12.7.10

COTW: Heroes in Training

Let me explain. One of the unfortunate realities we live with here is that if someone is sick enough to get intubated (a tube in the throat and a machine to help breathing), the odds that they will recover is slim. Very slim. This even goes for the previously healthy. It may be because our ventilator is from the 1970's and looks remarkably like a stereo receiver that my parents had when I was growing up. Truth be told, the answer is more complex than just old technology, but suffice to say the prognosis for such patients is poor.

Which is part of what makes the story of Ernest so remarkable. He was eight months old, and came in with bad bronchiolitis. You may have heard of this in the US, and it's often a mild viral infection, but sometimes it can be deadly if you can't support their breathing through to the other side. This was the case with Ernest, and so after a few days in the hospital, he was put on the ventilator.

One night on call, I am paged urgently to the ICU, because Ernest has crashed. It's about 3 or 4 minutes from my apartment to the ICU, and I arrive to find that my intern and my family practice resident have resuscitated Ernest successfully.

Let me explain. Another unfortunate reality worldwide is that, if your heart stops beating, your odds of survival are poor, despite what the television dramas show. It's better for kids, but when the heart totally flatlines ("asystole"), it's tough even in the best of circumstances. Here at Tenwek, where our staff is limited and simple things like not having the little plastic connector to the oxygen supply often get in our way, it's even more complicated.

So, when I arrived in the middle of the night to find that my team had already successfully brought back Ernest's heart in just such a scenario, I was stunned. And blessed. Back on the ventilator he went, and day after day we continued to struggle for him.

Let me explain. Tenwek Hospital is a teaching facility. Currently, we have at least 25 Kenyan docs (or P.A. equivalents) that are here to be trained for anywhere from one to five years. And we the McCropders didn't fully realize this when we decided to come to Tenwek, but it's been a happy "coincidence", since we have since decided that medical education is where we want to invest ourselves, and here we get a chance to learn how to be educators.

So, this was not just an amazing victory for Ernest, but it represents our trainees' ability and accomplishments for a whole future career of patients they will care for. It shows timely response and heroic effort, and it gives me great hope.

"Ernest" battled in the ICU for several more days. He finally started to improve, and I took this picture of him and his mom, on the day of his discharge, with the two heroes in training who saved his life. He went home, as far as I can tell, as healthy as any other little 8-month old boy.

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