Typhoid Code

April 4, 2013

It happed so fast. I thought she was looking at me. Then I realized she was looking through me. I was watching her die and I didn’t even know it.

It was the end of a long day when Olen pokes his head into the Bloc and says “I had to search high and low but I think I found a case of appendicitis”. It had already been a long day with two thyroidectomies. But the thought of blood and pus gave me a second wind. Weird, I know.  

     

It took about 4 tries for the student nurse to finally get an IV started. The only information I had on the patient was that she had pain that started in her right lower quadrant yesterday and was now radiating throughout her entire abdomen. Looking at her abdomen it looked tight and swollen.

After Dr. Rollin exams her the diagnosis changes is ectopic.

1625 Simeon gave the spinal and we wheeled her into the OR. I hooked up the blood pressure cuff and the 02 monitors. Both read at 000. I open her fluids wide and start prepping her for surgery.

She was moaning in pain and I was praying the spinal would take her pain away.

Within the 5 minutes it took me to prep her I noticed that her stomach looked bigger. Blood? Gas? Poop? Pus?

Both monitor are still reading zero. Typical equipment here. Never works when I really need it too. She’s looking around and grimacing and talking so I disregard the monitor for now. Rollin and Jon (medical student from Loma Linda) come in and starting draping the patient. Monitors still reading zero. We pray and start the surgery.

1640 Once we reach the inside of the abdomen pus start spewing out. Suction! Pus is followed by a lot of poop.  Perforated Typhoid is the official diagnosis.

Finally the monitor starts reading BP 42/26, Pulse 49, 02 89. The fluids are all the way open. I cycle the machine and it comes up zero. I decide that a second line couldn’t hurt but I’m momentarily side tracked.

I’m holding the patient’s head still cause she keeps thrashing around. When suddenly she stops. She’s looking right at me eye wide open. I’m taken back by the intensity of her stare. I wave my hand in front of her eyes. Nothing. 

Madam! Sa’va?

1650 The O2 monitor starts beeping loud and fast. Ndilbe and I look at each other then to the monitor. 51%! Crap! We both react together. He gabs the Ambu bag while I thrust her head back and open her airway. I position the mask and he starts pumping. Olen walks in again “ Oh, that’s not good.” He takes over bagging and gives instructions. Surgery is stopped. Jon is starting chest compressions as I draw up medications.

Chest compressions.

“Pulse?”

“Weak”

“Atropine”

Simeon rotates in with chest compressions.

“Stop”

“Pulse?”

“Weak”

“Epinephrine”

Jon with compressions.

It continues….

1720 We call the family in to explain the situation. Right in the middle of telling the family that the patient was not responding and is not going to make it.

“Strong pulse!”

Olen stops talking to the family and tubes her. I check placement.

“It’s good.”

“Why is there fluid in the tube?”

The balloon broke. We tube her again. Pulse is gone

1730 time of death

We cover her with fabric. Place her on a metal stretcher and carry her through the hospital grounds, through the TB area and out the back of the hospital to a small building I’ve never seen before. I’ve never carried out a dead body.

We come to a small brick building and we stop. All three men look at me and I know that this is not a building that I want to discover. That’s where they keep the dead bodies till their families can take them home.