  I quickly talked to Bill hoping there might be an alternative, as intubating someone in our hospital and keeping them alive isn't easy.  This isn't something you can do on everyone and isn't something that I have done in my 7 yrs here.  He agreed, that this was our only chance, and a small chance at that.  I went to find one of our anesthesia folks to come and help with the intubation and sedation we would need.  David was able to intubate her without difficulty and we set off to try and rest her lungs while we were breathing for her.

Zach Hartwig, one of our MKs walked into the ER right about then, looking for me to give him some medicine for an injured hand.  I told him it would be a few minutes and he asked how he could help.  So we taught him how to squeeze the bag, and he did.  We don't have a ventilator, so once we intubate someone, we have to breathe for them by squeezing a bag to move their lungs and breathe for them, this requires someone at their bedside constantly.  For now the next 3 hours, that person was Zach.

David and I kept adjusting medicines and suctioning the kid to try and get the right balance of medicines so that we needed as little nursing intervention as possible, as Zach squeezed the bag and mom kept a vigil at the bedside praying for her daughter.  Mom obviously didn't fully understand me when I told her what we were going to do to her daughter, as about 10 minutes after intubating her she asked if we were done and if we could take the tube out, it was obviously traumatic to her to see her little girl, seemingly dead with a tube taped to the side of her mouth.  We explained to mom that we had to keep her like this for a while, and she agreed to let us keep going.

We found a nurse who could stay at her bedside through the evening so Zach could go home, and we carefully transported her to the pediatric ward.  For a few hours the baby did really well, the medicines worked, she stayed asleep and we kept breathing for her, but after a number of hours, the sedation started to wear off, her IV came out and we lost our ability to keep her still.  So we took out the tube and hoped for the best.

It has still been touch and go, but it looks like she is going to be okay.  She is able to breastfeed, which is a great sign that her breathing has improved.  I am thankful that this little kiddo did well, and am thankful for the team of folks who helped to care for her to help see her through this asthma attack.  Please pray for this little one to do okay with the medicines we have to offer here, and that we don't find ourselves here again anytime soon.