Friday, June 29, 2012

Eclampsia!


The Crew: father, mother, baby, doctor, nurse, and mother-in-law

Loud cries and wails rose in crescendo, marking distress and disaster more clearly than any siren, and accosting my ears as I suddenly became distracted from Prosper’s worship remarks during our morning staff devotional.

“Doctor, come quick!” Helen gasped, out of breath from her dash across the yard and now poking her head through the front door of the clinic. Her normally placid expression was replaced with one of anxiety and trepidation. A sense of urgency uncharacteristic of our usually stoic, unflappable cleaner and medical assistant pervaded her features.

Several staff members immediately rushed out and ran over to the hospital to assess the emergency. “I’m coming!” I call after their receding forms.

I know that Christiane, our head nurse, will begin the assessment of the problem without difficulty. I need a moment to seek strength and wisdom, courage and a clear mind, from the Source above. I am fairly certain that I’ll be engulfed in a complex medical emergency in just a few minutes. An extra sixty seconds of prayer is worth far more than those few seconds spent rushing ahead full of anxious, disarrayed thoughts.

Prosper bowed his head and gave what is probably his shortest closing prayer yet! The other outpatient clients, who looked rather wide-eyed and stunned, joined us in prayer.

With the final Amen, I stood up and took a slow, deep breath to calm myself before the storm brewing in my immediate future inside the hospital.

Several fear-filled relatives came spewing out of the hospital front entrance, wailing with loud lamentations, wringing hands, and holding their heads in a gesture of unbearable emotional distress.

Making it through this gauntlet of wailing human bodies, I entered the maternity ward where our very first antenatal patient had delivered a healthy baby girl the evening before. There had been no complications. Everything up to this point had been perfectly ordinary.

The scene that met my eyes seemed surreal, like a bad dream. Visiting family members, dressed in colorful traditional wrappers and headscarves, agitated in futile circles of arm waving and crying. They were full of fear but powerless to do anything. A palpable atmosphere of panic filled the room and mixed with the aroma of traditional Cameroonian food and hospital antiseptic. Large plastic coolers were clustered on the floor along with plates, bowels, and other utensils that lay in untidy piles. Suitcases that were open and overflowing with clothes, linens, blankets, and other personal toiletry items decorated the empty patient beds. There was enough stuff in the ward to appear as if an army of Africans had moved permanently into the hospital! Disguised amongst all the belongings, against the far wall, stood the plastic bassinet with a contented, sleeping baby girl cocooned snugly under layers of warm blankets.

Pressing through this chaotic mass of wailing flesh, I found our patient convulsing in bed while her terrified husband cradled her limp head in his arms. Her eyes were rolled back in her head unconscious of the drama around her. A trickle of spittle flowed down the side of her cheek from the frothing secretions bubbling from her mouth and causing her to emit eerie rasping breaths.

Oh! Doctor! Ooooooohhhh….” Rosie’s mother in law grabbed my arm in desperation.

“Everyone, out!” I shouted. “Out, out, out!”

I felt like Jesus as he dismissed the wailing crowd from the dead girl’s room. (Mark 5:39,40)

I carefully unlatched the mother-in-law’s fingers from my upper arm and reached the bedside.  Christiane was at the head of the bed and Noela was at the foot.

“You know what she has?” I queried my nurses as we rolled Rosie on her side.

“Preeclampsia?” Christiane replied hesitantly.

“Very good,” I encouraged her. “Actually now she has eclampsia since she had a seizure but, yes, it began as pre-eclampsia.”

The nurses and husband finished getting her in a proper position. Then I shooed the husband and mother-in-law out the door.

“Noela, get the oxygen.” She scampered off to get the oxygen concentrator machine. Thankfully, I’d just checked it yesterday and attached new tubing so it was ready to go.

“Christiane, get an ampoule of diazepam and give it to her I.V.” She nodded and went off to get the medication and needle.

I took the blood pressure cuff and wrapped it around Rosie’s arm. 160 over 101 mmHg it read.

I listened to her heart and lungs and checked her pupils and capillary refill. Other than an elevated blood pressure, her vital signs were normal. She had a little swelling in her legs but otherwise her physical exam was average too.  My heart calmed down a little.

Noela returned with the oxygen and we positioned the nasal canula onto her nose.

While Christiane slowly gave the diazepam intravenously, I went outside to give the troubled husband a job to do. He needed something to distract him from his apprehension.

“Go, buy this medicine,” I commanded. I had written for magnesium, which is the treatment of choice for a patient who has eclampsia.

He gratefully took the prescription and ran off to the nearby pharmacy. When we don’t have a drug in our stockpiles, the local, private pharmacies are another resource for patients.

Leaving the patient in the capable hands of Christiane and Noela, I went over to the house to do a little research. I’ve never given magnesium for eclampsia in Africa. In America, it’s always given as an intravenous drip. Here it is better to give the drug intramuscularly because a drip can easily go too fast or too slow. With the inadequate number of nurses, their limited experience, and lack of I.V. pumps that can dispense drips at a controlled rate, it is safer to give magnesium more conservatively.

I found the reference I was searching for and copied down the particular regime to administer.

I went back to the hospital and found Rosie agitated by the nasal canula on her nose. Noela and Christiane were taking turns holding it in place.

“Call the mother-in-law. She can help keep the canula on.” I advised our nurses. (If you haven’t noticed, I’m a believer in getting the family to help when it’s proper and appropriate! This situation fit my definition!)

The Mother-in-law did a great job soothing Rosie and maintaining the oxygen.

Finally, the husband returned with the needed magnesium.

I took the bag of medicine eagerly and pulled out the box of ampoules. Hmmm…instead of magnesium at a concentration of 50%, these were only 15%. “I’m going to have to recalculate my dosages.” I sighed. “It’s going to be a lot more medication to give intramuscularly.”

I wrote and then verbally instructed Christiane on the administration of the medicine.

She nodded and then brought the proper syringes for the intravenous bolus and subsequent intramuscular injections. I left her after I observed her begin the infusion.

There was nothing more to be done. I walked out of the patient’s room, which had become a much quieter sanctuary with only the mother-in-law sitting at the head of the bed comforting Rosie. Already, she was perking up and more alert.

Outside the room, the relatives were still in a state of mass confusion. Some were praying loudly for Jesus to save and the devil to be repulsed. Others were simply wailing and holding their head in their hands. The husband stood uneasily and silently in the midst.

I put my hand on the husband’s shoulder. Trying to sound more confident than I felt, I reassured him. “Don’t worry. She is going to be fine.”

He gave a quick smile.

“I sure hope she is going to be fine,” I say to myself. This is the first time I’ve ever seen eclampsia. Sure, I’ve seen pre-eclampsia but I have never witnessed an eclamptic fit. I really don’t know what to expect. How quickly will she recover? Will the modified magnesium dose work? Will the mother be able to breastfeed her baby?

Only time will tell. I say my own prayer for Rosie’s recovery.

A/N: Rosie went on to make a full and complete recovery with no further seizures. She and baby are doing great. I had the honor of giving the little girl her ‘English’ name. I chose Antoinette after my mother’s first name. She is now officially Akawung Antoinette Abowoh!