Sunday, October 2, 2016

Road to Recovery

I was attempting to sleep in between phone calls one night when the phone rang, again.  The nurse said the child on bed 23 was having more trouble breathing, could I come.  I had admitted the girl a few days prior.  She came in with cough and difficulty breathing.  The chest Xray showed a huge heart and an ultrasound showed a lot of fluid around the heart.   We started her on TB treatment and expected her to get better in the days ahead, like the many others we have seen before.

As I got dressed and drove down to the hospital, my mind was racing, trying to figure out what might be happening with the little girl.  Knowing she had a pericardial effusion, I was concerned that the fluid around her heart was giving her difficulty breathing. 

I got to the ward and found a little girl whose face was significantly swollen, and had 6 anxious family members huddled around her, obviously worried about her.  After talking to the family, and examining her, I knew the fluid around her heart hadn't responded to the TB treatment.  As I looked at her, I knew there was only one thing I could do - drain the fluid around her heart relieving some of the pressure causing her heart not to pump and fill like it needs to or she would die.    

The procedure, a pericardiocentesis, may not sound difficult you just put a needle just below the sternum or through the ribs, advancing it far enough to get into the fluid around the heart, but not too far that you get into the heart and cause bleeding that can't be stopped, but it is.  There are lots of variables in this procedure that make it something we do, when there are no other choices - meaning the patient will die if we don't, but we know that if it doesn't go well, the patient can die if we do.  So we don't take the risk lightly.

I talked to the family, I explained what I needed to do and told them the risks of doing it and not doing it.  I gave them some time to think it over and went and collected what I needed to do the procedure.  I came back to the ward and found them with their heads down, praying and seeking God for this little girl.  We prayed together and then got to work to save her life. 

The first thing we needed was to get an IV going, to give her medicine to help keep her asleep while I did the procedure and to be able to give her medicines if something went wrong.  3 nurses tried 6 times, but were unable to get a vein, so I put a needle into one of the bones in her leg, in order to get us access.  After that, we got the US machine set up and I went to work.

The first few times I put the needle in, I didn't get anything back, no fluid came.  I adjusted and readjusted what I was doing and the 3rd time I finally got the fluid.  It wasn't a yellowish reddish liquid like I was used to, it was thick yellow pus.  I was able to drain off 300cc of pus from around her heart, giving her heart the room, it really needed to contract and expand and get blood to the rest of her body.  

The following day she went to surgery, and had a hole cut into the lining around her heart, draining off more pus and fluid.  She had a rocky road after surgery - establishing an IV in her was more than difficult as every vessel was full of a blood clot, but she managed to get on the road to recovery.  I would often see her dad pushing her on a walker as she got better and was getting ready to go home.  Unfortunately, less than a week later, she came back with more shortness of breath and this time we removed fluid in her lung and continued our medicines.  She still has a road to recovery, but I am sure thankful that we have been able to help and that her family hasn't stopped crying out to God for her and her health.  Would you join them and us in continuing to do so?