A bit of a sad week...

Debbie:

The last 2 weeks at work have been tough on Karen and I as we've been faced with many patients have been extremely sick and been forced into the realisation that we can't do as much as we would want to for them. We'd like to remember them:

The first patient was a female aged 25 who, when she was admitted last Monday, was septic with an unknown infection. I cannulated her, took blood tests and started the antibiotics that the Doctor had prescribed. The next day we went to Pabbo Camp to help with the HIV clinic. When we returned to work on Wednesday I was happy to see that she looked better and appeared to be improving. The Doctors came onto the ward and started their rounds and Karen and I began assessing our patients, sending off blood, sputum and urine tests and giving treatment. I went to see the lady just before midday to check her observations and found that her blood pressure was unrecordable and peripheral pulses could not be felt. The Doctor had seen her earlier in the day and stated that her chest x-ray was poor but she had been alert and orientated then. By this point the lady started becoming slightly agitated and had difficulty breathing. I called the Doctors over immediately after realising that she was haemodynamically unstable but there was nothing that we could do quickly enough to save her. She slipped away before our eyes. Her mother was present and began praying and was obviously very distressed. Karen and I stood with her and bowed our heads as a sign of respect. I sat with the lady and put my arm around her. The only word that I could say to her that she would understand was 'sorry' which made me feel so helpless. When I sat next to her she put her head on my shoulder and wept. The patients sister then arrived and was so distraught. The loss of this girls life was so sudden and unexpected that it had shocked both nurses and family. To make matters worse, it transpired that the family were far from home and to take her body home they would need close to 100 pounds which they did not have. I hope they found a way to take her home. May she rest in peace.

Our second patient was a lovely young girl aged only 15 who had such a sweet temperament. She was admitted a month ago and so Karen and I got to know her and her family quite well. She had complications related to Rheumatic Fever and had developed heart failure, admitted with difficulty breathing and chest pain. Although the Doctors prescribed all of the medication that they could for her she deteriorated and passed away over the weekend. In the UK we would have had the resources to give her so much more and such a better chance at life. May she rest in peace.

Our third patient was a 34 year old lady admitted with a swollen abdomen and reduced appetite. The Doctors ordered an ultrasound of her abdomen which found that she had cancer. With no treatment available at our hospital we were only able to give her end of life care as the cancer was quite advanced. She did not complain once even though her abdomen must have been so uncomfortable and she would have found it difficult to eat, walk and do other normal activities. She also passed away over the weekend. May she rest in peace.

Karen:

An early morning knock at our door and there stood our housekeeper in floods of tears. Her relative had just died. That relative being a 13 year old boy who we had been caring for on our ward for the past week and fighting so hard to save his life. Her news was utterly devastating for to both Debbie and I as we united in her grief.

This was perhaps the most devastating death since we arrived in Uganda 4 months ago. We first looked after this HIV positive boy back in November , along with our colleague Dr Sally, when he was exceptionally unwell and suffering from nose bleeds and vomiting blood. Against all the odds, he fought back and walked out of the hospital smiling. This gave us optimism when he presented once again with the same symptoms, but this time complicated further by a raging temperature with an infection of unknown origin. He was found to be severely anaemic and suffering from thrombocytopaenia - a low platelet count resulting in the bleeding.

Every day his temperature crept up until it hit 40.9 Degrees Celsius. He received a cocktail of intravenous antibiotics and medications with an unrelenting fever, eventually thought to be TB Meningitis. He received in total 7 units of transfused blood over the course of the week. Acquiring the blood was no easy task. The laboratory had no B+ blood in stock and so obtaining every single unit he required was an ongoing struggle. Urgency is non-existent in Uganda and so when I ran into the lab saying I needed blood urgently they failed to react until I was almost in tears of frustration! By the end of the week, I think they were getting increasingly familiar with the sight of this crazed 'muzungu' nurse and responded with a little more haste! It was from a contaminated blood transfusion for a childhood illness, likely malaria, that he developed HIV 6 years ago, ironically on this occasion it was a blood transfusion that would contribute to possible saving his life.

This poor child continued to vomit clots of blood and developed bloodied watery diarrhoea. Towards the end of the week he was becoming increasingly weak, and began convulsing - a serious sign of neurological deterioration. He was such a brave young boy with an incredibly caring family who sat with him night and day. Debbie and I left work on Friday willing him to make it through the weekend to stand a fighting chance. In my last words to him, I urged him to keep fighting and that we'd have a party the day he was well enough to once again leave the ward smiling. Sadly this was not to be the case.

I spent Saturday morning with his family at the hospital as they prepared to take his body back to his village 2 hours away for burial. His mother spoke of how the death of her son was 'God's Calling'. I found it comforting that despite the loss of her child, she found so much strength in her faith , something that no-one can ever take away from her. His mother thankfully spoke good English and so I was able to communicate with her. So often it is frustrating not to be able to communicate with relatives when their loved one dies due to the language barrier, only being able to say 'sorry'.

All day Saturday we felt in mourning and questioned if there was any more we could have done for him. What is difficult about times like this is that we are minus our usual support network that exists at home in the UK. While there are a few medical folk here with whom we can discuss cases and 'offload' it is not the same as being with your good friends and being able to distract yourself by watching television, or a film, and the ease of being able to put a pizza in the oven for dinner! Our feelings are often compounded by the frustrations that exist at the back of our minds when we know what care the patient would have received in a developed country. But those sorts of thoughts almost become a form of self torture because those treatments and interventions just don't exist here.

This last couple of weeks have proved very difficult as we have experienced so many deaths on the ward. Looking through the death register book I sadly realised that of all of the deaths the eldest had been a mere 50, with most aged between 20 and 30.

May their souls rest in peace.