Amolengue akwi kirikiri

 Day starts with a bang.  Two children in status epilepticus, one unconsolably screaming toddler seems encephalomeningitic, and my favorite ex-preemie (26 week twin) getting CPR, two round of epi.  She has fought her way to the age of 7 weeks, three of which were spent at home.  She has not quit through 2 weeks of unremitting fevers, tachypnea and tachycardia, but I have run out of treatment options.  She survives the resuscitation, then recurrent hypoventilation/apneas.  We bag her back 2 more times while discussing likely outcome, with help from the "mental health" team.  I and the nurses (including initial stay in the NICU) have had trouble connecting with this teen mom of few words, although she does not object when we stop bagging during arrest # 4.  I learn that labor was triggered by a fall.  Healthy toddler sib at home.  I didn't know.

     Eventually apneic, starts to brady down.  Mother declares that the patient is already dead, and she wants to leave with her.  I make a brief attempt at explaining that I support her decision, although I cannot declare death while I hear a heartbeat - I don't make an impression since the baby looks very dead.  I make sure with the staff that everyone is ok with skipping the "Against Medical Advice" form.

     There is lots of medical "low-hanging" fruit.  The kids who stop seizing quickly, wake from comas promptly, defervesce rapidly, all with treatment by protocol, do great.    Those get quickly transferred back to Gen Peds or malnutrition ward, so don't stick in the mind.  We sometimes stack two to a bed; space is at a premium.  A goal for hospital and project is to improve rapid treatment initiation and close monitoring of volume status and glycemia, as some potentially salvageable kids die from treatment delays.  The kids who reach the end of the protocol still sick, but not yet dead, are my painful cases.  I have time to come up with something, and there are options - but protocol guidance is limited, as is my experience here.  There is no microbiology.  We have point of care Falciparum and hemoglobin, glucometer, HIV (antibody only), syphilis serology (qual not quant), GeneXpert (TB 50% sensitive), hep BsAg, hep C Ab, urine dip, x-ray.  Blood bank does A/B/Rh (with HIV, syphilis) for transfusions. We've been asked for equipment wish-list; we agree on wanting peds BP cuffs.  I think I'd like an EKG, too.  Everyone is tachycardic anyway since our transfusion threshold is 4. But man, giant livers and spleens - you can't miss them!  Unfortunately they do not add much diagnostic precision.

     Thank you for tolerating my venting.

One of our ICU-only treatments - suction.  Human (not wall-) powered.  It works!