Rejoice with those that rejoice

             

Often times here I do not post or share what is happening at the hospital or with me. Some of that is just a time factor but a lot of the time the stuff to share is the hard stuff. The patients that didn’t make it or the outcomes we wish were different after the fighting and pushing. Those are hard stories to tell and often not the stories people want to hear. But they are the reality of working in a resource limited setting where often patients wait too long to come in and a hundred other reasons.

            So you are thinking what’s coming. Is she going to go down the dark path and share those stories now. No, I am not those are the stories best kept close to the ones here that fought hip to hip with me and we lost anyway. 

            

          

 What I am going to share are two stories that should have also been on that list but by God’s grace and healing hand they are not. Here at HOH we get lots of newborns that come in on day of life 1 or 2 that were born either at home or at a clinic and something is wrong and they come in or get sent in. These babies get a full septic workup including blood and CSF cultures and antibiotics. It is standard workup that we do many times a week. This little boy came in on day of life 1 and got the full workup. He was found to have neonatal meningitis which is not super uncommon here and was started immediately on antibiotics. His counts in his spinal fluid were high enough that we decided to re-do his LP on day 7 of antibiotics to make sure his infection had cleared appropriately. On day 7 his CSF showed over 20,000 white cells (normal for a newborn is around 30 or less and his initial CSF had about 850). His infection was much worse and what we were using for antibiotics, standard anywhere in the world, was not working. We switched him to the broadest spectrum antibiotic we have and prayed. He was not doing great at this point. Granted he was 7 days behind on a bad meningitis. A bad nursing error occurred 2-3 days into treatment and he missed 18 hours of antibiotics. The next morning he went into full cardiac arrest. We got him back but wasn’t sure what we were getting back as far as neuro status. He was stable but very critically ill. The next day, he took another bad turn and started struggling to breath. A STAT CXR was done and his entire right lung was whited out. I then put in a chest tube and he stabilized again. That stayed in for close to week and the day I took it out he opened his eyes and looked at me like, “seriously take this thing out of me.” The chest tube came out and he quickly came off of oxygen. He had another LP later in his antibiotic course to see how the antibiotics were working and he had zero white blood cells, the antibiotics had worked. Now, to see if he would eat. We had been feeding through an NG tube for close to a month now. He stayed in the hospital and struggled to eat by mouth for another couple of weeks until we decided to put in a G tube so he could go home. He did go home and about 2 weeks later he started eating everything by mouth and the G tube was able to be removed. I kept telling mom while he was in the hospital that she should name him Lazarus because he was dead and now he is alive. I was kind of joking but trying to convey the gravity of his case with her. I got to see them in clinic right after the G tube was removed and Dad was with Mom and I asked him, “What did you name him?” He said, “We named him Lazare.” (That is French for Lazarus). I have gotten to see him a couple of times since he left the hospital and he is eating and gaining weight and has two of the happiest parents you can imagine. 

 

            

The next patient, is a 10 year old boy who presented with abdominal distention and pain for several days. This is not an uncommon complaint that we see. We have lots of diseases here that cause intestinal problems, the most common probably being Typhoid. This patient came in overnight and I received him the next morning. I examined him and another patient with the same complaint that were currently both in general pediatrics which are non-monitored beds meant for stable patients. He was awake and sitting up in bed and his exam was benign. The other child was very touchy in his abdomen so I decided to move that child to a monitored bed and left this child where he was. 

            A couple of hours later, this child, the I left in pediatrics goes into full cardiac arrest. After about 10 minutes we get him back. His ultrasound at that time showed many dilated loops of bowel and he needed to go to the OR but he just arrested. I put him in our intensive care for resuscitation. He was clearly in septic shock and we could not get an IV anywhere on him. I ended up placing a femoral line for a few hours until he settled out a little bit. His exam got worse and worse and his abdomen more and more tense. He did finally go to the OR. I took some time before he went to pray with him and his mom with a translator and told him I would see him when he got out. In reality I was not sure he was coming back out of the OR. He had a volvulus, which a twisting of the bowel on itself, and a lot of his bowel was dead. He was given a jejunostomy and had very little viable small bowel left at the end, but was alive and awake. The surgeons were able to do a re-anastamosis less than a week later which was the first big step for him. Next and the biggest step was nutrition and would we be able to come up with things for him to eat, in small quantities, frequently, that would give him everything he needed. We talked to a nutritionist who has been in Togo and knows what is available and came up with a plan. He was in the hospital for another couple of weeks and his parents did everything exactly the way we asked them. And he gained weight, did not have diarrhea or vomiting, and had no complications from his surgery. I have been able to see him twice since his discharge and I have finally gotten him to give me a high five. I tell his parents every time how much of a miracle he is and how their care and concern has made his recovery possible.     

This is him in clinic last week 

So many days here are hard and so many cases are difficult. But sometimes…..sometimes….there is joy and gladness. I choose today to rejoice with those that rejoice. 

            “Rejoice with those who rejoice, weep with those who weep” Romans 12:15