The Eleventh Hour

[ :the latest possible moment.]

With our first week of surgeries here in The Republic of Congo done, there is a tangible excitement on deck 3 as the sounds of patients echo down the corridor.  The Africa Mercy feels like a hospital again.  There are always a few patients for whom the arrival of the ship could not have been timelier, as was the case for one young boy this week.

On screening day one of my rolls was to be on the Emergency Medical Team (EMT) in case anyone on site (crew member or otherwise) required immediate medical care.  About mid-morning we thought we heard an EMT call over the radio but weren’t sure, so Beth went to investigate.  A couple minutes after she left it became apparent that they were indeed requesting the EMT to respond to Gate 4.  Standing next to all the gear, I realised that the rest of the crew on the EMT were currently nowhere to be found… & Gate 4 was on the opposite side of the screening site!  [gulp]  I quickly grabbed my translator & told him to carry one of the large EMT bags & follow me.   Nate was nearby & grabbed the monitor & suction, & I threw the other EMT bag on my back & took off in the direction of Gate 4.  I have to mention, these bags are seriously heavy, & I usually struggle to get them off the ground, let alone run with one on my back.  It’s moments like these you need minties Adrenaline!!  One of the security officers met me half way across the soccer field & carried the bag the rest of the way.  Beth had heard the EMT call over the radio & already made her way to gate 4, along with one of our Anaesthetists, Michelle.  Our patient was a young child in respiratory distress, obvious from his audible stridor & significant work of breath.  Michelle looked in the back of his throat & saw that he had a tumour obstructing his airway.  Realising there was nothing we could immediately do & he was maintaining his own airway (as best he could), we consulted our surgeons & managed to fast track him through the screening process.  I’m not sure how this patient & his family ended up at the exit gate, but he was definitely in the wrong place at the right time.  

Fast forward one week & I am working night shift on the Max Fax ward.  This little guy had been admitted to the ward pre-operatively, & his surgery was scheduled for the following day.  I was warned that his breathing sounded horrific, & when you walked onto the ward, there was no mistaking it.  As a paediatric emergency nurse, I knew that his stridor & severe work of breathing would have earned him a category 1 in my emergency department back home, & likely a spot on an emergency theatre list.  But on this night, all we could do was wait for his surgery the next day & pray that he maintained his airway through the night.  Exhausted but unable to sleep, he sat on my lap & grabbed at me in desperation when he momentarily couldn’t get any air in.  Occasionally I heard nothing but silence as his chest heaved in & out without actually moving any air.  But each time he would gasp & manage to suck some oxygen down into his lungs.  I tried to find a comfortable position for him, so he could sleep on my shoulder sitting up & breath easier, but there was no sweet spot.  It broke my heart to not be able to relieve his struggle to breath.  But I knew his surgery was only hours away, so myself & the other nurse on duty kept counting down… only 4 hours until your surgery little man, hold on!!!  As I sat there with him on my lap struggling to breath I wondered, how long had this poor kid been compensating like this?  How long had it been since he had had any REM sleep, & how much longer did he have before his airway would have completely occluded?  It certainly felt like the eleventh hour for this little guy.  All I could do was hold him & pray, because although all creation has limits (including medicine) my God has none. 

On Wednesday morning he received his surgery, & after a couple days on the ventilator, he is now breathing on his own & I am told, recovering well.  I can’t wait to see him run down the halls smiling.  But for now… he just needs to sleep.  

Emmanuel  [ :God with us]

Let the eleventh hour quickly pass me by.  I’ll find you when I think I’m out of time.