(Note: The majority of this e-mail was written last night but I could not finish it before my brain neurons ceased to fire. I finished it today still in the perspective of last night.)
Whew! What a last couple of days! Since Friday I have participated in five surgeries (another c-section is scheduled for early tomorrow morning) and cared for a patient with a bleeding ulcer and anemia, another who required a blood transfusion, and a little boy last night with epilepsy, among others. In total I have slept 14 hours in the last three nights including only 4 hours last night due to the boy with epilepsy. Again, please excuse any disjointedness.
It has really been a rewarding, exciting, and stressful experience working here as the nurses aid students simply do not have the training to care for people beyond the typical post-op. Whenever there is a more complicated patient I take part of the care and do incessant instruction with whichever students I am working with. Inevitably the more serious patients, the emergency ones, come later at night which always cuts out a large chunk of my sleep time. I have so much respect for the two doctors who work here. They are on-call at any time of the day or night.
Last night (Sunday) when passing through the clinic to go to my house after dinner I noticed a lot of activity in the nurses station and one of the nurses jogging back from Dr. Federico’s house. I poked my head in to see what was the matter and immediately went into “nurse mode.” I found a four year old boy named Isidro in the arms of his parents within the throes of a seizure. Knowing the doctor was on his way I asked for the boy’s temperature and began assessing his respiratory and cardiac status. Within a couple of seconds the doctor arrived and ordered for an IV to be started and began asking the parents questions. While we were working to cannulize the boy the doctor got some medications ready. As soon as we had the IV open and stabilized he added antispasmodic medication to the tube which inexplicably crystallized. We changed the tubing and he tried again, this time retracting some of the IV solution into the syringe to be sure the issue was fluid incompatibility. It was. As that medication is the only type of antispasmodic they carry in the clinic we only had to hope that other techniques would help to alleviate the spasms. The seizures caused the boy to breathe only sporadically which in turn caused his blood oxygen saturation level to drop as low as 60% (it should stay between 93%-100%). We placed an oxygen mask and suctioned extra mucus in his mouth. The seizure lasted about 10-15 minutes and even then it did not completely resolve. Once that seizure ended we still had to work diligently to stabilize the boy’s vital signs.
The whole process was very scary for the doctor and myself because we knew the seriousness of the situation. Not only was I witnessing the result of brain damage, I was witnessing continuing brain damage as every second the seizure lasts more damage is done to the brain and peripheral nervous system. In addition to that, most seizures last 15 to 30 seconds. These lasted from 10 to 15 minutes. Of course, the family was heartbroken to see their boy’s body ravaged by a faulty nervous system but they did not know about the continuing damage and we did not have the heart to tell them. One of the most difficult aspects of that night was that we did not have the medications to treat the immediate symptoms and minimize the damage nor the labs to determine how to stabilize him for a longer period of time but we could not transport him to a better equipped facility in an unstable condition. The best place to take him would be the hospital in Merida but that is two hours away. The next best place is Valladolid, 40 minutes away. The doctor and I talked at length about the possibilities and impossibilities of transporting him. Finally Dr. Federico determined that he wanted the boy to stabilize before we called the municipal police (the closest medical transport system available) and sent him to Valladolid.
That being determined I pulled out my nursing books and researched the etiology and treatment options for his condition as well as continued to monitor his status and vital signs. Through my research and application of specific assessments I determined that Isidro had increasing edema (inflammation) of the brain which would only put him in a more unstable state. I reported my findings to the doctor and suggested giving him an anti-inflammatory medication and transporting him as soon as possible. Dr. Federico concurred and he gave him the medication and called the municipal police, 45 minutes away (oohh... what a rush to make a suggestion to the doctor and be correct!). Right after he ended the call another seizure happened (the third one of the night but I cannot remember exactly when the second one happened), I believe because of increased body temperature (unstable vitals is another sign of brain edema). This seizure lasted another ten minutes.
After this seizure both the doctor and I were rather despondent because there was nothing more we could do. I had been praying off and on for Isidro and his family the whole night but at that point I got on my knees, put my hand on his forehead and prayed. I prayed for healing for his brain, his entire nervous system, his damaged and exhausted muscles, and his tired heart, among others. I prayed for God’s will and his glory through the situation and for salvation for him and his family members. After several minutes my vocabulary was dry. I was at a loss. How many times can you pray for the same thing? Does God consider repetition nagging? Does He listen any more or less when you repeat your requests? After I had no words I just asked that the Holy Spirit would pray for me. After all, he knows the desires of my heart. He knows better what the boy needs. How amazing it is that we have the Holy Spirit praying for us in ways we do not know! Praise the Lord we have an advocate living within us so that we can approach the throne of Grace and petition the One who is all-powerful on behalf of specific people and situations!
Isidro finally left the clinic at 1:30 in the morning and all in all, the episode lasted about five hours. I still do not know what has happened with him but I continue to pray for him.
Learning about the girls and participating in the culture has helped me realize what a tiny level of experience they have. Daily activities such as cooking, cleaning, and doing laundry take up so much time that there is little opportunity left to study or pursue hobbies. The girls come from uneducated families so they have no love for reading, a limited vocabulary, a very low reading comprehension level, and a generally low comprehension level for new information. They have virtually no critical thinking skills or patient assessment skills. When I am working with a patient and ask one of the nurses for materials I have to be very explicit on how quickly I need it because they cannot assess for themselves how serious a situation is. This has created some frustrating issues while working with these emergent patients. Twice in the last couple of days I have asked for an endotracheal tube to be brought to the room just in case the worst happened and they did not even know what it was! I tried explaining that the anaesthesiologist uses it when starting surgery and even explained that it is a tube you put down someone’s throat when they cannot breathe and yet they do not know what it is to at least let me know whether they have one in the clinic or not! I have slowly discovered how the girls do not have the training or the comprehension level to think about possibilities and alternatives. If they are not told exactly what to do, they have no clue!
Slowly developing the role of primary instructor and corrector I am also discovering how prideful they are. When I am their happy-go-lucky friend everything is fine but as soon as I or anyone else corrects them they shut down and become very defensive. I believe part of the reason they are very sensitive to correction is because this culture is very passive. Their child training techniques are very passive, their consideration for time is passive, even their sentence structures and verb choices are CONSTANTLY passive and nondescript! For example, “to be weighed, please” actually means “please step over to the scale so I can weigh you.” I have also found that they have no concept of perseverance. During the first week or two of devotions I felt they were going rather well. It has developed to the point that it is unusual for more than two of the six girls to have read the one chapter assigned for that morning and twice they have eaten breakfast and left before I got there! We had two music lessons and no more, three volleyball practices, and I have had one English tutoring lesson with one of the students. Maintaining the lessons is also increasingly difficult for me as I often need the afternoons to take a siesta due to working late at night and the girls do their chores in the morning. Ahh… perseverance, what a word!
Prayer:
For Isidro and his family, his health and speedy recovery, that God would do a miracle in his life and reverse any and all brain and nervous system damage and he would have no more seizures (a medical miracle). Salvation for the family. Ultimately, that God would have his hand on the boy and his family and His name would be glorified in this situation.
For my relationship with the girls. That I would be able to continue to teach and train them, that the Lord would open their hearts and minds to the new information, and I would continue to develop deeper relationships with them. Their names are Claudia, Lina, Reyna, Gladys, Marta, and Maritza.
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