face to the flashing numbers on the monitor.
The child couldn’t breathe on his own any more. His ribs and diaphragm were too tired. He needed a machine to do it. We didn’t have one. I removed the face mask.
“Michael, start bagging again. That mask. Yeah. Right. Like that. Perfect.”
I grabbed a handset off the nursing desk.
“Brian for Dr. James. Brian for Dr. James.”
“James, go ahead.”
“Brian, I’ve got a kid here who needs to be intubated or he’s going to die. Likely pneumonia. He’s got a fever. I just don’t know if I should do it. We have no ventilator. Over.”
He would be right there. Sweet.
I returned to the pharmacy and fumbled through its shelves in the dark, flashlight in my mouth. I still haven’t figured out where the light is.
What size of tube? Age over four, plus four … a 5. Suction … where is that? Here. Laryngoscope. What size blade? One miller, I guess.
By the time I got back, Brian was in the nursing room.
“Yeah, I agree with you. He’s not really breathing. How long has he been this way?”
“Mother says he was fine this morning, but I doubt that. He’s going to die any minute.”
He looked at the laryngoscope and tube in my hand.
“I say go for it. We’ll call a nurse from compound 2 and she can bag him.”
“For how long?”
“I don’t know. How long do you think he’ll need it?” he asked.
“He’s not going to turn around in an hour. Not if it’s pneumonia. It would have to be at least overnight. Maybe even longer.”
“Overnight, then.”
Brian called on the handset to compound 2 and asked for our best nurse. I sat down with the mother.
“Your baby’s not breathing very well. See? He’s only breathing small. Not good. We need to help him breathe. Put this tube down his throat to push in air. I think if we do not do it, he will die. Even if we do, he might die. I don’t know. It’s the only thing I can do.”
The nurse translated and the mother agreed.
I put the flat blade of the laryngoscope past his tiny white teeth and pushed his tongue to the side. I lifted the blade until I could see his vocal cords. They flickered with each breath. I pushed the tube past them, into his trachea, then attached the bag to it.
His oxygen saturation improved to 100%. His chest rose and fell with each small squeeze of the bag. I hoped the MOH delegates would walk by, but they never did.
Muriel arrived from compound 2. She’s young, was trained in Khartoum, and worked with MSF for years in Darfur. She is interested and competent, the best we have.
“Okay. Like this. Just a gentle push. Watch his chest. In … and out … in … and out. This is the suction machine. You work it with your foot, like this. You’ll need to suction him every hour or so.”
I addressed the other nurses. “This is a hard job. You will have to help her. You too, Mom. She can’t stop. If she does, the baby won’t be able to breathe and he will die. Okay?”
We left them, Muriel pushing on the bag, twelve times per minute, 720 times per hour.
I wonder, in cases like this, if the battle is worth fighting. The war is a long one, and the odds are stacked so heavily that perhaps energyis best conserved. Maybe it’s best to use likely defeats to increase our resolve to work towards a day when they will be easier to win. But then there is the other tack. Battle, every time, with everything you have. Do the best you can for the person in front of you. Persuade the family of every malnourished kid to get into the truck, to come to the hospital, to be fed until they’re better. Track down each TB patient who left, frustrated, halfway through his long treatment and try to get him to come back even though the countryside is littered with tuberculosis patients we will never see and one case will not tip the balance sheet noticeably towards a TB-free future. To the world it doesn’t matter that much. Until you remember that it means the world to the patient. One exact world,
The child couldn’t breathe on his own any more. His ribs and diaphragm were too tired. He needed a machine to do it. We didn’t have one. I removed the face mask.
“Michael, start bagging again. That mask. Yeah. Right. Like that. Perfect.”
I grabbed a handset off the nursing desk.
“Brian for Dr. James. Brian for Dr. James.”
“James, go ahead.”
“Brian, I’ve got a kid here who needs to be intubated or he’s going to die. Likely pneumonia. He’s got a fever. I just don’t know if I should do it. We have no ventilator. Over.”
He would be right there. Sweet.
I returned to the pharmacy and fumbled through its shelves in the dark, flashlight in my mouth. I still haven’t figured out where the light is.
What size of tube? Age over four, plus four … a 5. Suction … where is that? Here. Laryngoscope. What size blade? One miller, I guess.
By the time I got back, Brian was in the nursing room.
“Yeah, I agree with you. He’s not really breathing. How long has he been this way?”
“Mother says he was fine this morning, but I doubt that. He’s going to die any minute.”
He looked at the laryngoscope and tube in my hand.
“I say go for it. We’ll call a nurse from compound 2 and she can bag him.”
“For how long?”
“I don’t know. How long do you think he’ll need it?” he asked.
“He’s not going to turn around in an hour. Not if it’s pneumonia. It would have to be at least overnight. Maybe even longer.”
“Overnight, then.”
Brian called on the handset to compound 2 and asked for our best nurse. I sat down with the mother.
“Your baby’s not breathing very well. See? He’s only breathing small. Not good. We need to help him breathe. Put this tube down his throat to push in air. I think if we do not do it, he will die. Even if we do, he might die. I don’t know. It’s the only thing I can do.”
The nurse translated and the mother agreed.
I put the flat blade of the laryngoscope past his tiny white teeth and pushed his tongue to the side. I lifted the blade until I could see his vocal cords. They flickered with each breath. I pushed the tube past them, into his trachea, then attached the bag to it.
His oxygen saturation improved to 100%. His chest rose and fell with each small squeeze of the bag. I hoped the MOH delegates would walk by, but they never did.
Muriel arrived from compound 2. She’s young, was trained in Khartoum, and worked with MSF for years in Darfur. She is interested and competent, the best we have.
“Okay. Like this. Just a gentle push. Watch his chest. In … and out … in … and out. This is the suction machine. You work it with your foot, like this. You’ll need to suction him every hour or so.”
I addressed the other nurses. “This is a hard job. You will have to help her. You too, Mom. She can’t stop. If she does, the baby won’t be able to breathe and he will die. Okay?”
We left them, Muriel pushing on the bag, twelve times per minute, 720 times per hour.
I wonder, in cases like this, if the battle is worth fighting. The war is a long one, and the odds are stacked so heavily that perhaps energyis best conserved. Maybe it’s best to use likely defeats to increase our resolve to work towards a day when they will be easier to win. But then there is the other tack. Battle, every time, with everything you have. Do the best you can for the person in front of you. Persuade the family of every malnourished kid to get into the truck, to come to the hospital, to be fed until they’re better. Track down each TB patient who left, frustrated, halfway through his long treatment and try to get him to come back even though the countryside is littered with tuberculosis patients we will never see and one case will not tip the balance sheet noticeably towards a TB-free future. To the world it doesn’t matter that much. Until you remember that it means the world to the patient. One exact world,
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