A difficult day

   It is with a sad heart that I write this. It's been a tiring week of call, and it's just the first of many. Women delivering on the floor, a 10 year old weighing 11 kg (25 lbs) died, three cesarean sections, all of which left me soaked to the bone with sweat (I literally had sweat drip off my fingers when I took my gloves off afterwards, one of those sections was for a placenta previa. The infant was alive when she came in, but by the time we got to our "STAT" cesarean 2 hours or so later, the infant was dead. 
   Last night a woman who had been here for mastitis, and was getting better, had a seizure with a fever to 39C (102F). After 30 minutes of seizing, we finally got them to stop. We gave her antibiotics and anti-malarial medications. She was non-responsive last night, but it was soon after she had received diazepam. This am she was still non-responsive (not a good sign). Then, I was in the middle of seeing a man who came in with tetanus when all of a sudden the family of the patient behind me started wailing. I turned and realized the patient was dying. I started chest compressions after I didn't feel a pulse. The nurse kicked the family members out of the room, but I could still hear them wailing outside. I asked for the nurses to get an ambu bag, adrenaline and atropine. He fumbled to find the correct size of bag for an adult patient. I asked another nurse to do chest compressions while I found the ambu bag and drew up adrenaline and atropine. I gave them to the patient, but without results. I took over chest compressions again, but every time I stopped, there was no heartbeat. 


Finally I called it-she is dead.

   I don't know how to write how I feel. Numb would be one word I could use. Also sad, frustrated, and a little angry. Why did this woman die? What caused her seizure? She had no previous signs of sepsis. No fever, no blood pressure problems. Was it malaria meningitis? Shigella? Staphlococcus or Streptococcus? Septic emboli? Or something unrelated? I'll never know. I keep wondering if there is something I could have done differently. Something I missed. If we had better diagnostic tests, would it have changed anything? 

   Now the family will have to buy formula to feed the one month old infant, who is still at his birth weight. It's $8 for each small can of formula powder. Will he suffer from malnutrtion because of his mother's death? Can the papa afford to continue with the formula? Will he switch to the powdered whole milk, which is cheaper but does not have as many calories? Will he get ill since he didn't feed from the time his mother had a seizure until just 30 minutes ago? (A total of about 14 hours). 

   I stood out in the pouring rain and cried. I only wished it was raining harder, with a force to match my feelings. The family wailing filled my ears. I wanted to wail with them. Wanting to cry out-why God? Why? I don't understand. I'll never understand. I know ultimately He is in control. He is just, and right, and good. Evil and sadness and death are not in this world because of him, but because of the Evil One. I know these things in my head, and mostly feel them in my heart. The knowledge helps, but it doesn't make the hurt go away.