This was my first full-time week in the ICU. Some days were better than others, but the overall mortality was 40% in the unit. I've been told that the annual mortality rate in the ICU is about 65%. They are so resource poor that often times there is nothing to be done with our patients. Thursday was by far the hardest day. My ICU senior (attending) was called into an emergency. Out of no where two of the five patient's blood pressures started to drop. One was suppose to be taken to the OR but had gotten bumped for a different emergency. She was desaturating and even on 100% FiO2 we could barely get her sat above 88-90%. I was very proud of the nurse, Céline. She was attempting to troubleshoot and was suctioning, checking for a cuff leak, everything that I would hope would be done. I was very proud. However, post-surgery when I went to check on her I took a few minutes to look at her vital signs and heart rhythm and knew that she was going to be dead within two hours. I walked out and went to the office to do work. An hour and a half later Vanessa, my general surgeon roommate, who had operated on the patient told me she had died. The other unstable patient died on night shift. There was nothing to do be done. Both of them were maternal cases. One had given birth I believe less than 10 days before.
The nice thing about this week is that Vanessa has been in the OR (or theater as they call it) and therefore we share a number of the patient's. It's nice to be able to discuss the surgical patient's with her because I always understand the patient story. It's been hard to follow nurse report at times because it's in a combination of Kinyarwandan, French, and English. Not to mention that report is extremely different here. One of the goals that my Head of Department (Medical Director) has given me is discussing accountability with the nursing staff and helping take ownership and responsibility for what they do. Not the easiest task in the world, but fingers crossed. It still amazes me how different nursing is around the world.
The other good thing about this week is that I now have a multitude of projects to get started on it. Other than that, not much has happened this week. We are finally feeling settled in our house, which is beautiful and made so much better by the hiring of a housekeeper. Our house keeper is also Vanessa. What are the odds. She was trained by the nuns in culinary and is very hard working. She is a fabulous cook and everyday I come home to find my bedspread fluffed and arranged as if I were in a hotel. It's marvelous. I am going to be so incredibly spoiled this year. She cleans, cooks, does laundry, and is my new favorite person. Our guards are also adorable and will do just about anything we ask (or don't ask... they clean our borrowed car every morning at 6:30 am so it's ready to go by 7 am). This morning Julie planted some seeds she brought with her in a section of our garden that they had tilled for her. They are so great and make us feel very secure, even in our very safe little town.
Julie and I are going to go for a little hike through the local arboretum this afternoon as Vanessa is on her way back to Kigali for a surgeon's meeting tonight. We need to burn some calories since I fixed Nutella and bacon stuffed french toast with fried sweet bananas and fresh passion fruit juice for breakfast this morning. It was lovely. We ate it out on our veranda. While chowing down, we noticed a rather large flock of birds circling and wondered what they were after. It was then that Vanessa pointed out that they were bats. Sure enough she was right. I've never seen bats in broad daylight before. And they eventually roosted in a tree across the street. Not sure why they were out but man do they make quite the noise! Screeching to beat the band! Now we know that it isn't birds making that sound though. We just assumed it was, now we know better.
Off to enjoy this beautiful day! Photos posted to Facebook and my iCloud Stream for those that have iPhones. More to come! Lots of love.
Lessons Learned:
1) There are going to be a lot of days where there won't be anything anyone can do for the patients.
2) I'm going to learn a lot about OB and Pediatrics this year... my unit is the only one with functional oxygen, therefore we get all ICU patients. (Any stateside help would be nice)
No comments:
Post a Comment