Thursday, June 11, 2009

Kids in Crisis

We thought we were finishing afternoon rounds about 5 PM yesterday. Then Tracy and Zebedee were admitted.

Tracy, 11 years old, was struggling to breathe. Her oxygen saturation was 74%, temperature 40 degrees Celsius (104 Fahrenheit) and pulse 176 (that's right, not 76). Her shallow respirations were 66. According to Tracy's anxious mother, the child began getting sick one month ago, about the time her baby sister died from biliary atresia. Tracy's chest xray revealed diffuse infiltrates in all three lobes of her right lung. An ultrasound confirmed there was no pleural effusion. Her platelet count was low, she had 50% bands, and petechiae were present on both palms. DIC? we wondered. And why?

Tracy was critically ill, and we did not know if she would make it through the night. She was tucked into a bed next to the nurses' station on the ward, the best "ICU" care we can manage, and given stat doses of an antipyretic and IV Ceftriaxone, the only broad-spectrum antibiotic available. But Tracy was still gasping for breath until we found an unkinked nasal cannula and connected the oxygenator that had been donated to Maseno Mission Hospital by parishioners at St. Barnabas Episcopal Church in Falmouth, Massachusetts. Tracy's breathing eased immediately, although we needed to keep the flow at 3-4 liters throughout the night.

This morning, I went early to the ward, half-expecting (and fully-dreading) to find an empty bed. Miraculously, the child was alive, conscious and resting comfortably. Her mama, who had slept next to her all night, was smiling. During the course of the day, we have been able to gradually reduce the oxygen flow to just 1 liter via nasal cannula. We do not yet know the source of Tracy's sepsis (RSV? viral pneumonia? shock lung?), but she has survived the first 24 hours, thanks be to God -- and to the people of St. Barnabas.

Seven-year-old Zebedee was waiting patiently in his mother's arms while we stabilized Tracy. The clinical officer took his history while I took his temperature. We watched in dismay as the column of mercury (yes, sorry: mercury) rose to the very tip of our thermometer. It read 41.5 degrees Centigrade, or 106.7 degrees Fahrenheit. We promptly administered an IM antipyretic, IV fluids and began to sponge him down. But even gentle sponging caused Zebedee unremitting pain because he was in acute sickle cell crisis. We administered two units of blood, but all of his joints still hurt. A large fluctuent abscess adjacent to his right elbow was incised, drained and irrigated with normal saline. We removed 20 cc's of pus and dressed the wound, then began IV Ceftriaxone when the lab culture revealed Salmonella. And we prayed that yet another child might make it through the night.

Zebedee was still listless, feverish and in pain today, but his temperature has ameliorated somewhat. This afternoon we changed the dressing, irrigated the wound and replaced the wick after draining another 15 cc's of purulent fluid from his elbow. Zebedee is a very sick, but very patient, little boy. He wept only a few silent tears during the procedure. His relieved mama smiled at the camera for both of them. We hope we can get them through this crisis, with God's help and your prayers.

1 comment:

Anonymous said...

praying in Ennis. xo l&h&b n&e