No rest for the weary

Late last night I tweeted that a woman was being brought down from the cholera house who was having trouble breathing and unable to hold her neck up. They rushed her down and as soon as I assessed her it was clear she was fluid overloaded. Her Spo2% was in the 60s and her lungs sounded like she was breathing under water. We quickly got an IV in and pushed lots of lasix, cathed her to measure her output and as a last resort tried and albuterol/steroid treatment. She improved significantly within a couple hours so I left her with her husband in the dressing room and gave instructions to wake me up if they needed anything. While that was happening Licia got a call from the cholera house that a disgruntled and/or crazy patient ripped out his IV, and choked the nurse, pinning her to the ground. She and Enoch ran up there to find the patient tied up and gave him some meds to chill out. He was kindly sent home and asked to seek care elsewhere as needed :) I head up to our house and check on Marilice who seemed to really be doing great, got a shower and finally got to bed before my 6 am shift at the cholera house. Anna stays up with her because she is looking a little dehydrated and tries to get her to drink. She dozes off about 3 am.

Meanwhile (unknown to the rest of us) Licia gets another late call from the cholera house about a young man who is having severe seizures. She stays up there until 2:30 when his seizures finally stop. Turns out he has had them before in his life and the cholera must have brought them on. He is doing great today.

Anna comes and wakes me up at 4:30 and I assume it is for the above lady but instad she has Thallie in her arms and says she thinks she is having seizures. We look at her and sure enough she is having mild seizures. My first thought was fever, but her temp was only 99, so the only thing I know to do is give her tylenol and phenobarb. I run down to the clinic to get the meds and I get stopped by the mother of the mastitis lady who is staying here and her 1 month old baby is going downhill quickly. Lots of puking, dehydrated, not looking good. Quick give him some zofran and tylenol and run back up stairs. Crap, fluid lady from last night is still in the dressing room. She has some complaints that I can't understand but her oxygen sats were in the 90s so I decided to deal with her later. It is 5:10 am and I am dripping in sweat. Then we look over at Marilice and she is really getting dehydrated and decide she will get an IV when Lori comes over later in the morning.Then the electricity goes out because the oxygen concentrator takes up too much electricity and her breathing goes so bad. She is coughing hysterically and her sats go down to the low 80s. So Anna calls someone to come turn on the generator and I get ready to go up to the cholera house at 6. I leave poor Anna with the two bad girls and begin the most insane 6 hours of nursing care I have ever done. More than 100 patients. Over 60 are on IVs and the house is PACKED. It's kind of a blur, but I remember a few almost panic attacks and desperately calling Licia at 8:30 for reinforcements. I took out at least 5 infiltrated IVs, started new ones, dumped poop buckets and treated muscle cramps. At one point I was standing under the IV pole pictured below (1 pole, 7 bags of fluids, 4 patients- arghh!!!!) straddled over a cot trying to give oral doxy to a teenage girl who is really really bad and she PROJECTILE VOMITS all over me. I have to start IV cipro since she cant keep that down and instead of stopping to clean up, I kid you not that I just squirted hand sanitizer in between my toes in my chacos. Can you see why I had to throw all my obsessive good nursing skills out the window and hide in a corner and cry? And this isn't even my life. Lori and Licia are officially insane because only insane people could do this everyday. I'm tired and weary and stressed with the responsibility of these lives.










In all of that there are some precious, healthy, grateful patients who make all of this okay.









Thallie continued to have seizures and needed to be put on oxygen this morning and we only had one working oxygen concentrator so we had to take Marilice off and she did not do well at all. Until we could get an old machine working and fix the generator to give power to two machines we had to decide which girl to give the oxygen to. These things are beyond unfair. They are both on oxygen and IVs and stable for the time being but Thallie is pretty sedated as she is still having seizures. Please, please pray for both of these little girls tonight.

In completely other news, Lori and I are teaching a training class for community healthcare workers to set up 12 stations in the surrounding area to triage cholera patients. It's a brilliant concept but it's going to take a lot of time and work that Lori doesn't have to spare so you can pray for that class and all the workers who will be helping get our cholera numbers down.