Friday
December 4th, 2015
Friday was crazy. The hospital filled like a rain bucket, and there were children needing chemotherapy, another girl with Leukemia undergoing a blood transfusion, mothers were not expressing enough milk for their babies, and IV’s were infiltrating.
Doing rounds in the morning, I wasn’t prepared for the putrid smell that awaited me on the other side of the closed isolation door. I had been informed it was a man in a motor vehicle accident, who now had gangrene, and most likely needed an amputation. Walls were no barrier to the fumes, which wafted into the nursing station, and should have heightened my awareness. Upon entering, my hand flew to my face, and I realized I was already wearing a mask. I tried not to gag, as I checked his IV, lungs, heart, and bowels. The smell was horrendous… he took no notice, smiling and nodding happily as I buzzed through the assessment.
The surgeons entered, took off the soaking leg wraps, and told him what was necessary. The only way to save him was through an amputation. The man shook his head vehemently.
“What do you do for work?” the surgeon asked the patient.
“I am a farmer!”
The surgeon reminded him of the smell that is produced when an animal expires, and pointed towards his leg.
“This is the smell of death.”
One of the surgeons kept stepping out of the room between sentences, to breathe the half-infected atmosphere outside isolation. The air inside the patient’s space was thick and heavy, radiating from his left leg — a gaping wound, thigh and calf, penetrating to the white bone. It was packed with yellow and green purulent puss, and bleeding.
In Islam, there is a belief that the body with which you die, is the one you will have for eternity. Perhaps, this greatly affected the man’s decision to amputate his leg. He stalled — saying he would call his brother. Then he refused. I saw him crawl on his hands out the doorway, to a wheelchair awaiting him. He went home. I felt bad. A part of me sighed with relief as the smell was among, if not, one of the worst I have inhaled, yet a sense of guilt and pity crept in…He needed the amputation or he would die. The surgeon had sent him home with no medication. No antibiotics.
“He needs to smell his own smell”, he explained.
And the smell lingered in the station all day.
Afternoon came, and I was taking over the pediatric ward for a nurse on break. While pushing the last of the scarce milk through an infant’s NG tube, a nursing aid ran in.
“SI5”, they said.
“Okay, I am coming.”
I turned around to finish up the milk.
They grabbed my arm. “It’s an emergency.”
I hurried past the patterned curtains and saw the family standing around the bed, the monitor screaming as the patient’s oxygen fell and his heart rate dropped lower and lower. 49. 47. 46. 41. The paralyzed man (the one who had taken a beating from the riots), was barely conscious, his eyes rolling back under his lids. His oxygen saturation was in the 50s, despite the nonrebreather mask, and he was foaming at the mouth.
Kokou, the nurse, rushed in.
“I’ll go get Todd,” I told him.
I picked up the phone and dialed. There was no answer at the clinic. “He is in the OR”, someone informed me.
I hurried down to the OR and pushed open the door. He looked up from his operation, where he was bent over an open abdomen.
“It’s SI5. His oxygen is in the 50s and his heart rate is 41 and dropping.”
He had been warning the family of this possibility, every morning.
“Try Salbutamol 2.5mg nebulizer, and give Lasix 40mg IV, he said through his mask. Maybe the patient needed to clear out his lungs.
I took off through the corridors, and back to the station, removing the green ampules from the medication drawer.
“Don’t you want Salbutamol?” Kokou asked over my shoulder, as I snapped the top off the third ampule.
I glanced down. I had been snapping the top of Decadron vials — same color and size as the salbutamol. Oh goodness. That is what labels and eyes are for. Relieved he had caught my error, we poured the medicine into a nebulizer, and pushed the Lasix through the IV. Then waited.
Slowly, the patient’s heart rate and oxygen came up again; his son, brother, and sweet wife, breathing sighs of relief, yet probably aware he was far from the clear.
By 7:30pm, I was leaving the hospital, and headed to the guesthouse for my refrigerated egg sandwich. I thought of the man who needed an amputation, wondering if he would come back. I hoped he would. I had a harder time wishing for him to be under my care. I also hoped that the patient in SI5 would make it through the night. I couldn’t help but think he was still there for a greater reason. Maybe morning would tell.
