Cold Night, Warm Heart
Sunday August 1, 2004
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I had responded to a television documentary by World Vision, a relief organization, that publicized the lack of nurses in Somalia during the country's famine crisis - a far cry from Overlook Hospital, a suburban teaching hospital in affluent Summit, NJ, where I was working. I was accepted to go to Somalia; however, four months before I was scheduled to leave I received an emergency request from World Vision to go instead to a refugee camp in Thailand, where an outbreak of typhoid had caused a staffing crisis. I was fortunate to be granted a six-month leave immediately and set off on an adventure that would change both my outlook and my priorities in life.
From the many experiences during my tour, I vividly recall the events of one mid-January night. It was bitter cold; even three layers of clothing could not ward off the dampness. Dusk was approaching, and my nurse colleagues had departed, leaving only Dr. Derek and me to attend the adult, children, and infant wards.
My nursing rounds included supervising the two male Hmong nurses on each ward, starting IVs, and checking medications. This particular evening as I left the adult ward, I became aware of a commotion on the infant ward. I hurried there in time to witness a tearful mother place her baby in Dr. Derek's arms. It was common to admit a baby in a comatose state or exhibiting seizures (most commonly from tetanus, meningitis, or thiamine deficiency). This particular baby was ashen and gasping with an inspiratory stridor. I noticed a black powder mark on her forehead, which indicated she had seen the shaman, the spirit doctor. Coming to the hospital would have been a last resort for the Hmong, because they are Animists influenced by spiritualism.
Dr. Derek placed the child, Chou, on a wooden table near the open window, the only source of light. He began mouth-to-mouth breathing while I auscultated a slow heart beat. I shouted for an oxygen cylinder and suction. The suction apparatus was foot-operated! Awkwardly, I pumped the pedal to create suction and attempted ventilation with the resuscibag. There was no improvement. Unable to intubate Chou because of swelling of the epiglottis, Dr. Derek felt the only option was to perform a tracheostomy. He promptly did so - using his pocketknife. The only available tube was a 3.0 endotracheal (generally used for newborns weighing between 4 and 5 pounds), which he readily inserted. What an incredible relief to see Chou's color improve and watch her begin regular, independent respirations.
Dr. Derek cleaned the skin and inserted a few sutures. Everything happened so quickly and the family was aghast and hysterical. Dr. Derek tried to alleviate their fears - with the Hmong nurse translating, he made every effort to explain his actions.
It was truly a courageous act by Dr. Derek. We both were acutely aware that if little Chou failed to survive, it would undoubtedly be blamed on the tracheostomy. That news would spread through the camp like wildfire and could jeopardize the refugees' faith in our medical care. So we prayed and watched and cared.
By then darkness had crept in and, fortunately, the dim electric lights came on. As I thought about the long night ahead, I asked myself: How could I keep Chou warm? Could I successfully clear secretions using the antiquated suction apparatus? Where were my flashlight and batteries? And, of course, what was Chou's chance for survival?
I closed the wooden shutters and padded the table with blankets, surrounding Chou's sides with blanket rolls. I gently restrained her little arms and started an IV. Remarkably, I managed to find a tiny tracheostomy tube among the mishmash of equipment donated from around the world. I also uncovered some stockingnette with which I made Chou a ski cap and mittens. The Hmong nurses loved the "MASH" cap and it became part of their uniform on cold nights.
Observing Chou, taking vital signs, suctioning, giving antibiotics and watching for signs of alertness was never-ending work. Dr. Derek relieved me while I visited the other wards every two hours. About 1 AM, little Chou opened her big dark eyes and attempted to cry; I was so thrilled and relieved! As I held her tiny hands and kissed her, I believe I comforted her. Then, as often occurred, the generator failed. For the remainder of the night, I relied on my flashlight and was grateful it was only a few hours until dawn.
The day staff was a welcome sight because we had no phones to call for assistance. Quickly I recounted the events of the evening to them as they passed. They listened intently and were delighted at Chou's response to treatment.
At 9 AM, I said goodbye to Chou and headed toward my bamboo hut. As I closed my eyes, I reflected on the previous night's events. I knew that Dr. Derek's courageous actions and Chou's remarkable resilience would leave an indelible impression on my memory.
I visited Chou three months later. Her parents welcomed me to their hut, smiling and pointing. There she was, a beautiful, dirt-smudged child playing happily. She shyly rolled her big dark eyes toward me. Tears rolled down my checks. They were tears of happiness for Chou and her family because she had survived despite the odds and also tears of sadness for their past misery and unpredictable, possibly gloomy future. Little did they know how much they had given me - an everlasting memory and the knowledge that I had much to appreciate.
Sadie T. Fazekas, RNC, is an NICU nurse at Overlook Hospital, Summit, NJ.
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