So last week I was in Male Ward rounding on my
patients. On Monday, I had maybe 7 or 8
patients. One of them was Given. Given is a 28 year old HIV and TB positive
patient. He was admitted at the
beginning of July for potential cryptococcal meningitis. For those who aren’t medical, that is a type
of fungal meningitis. This particular fungus
is more common for HIV patients to get, and can be deadly.
He started treatment for this meningitis and a response to
the antibiotics seemed to be lagging a bit.
We were wondering why. We knew,
obviously, he was immunocompromised, but we were also wondering if something
else was going on: particularly a TB
treatment failure.
We questioned his family about how often he is taking his
continuation phase TB meds. His mom, at
this time, states that when he is not feeling well, she gets scared and does
not give him his meds. She could not
tell us how many days that he has gone without his medication for TB. We look at his DOTS card (Patients with TB
have to have somebody directly observe them taking their medicine and document
it on a card. In the States, nurses
usually handle this. In Africa, the
family handles it.). His DOTS card is
barely filled out.
We order a chest x-ray.
This x-ray looks hideous. Bad
infiltrate in his left upper lobe of his lung.
We start him on 2 more antibiotics for a possible pneumonia. We are still not positive as to whether this
is a TB treatment failure or just a bad pneumonia. So now, he is on 4 antibiotics, plus his HIV
and TB meds. Nine very potent meds.
All this time, he is not taking food or liquids by mouth
very well and vomiting often.
Antiemetics are not helping. So
we give him liter after liter of dextrose, normal saline, lactated ringers, you
name it. Hypotensive and tachycardic the
entire time, but surprisingly, a decent urine output.
He had his up and down moments over the course of the next
couple of days. Friday afternoon I go
and check on him after I finish in OPD.
He had taken a minor downfall.
Not improving and not responding to commands or his name. We discover that his lungs are beginning to
fill with fluid. In the meantime, his
respiration rate is around 35 breaths per minute (normal is between
12-20). Still hypotensive and
tachycardic. This is not looking good.
Saturday he was pretty much the same. Only a little less tachypnea. We maintain his current regimen and continue
to pray.
Monday, I transitioned out of the Male Ward and into OPD for
the week. Before I began in OPD, I
wanted to check on Given. When we walked
in, we saw him sitting up, bright-eyed and bushy-tailed. It was incredible! We could not believe it! He was responsive, alert and oriented x
3. His speech was still a little
slurred, however. Later that day, it
occurred to me in the back of my mind… what if this is just a peak before the
fall. I was hoping not… we would have to
see what the next couple of days hold.
Tuesday was a little more difficult for Given. He became agitated throughout the day, and
acted like he didn’t feel as well. His
belly was fairly hard and distended. An
abdominal film was ordered. Dilated
loops of small bowel… Bowel obstruction.
Enemas were tried, but ultimately, the only treatment was surgery. The closest place the surgery could be done
is in Livingstone. He was not stable
enough to be transferred to Livingstone… in the flatbed of a truck. Prayers going up cause I didn’t know what
was going to happen…
Wednesday: Julie
peeks through the window outside of Given’s bed. She sees the blue privacy curtains. She peeks in through the Male Ward door…
privacy curtains and what appears to be a covering over his head. She said, “This doesn’t look good.” My mind goes blank. It takes me several seconds before I can make
myself enter the ward to make reality what is already in the back of my
head. I finally walk in and see the blue
privacy curtains for myself. I walk
around to the other side of the curtains and find Given’s great-grandfather
trying to close his mouth. At that time,
Given’s sweet mother, Edith, falls onto the empty bed herself and buries her
head between her knees. It
happened. Given died.
I immediately sit down beside Mrs. Edith and put my arm
around her. (I find it very hard in
these situations to find the words to say, so most of the time I just set quiet
and was there with her.) Charity, my
awesome interpreter, begins talking to Mrs. Edith about various things, one
being the funeral arrangements. She is
so good. She has the biggest heart
ever. Given’s family lives an hour
outside of Kalomo, a city about an hour away from Zimba. They had no way to get his body home, so
Charity offered up some options for a funeral service here in Zimba. She has a heart of gold!
Throughout this entire morning of pain and suffering, as I
reflect back, I can definitely see God’s strength at work in me. Late last week, I was practically a wreck
knowing what was likely going to happen soon with Given. After his body was rolled out of the ward, I
was practically a wreck and very close to just losing it at the nurses
station. But during that time while I
was with Mrs. Edith, sitting with her and comforting her, I had an incredible
amount of peace and stability. I can
only thank God for that one!
I don’t like death.
Death is one of the things that really causes emotions to really spring
forth in me… even if I don’t know that person very well. I feel for the family that is hurting. Strength is not really something that I
consider myself having when dealing with death.
God is the true source of all our strength! I am now beginning to realize how close God
feels to us while here in Zimba. I love
it! I am seeing God in many situations
that I encounter at the hospital… in the hurt and the rejoicing. I long for that to follow me back to the
States.
It is crazy to think that we only have 2 more days in the
hospital before we prepare to leave (we will spend our last week in Lusaka,
about 6 hours away from Zimba). We have
already been here for a month… it feels like 2 weeks maybe! Time has really flown by. I’m not sure how much I like it flying by so
fast… maybe that is God telling me I need to come back soon…
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