Dresses and stresses

This morning we hitched a ride back into Bamenda for work, but ended up meeting with a seamstress (Wiliet) on the compound and headed to the market to buy some authentic African fabric for some homemade dresses. The patterns are wild and beautiful. Wiliet is making me a dress and a skirt and a funky shirt for Brooksy B.

I received my compound phone today which is equivalent to an on-call pager. When the scheduler handed it to me, she smiled apologetically and said, “I’m sorry, you’re on call every day. But I gave you a Saturday off.” On Monday the entire ward is mine, I think I have some reading to do. When I walked into dinner tonight, one of the surgeons was there and he said ‘I have a present for you’. Which for him is a set of triplets to be delivered this week. The general surgeons do the c-sections here. I’m so grateful that our Sinai NICU nurses sent me with some Ambu bags. ‘Don’t worry,’ he said, ‘I’ll send you some extra staff’. Thank youuuuu.

I had just sat down for a nice cup of tea and a chat with the boy tonight when the phone rang and the on call attending was on the phone and asked if I could come take a look at a baby in respiratory distress. I headed up to the hospital with pneumonia, viral syndrome, reactive airway disease on my mind. There I found a 3mos old baby febrile to 40C, tachypneic to 90s, and O2 sats in the 50s. On exam he looked dusky, severe retractions, fatigued, crackles throughout, sunken fontanelle, harsh murmur, and dysmorphic features (wide set eyes, flat nasal bridge, webbed neck, wide-spaced nipples). And the intern was reading from a chart, “…had a fever…was getting tired with feeds…transferred from outside hospital…and what does this say?...Complete Atrioventricular Canal defect.” Nothing like congenital heart disease and rapid heart failure to get the adrenaline going. Call cardiology? Holy crap, I don’t know what to do, normally these babies get whisked away to the cath lab. Okay, IV Tylenol and antibiotics and stat CXR. Place the oxygen. Do we do ECHOs here? Can we get some Lasix? He got 20mg of Lasix at outside hospital- He weighs 6.5kg, holy crap that was way too much Lasix. Can I give a bolus in a baby with florid heart failure? Why does he not have an IV? Why don’t we have a baby-sized BP cuff? Is he septic? Why are his sats in the 60s with O2 supplementation? Why is the only thing I can use for an A-stick an angiocath? Do I start digoxin? Why are the parents so calm? Is this Noonan’s or Trisomy 21? Does it matter?

I don’t know if the baby will make it through the night. My guess is that he has decompensated heart failure that was tipped over by some viral or bacterial infection (WBC 36), but we can’t do blood cultures and he’s too unstable for a lumbar puncture. I guess I can blast him with antibiotics and prayers and oxygen. The only thing that will truly fix him is cardiac repair, but that’s a little beyond my paygrade. Thank goodness for my budding cardiology co-resident Cheryl that I can frantically text about digoxin dosing and appropriateness. Thank god for friends with brains and hearts.

This is all I can do with what I have for now. I am in charge of managing this child on a tightrope of life and death, and I know that this is only the first of many. I’m not a cardiologist, but I will have to play one. I’m not a let-goer, but I will have to be one. All you can do is everything you can do.

Tomorrow is Valentines Day. Exactly one year ago from tomorrow, I met my most favorite patient ever in hematology clinic. His name was Kelvin and he was diagnosed with T myeloid leukemia and admitted to that hospital later that day. About a month ago, I attended his wake in Chinatown, the only ceremony of a patient I’ve ever attended. Even in one of the best hospitals in New York City, all you can do is everything you can do. I just got a tiny glimpse of how Kelvin’s oncologist must feel and it isn’t pretty.

But tomorrow is a new day and we will travel and enjoy beautiful Cameroon. For now, I will finish my cold tea, scratch my mosquito bites, and try to get some sleep.