Tuesday, February 9, 2016

Another Angel in Heaven

A baby boy died in my arms today. He took his last breaths as I propped him up on the bed. Death is all too familiar in the wards in Kenya, but not for me. Many diseases that could be treated in the developed world lead to death in developing and resource-limited countries such as Kenya.

Yesterday I began my pediatric ward week at Moi Teaching and Referral Hospital in Eldoret, one of the largest public hospitals in Kenya. I was excited and a bit nervous to start. It has been over 8 months since I last did any clinical work. The first day was rough, we had lots of very sick patients. Slowly we went through the patients deliberating over what our assessments and plans would be. Congenital heart disease, pediatric heart failure, hemophilia, respiratory distress, sepsis, infective endocarditis, rheumatic heart disease, malaria, meningitis, severe anemia, and burketts lymphoma to name a few.

I spent the day trying to help the interns take blood and check on the patients. I went home exhausted. In the morning I arrived on the pediatric floor. I was notified that two of our patients had passed away overnight. I felt terrible but this was not an uncommon occurrence in the Kenyan healthcare system.

It was an admission day today, which means any new pediatric patient comes to our ward. As soon as rounds were over we received our first two patients. One of the Kenyan medical students and I took the most urgent case. A baby boy who was having trouble breathing. Anemia was the suspected cause from the emergency room. When I first saw him laying in his mothers arms his body was limp, he was agonally breathing and his eyes were rolled back. Immediately I knew something was wrong. The mother was crying and I knew she knew something was wrong too.

We laid the baby down to examine him. His pupils were nonreactive, his breathing shallow, and his body limp. When I tried to stimulate the baby with a sternal rub, no response. I sat him up hoping he would have less difficulty breathing but nothing changed. His breaths were sporadic. I knew that we needed to start resuscitation now but it was just the medial student. I looked around but the medical student and I were the only ones in the room.

We called for help from a nurse in the hallway. "I need the bag mask stat." The nurse walked out of the room. A minute later she brings me a mask for the tanked oxygen. I was a bit frustrated about the communication barrier and the urgency of this situation. "No bring me the resuscitation kit." Again she went to find the kit.

Frustrated I called over a physician on the palliative care team from the states. "Can you help me with chest compressions?" I asked desperately. Finally the mask came. We started resuscitation. I tried to get a seal over the babies face, the bag was so large and the baby so small.

"Would you like me to give epinephrine?" asked the nurse. "Yes" I replied frustrated on why she was asking me, I am just a medical student. I had the medical student check pulse and listen for breaths and heart sounds. Still no pulse.

My hands were shaking as I held the bag mask. Then I realized I was leading a code. I was sweating and shaking. The mother was crying on the bed next to me. 5 minutes went by, then ten, then fifteen. Finally I looked up at the doctor across from me. We knew it was futile at this point.

I realized that I needed to end the resuscitation measures that I had initiated, but it was so hard. As a medical student my goal is to preserve life. I did not want to pull the mask from the babies face or tell the team to stop. But at the same time its Kenya and even if we did get a pulse and we could ventilate properly, there are no ventilators to maintain breathing and no ICU beds available.

"I think we should let the mother sit with her baby for a bit." I said hesitantly. The doctor across from me nodded in agreement. I stopped the resuscitation. I turned to the mother, I wanted to cry but I had to stay strong. I could feel my eyes welling up. I sat next to mom and I put my hand on her back. I don't speak much Swahili, I just said "Pole." Which means sorry. I gave her a tissue and I sat with her for a half an hour. I prayed with her and brought her something to drink.

I was pretty distraught and felt terrible afterwards. Could it have been my fault? I was still shaking as I debriefed with the medical student. At that point I was no longer mad at the nurse for bringing me the wrong mask or the interns for not being around. They know better how the system works in Kenyan hospitals. Lack of resources would have prevented this baby from surviving even if resuscitation would have been possible. At this point I was just sad. How can such a young life be taken from us?

RIP baby boy. I hope you are in a better place now.

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