February 7th, 2012: Today I was on the ICU unit of the Children's Ward. I started out taking care of a young patient who had drank cleaning solution and was poisoned because of it. It was interesting because on my assessment I thought I felt a hernia, but later found out that it was just stool. The things you learn here! I was worried he was getting pneumonia and his heart rate was not steady so I was happy to see he was in the ICU where he could be monitored. Out of no where, a doctor rushes in and says "get this child out of here right now!" we tried to suggest that the patient that was coming in be put in the bed beside the child but he refused, so we unhooked the child, found a bed and I focused on my new patient that had arrived. The nursing student that was working on the ward where the patient came from briefed me and I discovered that the patient had been admitted with uterine prolapse but it was obvious there were many other things going on. Turns out, the patient was HIV and TB positive with esphageal varices and DIC (Dissemenated Intervascular Coagulation). For any non-medical people reading this, this is a very sick patient. We started many IVs and eventually the blood pressure improved enough to sit the patient up to help the patient breathe as breathing was very laboured from all the secretions from the patient's throat. We had to do the blood pressure on the patient's leg which was new for us. We hung blood, got many samples to see what was going on and observed a femoral blood draw which was very interesting. The other nursing student went to the lab to deliver the blood and about 2 minutes after she left I noticed the heart rate decreasing. At a stable heart rate (75 beats/minute) I told the Zambian nursing student to run for help, this patient is going to crash. So she goes to get the nurse. Who stands there beside the other nursing student watching me try to get ready to resusitate the patient. Finally, at a heart rate of 42 I yelled "FIND ME SOMEONE WHITE!" As racist as I felt saying that, I knew that if they found a doctor or student from Canada they would help me resusitate. A doctor from home came in at that moment and after I inserted an airway he bagged. I was very upset because a student had borrowed my stethoscope for their exam and I could not listen for an apical heart rate to determine whether I should do compressions or not. The doctor on call came in at this point and using his stethoscope determined there was no heart beat so I started compressions. As soon as I saw that all the little blood vessels in the patient's throat had burst and she was bleeding out from everywhere, I listened for a full minute for any heart beat and the doctor called the patient. I was very composed until one of the graduated nurses that came with us came in the room. Then I heard the wail. It is so haunting it makes my skin crawl even thinking about it now. I just lost it then and had to leave the room to compose myself. I was so frustrated. It is said that the most important part of nursing is knowing when your patient is unstable and call for help. I was so angry because I did recognize it and I did call for help with ample time to get help, but there were no resources and no people that were helping me. After that bad day at the hospital I went to Safula Secondary School with 5 of my collegeaes and we spoke to 150 students about nursing and why you should enter it. It really helped me deal with the day that I had just had. It was really cool, they were so excited and asked many questions. At the end we let them listen to their heart beats and I was thrilled to meet a student who wanted to become a doctor. We set it up with the next year's group that this school will be a placement for nurses to come again and again. We got many amazing pictures! After the school we had dinner at Oasis Restaurant which was really good and that was the end of my day.
February 8th, 2012: Children's ward again today. Refused to go into the ICU so did general peds. Saw a few hydrocephalis patients, hernia patients, malaria patients and burn victims. Alot of the patients were improving which was wonderful! After my day my friends and I met up with a couple from America and a friend that I met on the boat cruise on the weekend to watch the football match at Nalumba 2 pub. It was so crazy! The food there was amazing. It took a long time to get but it was worth it. We were eating when Zambia scored and won the game! It was raining so hard it was flooding the shelter we were in, but people were outside dancing and sloshing beer everywhere and celebrating. I wouldn't be surprised if everyone at home couldn't hear us! The final game is on Sunday against the Ivory Coast so I am looking forward to that.
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