I spoke too soon again....

Ah, just when you think it is safe to blog, something goes all crazy on you.

Last night, after blogging and heading to dinner, we were sitting around chatting when a person started yelling into the dining building. Translation? "One of the hysterectomy patients is seizing." Well, that's not good. So the table emptied as we all ran back to the hospital.

By the time we get there, the seizing has stopped, but she is laying there largely unconscious. We put one of our portable oxygenation monitors on her - 65%. You really want to see above 94%. So, you say, put her on O2. Well, we don't really have any, per se. The only O2 tank is in the operating room. And the bed she is on doesn't fit through the door. We do have an oxygen concentrator, but that only got her up to mid 80's. Usually after a seizure, you are out of it for a bit, but then you come back around. That was not happening.

So, we got a cart, carried her by her sheet out the door (of a room that has 4 people and all their families in it), and take her back to the OR for O2. Thankfully, that got her up to 100%. Meanwhile you have 4 MDs and 2 anesthetists trying to figure out why she seized. Does she have an unknown seizure disorder? No. Does she drink and lot and is withdrawing? No. Could she have low sodium, low calcium, or low magnesium? Your guess is as good as mine, seeing as how we don't have any way to test for that. So we replaced all of them. She had had surgery under spinal marcaine, a bit of versed and she got the wound injected with Marcaine as well. None of these were at doses that should cause anything close to seizures. She then seized 2 more times without coming out of it in between, officially putting her in status epilepticus. Thankfully we had IV Versed, then found some valium to break the seizure. But she still was completely out of it.

In the US, we would intubate her. Here? There are no ventilators, so if you get tubed, someone sits there all night and bags her. That someone would be me. Thankfully she kept breathing on her own. We would also give IV seizure meds. None here. So we placed a tube in her stomach, confirmed it's placement only by listening, and poured phenobarbitol liquid down it. When she still wasn't coming around, we wondered if she had had a head bleed (and just our bad luck to be her surgeons that day). But, her lumbar puncture showed no blood, and when she did move, she moved equally on both sides... another theory blown.

By 9pm, we started setting up for shifts to watch her throughout the night. Since the surgeons and the anesthetists should be awake (preferably), Yvonne and I said we would do it. I went to bed until 1am, and was going to take the 1am-6am shift. At 12:30am, Yvonne came to our room and told me she had come around, had good oxygenation on room air, was recognizing family and was back in her room. Today, she has been groggy all day, but able to answer questions.

So good doctor, you say, why did she seize? I have no flippin' idea. Will she do it again tonight. Well, tune in tomorrow to find out.

Today was hyterectomies, hernias, hydroceles and lipomas. The funniest story was the guy I was examining in clinic for scrotal swelling. I was trying to determine if this swelling would go back into the abdomen (hernia) or stay in the scrotum (hydrocele). I started to gently squeeze the area to see. He moved my hands, and I was afraid I had hurt him. But instead, he knew exactly what I was doing and showed me his party trick. He pushed the whole thing between his legs, squeezed them together with great force, and with a strange sucking sound, the swelling disappeared, and he opened his legs with a great smile to show a normal scrotum. As Leslie says, this is Haiti.

Last day tomorrow. Mostly little surgeries because we don't want to leave major recovery in our wake. There are many abandoned children here, 9 of which have major medical problems (CP, MR, developmental delay), and 4 of which are delightful and healthy. Givenson turns 8 tonight, so we are wrapping up some clothes, toys and shoes for his birthday. Luvins (4), Reece (5?) and Shebani (3) take turns sitting on our laps and getting hugs. They are a joy to have around as I miss my own little ones. Soon I will be giving them hugs too.