Tuesday, March 8, 2016

Nuestro Superhéroe (Our superhero)

Today started off like days passed in the clinic. Triage is always the part of the clinic that takes a long time for a patient to get through because there's a lot of steps. For the babies and kids we have to get their weight, height, head circumference if they are under two years old, heart rate, temperature (trust tiny humans do not care of getting their temps taken or us listening to their heart!) and then ask their parents a number of questions about their medical history. This is all occurring in Spanish for my beloved students that are learning how to do their jobs in triage and learning basic phrases to help the patient thought triage.

Today, a tiny human went through triage today that truly had superhuman strength. His name is Jose Daniel. I remember him coming into the clinic all wrapped up in 3 blankets and a number of baby clothes. When I held him initially I knew he was tiny but you could barely see him. His mother told me he was premature and they had to deliver him early because she had preeclampsia. At that moment I knew this baby had already been through quite a bit. She informed me that he was about a month early and she had been to the clinic last week, with a different medical team, they just asked that they measure this tiny human's weight and length every week to monitor his growth. So, that was that. Yes he was quite small on the growth curve. Very small indeed. I remember asking his mother if she had any other concerns and she said no.

So, we passed him and his mother along to Dr. Lauri for further assessment. Well I'm not sure how much time elapsed but a student came out of the Dr. Lauri's clinic room and said Dr. Lauri needs you and the pulse oximeter. At this point, as a critical care nurse, I began to run all types of scenarios in my head as I informed my students in triage that I was needed in an exam room. It is very seldom that I am needed in such a manner as we generally see well patients. I prayed that whomever this patient was I was being called for, would be alright. So I headed to the interior of the clinic with the pulse oximeter we had. When I walked in the room I realized it was Jose Daniel. Dr. Lauri uncovered him from his cocoon. At that moment I understood. Our tiny human was breathing with all his might. The muscles in between his ribs were pulling with all their tiny might just so he could get some air. This tiny human was in distress. At this point, Dr. Lauri in all her poise, wisdom and calm had come up with a plan. She asked me to accompany this superhero and his mom to the hospital along with Rabbi. So we began the process of getting our selves together for the trip. I spoke with Sonia, one of the community health workers, and informed her of the situation. I asked for a bus that could take us to the hospital because waiting for an ambulance could have taken quite some time. While we were waiting, I went back to the pharmacy area to inform Jose Daniel's mom about how much time we would be waiting before going to the hospital. When I saw her in the hallway, I noticed that she seemed perhaps overwhelmed but still confused.

I decided at that point my needs were going to sit in the back seat for a minute. I sat with her for the 15-20 minutes it took for the bus to get to the clinic. I asked her, "¿Entiende lo que está pasando?" In English, do you understand what is happening? She was able to tell me that she knew the baby was having difficulty breathing and we needed to go to the hospital. It was at that moment that she asked me if we couldn't just wait a month for when he would be going to get further lab tests. As you can imagine, I was frightened. I was frightened because she didn't understand that how much he had been struggling to breath. She hadn't quite yet put it together that his work of breathing was related to him by growing. So, I had a heart to heart with her. I explained that he was "luchando por aire" or fighting for air and everything he eats has been going to is work of breathing. I explained that is why he wasn't growing. She asked me if that is why he needed to go to the hospital now. I had to tell her yes. I had to tell her that we needed to figure out what was causing him to struggle so much.  So we took him. We made a stop at his home and I spoke to his father. His concern was that they had just seen a doctor last week and they told them he was ok. Disappointing is all I could think. How disappointed Jose Daniel's father looked when he told me that information.

As we drove through the beautiful hillside to Sololá, I started thinking about how I was going to get the point across in Spanish to the doctors or nurses or both that we would meet at the emergency room. All I kept thinking is, I'm willing to fight someone to make sure this child is admitted. And as God would have it, the nurse I met that day looked at me and said, "¡Gracias a Dios que traen este bebe al hospital!" Thank God you all brought this baby to the hospital. Immediately, I knew our journey was into compassionate and knowledgeable hands. He had a nasal cannula in his tiny nostrils within 5 minutes after she tried and tried to get a pulse oximetry reading on him and could not. He was back to X-ray within 10 minutes. It was a much smoother process than I had concocted in my mind. So we left this family there, in capable hands.

I have had a few difficult patient/family conversations before and they can be difficult. I just hope I was gentle enough with this mom.

That day I think about often now. The importance of taking your time and making sure all involved know what is going on. The importance of having a medical team that can maintain calm when things become critical within seconds. To be a part of a group that has doctors that are thorough in their assessment of their patients. I am blessed beyond measure to have encountered Jose Daniel. I am lucky to say that I got to be the one to have a heart to heart with his mother. I am lucky to have been the last one to leave the emergency room when his mother had her breakdown. And Jose Daniel is lucky to have the mom he has. That she followed the prescription of the physician. I'm glad we didn't let her just do the weight and length as she had wanted. I'm proud of the students as they were flexible and able to move into positions to cover the spots myself and Rabbi left open. I'm just grateful. I am praying for you every day Jose Daniel. I'm praying for you always.

Stephanie Ibemere

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