This was the night. Day two the clinic had received multiple patients and the night crew swerved their way through the crowded streets to get to work on time. Light showers had continued to fall for the past 24 hours, making the 200-meter driveway to the clinic too risky to traverse in the van. I don’t think the cows would have the man-power, or horse-power, to get us out, should there be a derailing. I thought about the thousands of little shelters on the hill, and prayed against the landslides.
“Out here, please!”
The driver opened the side door of our van and ushered us towards a ditch, where a bridge lay for crossing. By bridge, I mean three sticks, a foot and a half apart each, with some broken plywood scattered around. I looked at it for a while, while the Bangladeshi darted ahead of me in the dark, then turned around to shine their lantern at the broken sticks. I held out my hand and there was a long hesitation before they halfheartedly stabilized me by my fingernails. I remember reading about the outlawed PDA in Bangladesh — except men-to-men. They could hold hands, walking and talking.
We made our way to the clinic, lanterns swinging in the hands of our guide, and the lights from the familiar white tents beckoning ahead. We were divided in two work zones — red was critical confirmed Diphtheria cases and orange was suspected or stabilized patients. These patients were unpredictable — either climbing to their discharge home, or quickly falling within minutes. During New Years day there had been plenty traffic, with one little boy left in the red zone on one-to-one nursing care and eight patients in the orange zone.
Nurse Practitioner, Emily, and myself, put on our appropriate Personal Protective Equipment (PPE), and gathered report from the day nurse. I wasn’t concerned for our own safety — I’d been vaccinated before I could eat solids; but the PPE served as protection from other possible diseases, as well as spreading Diphtheria to the rest of the population.
I think we were both incredibly nervous.
“Their respirations are 20 or 24?”
“I think their pulse just went from 100 to 103”
For the first four hours of our night shift, we paced the tent wards, checking and re-checking the charts, and verifying vitals with the baseline again and again. Diphtheria is not very easy to treat, and serious once it progresses. Some of the more absolute signs of Diphtheria — bull’s neck and a pseudo membrane — are indications that the antitoxin (DAT) needs to be administered. The drug itself has highly probable adverse effects that could even kill the patient.
“Does it hurt when you swallow?”
“Is your nose runny?”
“Are you having trouble breathing?”
And we would stick a spoon, tucked away in a disposable rubber glove, into their mouth, and shine a light insidelooking for any possible pseudo membrane. It would be a thick, white or grey lining in the back of the throat that would confirm the dreaded diagnosis, and would have us grabbing the patient, rushing them into the “red zone” before their airway closed further.
We were watching the little eight-year-old boy the whole night. His pulse was 108, then 114. Everything else was normal. We checked back in an hour to re-check — one hour before the night was over. His pulse was 144 and his Temperature was 40.2 C.
And there it was. The dreaded membrane.
“I can’t walk” He had told us.
I moved to pick him up in my arms and carry him to the “red zone”. He pulled up his chin, pushed off the bed on his own, and admitted himself to the ER, his dad following close behind.
While Regina started the DAT testing — a test done before the administration of DAT, to see if the patient will have a reaction — the translators spoke with the boy’s father.
“We’re waiting for a consent” said Dr. Donna, arranging the vials on one side of the bed.
I looked back towards the father, and his eyes told me a thousand things: the doubt he was having about making this medical decision — his son could die by Diphtheria, but he could also die through treatment -, the foreign doctors and nurses, the strange drugs, the love he had for his boy, how he had escaped so much, only to be taken down by a spreading disease in the home he was trying to provide for his family.
Minutes passed and I saw him nod, as they handed him a paper to sign. With an intravenous in the boy’s left arm, a saline bolus was given and the DAT testing was underway, in preparation for the administration of the antitoxin.
The day nurses soon arrived. We handed off report, and I glanced back to where the little boy was lying, the father right next to him. I knew he wouldn’t leave until his son was better, and I would see them again come nightfall.