I (Jessica) was on call yesterday and I must say it was one of the sadder days I've experienced in awhile. Started with rounds, and once again, our burn ward is full of tragic stories. On the pediatric side there was an 18-month-old boy who'd been burned by hot daal (the lentil soup that Nepalis eat every day). The burns weren't particularly deep, but they were extensive, covering about 50% of his little body. He wasn't doing so well yesterday morning, and was starting to show signs that he might not make it (unfortunately, I've seen enough of these burned kids now to start recognizing these signs which to the casual observer might not seem like such a big deal). We did what we could and moved on. I was hopeful, but not optimistic, that he would improve.
I've already written about electric burns. Currently we have 2 patients with electric burns. One is a man I wrote about before who has huge wounds on his chest and back from the current passing through. He is actually improving, and many of his wounds have been grafted and done well. His finger, however, hasn't done well and it's being amputated today. He was discouraged about that. However, looking at the bed next to him, he has reason to be thankful. The young boy who was in that bed previously who lost one arm at the shoulder and eventually went home has been replaced by another young boy, 9 years old, who has lost BOTH arms at the shoulder because of an electric burn. He was playing in a power station! In the bed next to the kid is a middle-aged man who has a seizure disorder who rolled into the open fire in his home while having a seizure. His burns are all quite deep, and cover about 20% of his body. I think he will make it, but he has a long way to go. Finally in the corner is a young girl, about 20 years old, who poured tar all over herself and set herself on fire. Sadly, this is a common way for young women in Nepal to attempt suicide, and it is all too often effective. Just before she came we had another young girl in the same bed (incidentally with the same first name as this one) who had done the same thing, only with kerosene instead of tar. She didn't make it. But this girl seems to have regained her will to live, and is quite motivated to get better. I think she will do okay in the end.
So that was our morning rounds. In the afternoon I had to do an emergency C-section for a lady with twins who had "fetal distress" (indicated by an abnormal heart rate of the babies). Both the babies I pulled out were "flat" (i.e. really floppy and not showing many signs of life), but thankfully were resuscitated and seem to be okay now. Mom, however, bled a lot, and I had to resort to almost every surgical maneuver for post-partum hemorrhage that I know. Thankfully it stopped before I had to do an emergency hysterectomy. So I guess that story had a happy ending.
Not so the next C-section, which was for a lady who was 31 weeks pregnant and had come in with bleeding. Baby seemed okay, and the bleeding wasn't too extensive, and so the team had decided to give the mom steroids to help mature the baby's lungs and just observe her closely, hoping to be able to wait a couple days before delivery so that the baby would have a better chance of surviving. Things went well for several hours, but then at the early evening check, there was no heartbeat. An ultrasound confirmed that baby had died. She was breech (head up instead of head down), so needed a C-section. It's an awful feeling to pull out a dead baby! The operative findings confirmed the suspicion: that the placenta had separated from the wall of the uterus (placental abruption for all you medical types). All in all the mom seemed to take it well. I can't imagine!
Finally, just before I went to sleep I got a call that my little burned boy had died. I could hear wailing in the background while I talked to the resident on the phone. A sad day on many counts!
Thankfully the weather these days gives us reasons to smile. Daytime temperatures are lovely, and the views have been very clear. It's hard to believe that the mountains, which are so clear these days, are hidden much of the year by clouds and haze. It won't be long before it starts to get cold, but we're sure thankful for this season while we have it.
I've already written about electric burns. Currently we have 2 patients with electric burns. One is a man I wrote about before who has huge wounds on his chest and back from the current passing through. He is actually improving, and many of his wounds have been grafted and done well. His finger, however, hasn't done well and it's being amputated today. He was discouraged about that. However, looking at the bed next to him, he has reason to be thankful. The young boy who was in that bed previously who lost one arm at the shoulder and eventually went home has been replaced by another young boy, 9 years old, who has lost BOTH arms at the shoulder because of an electric burn. He was playing in a power station! In the bed next to the kid is a middle-aged man who has a seizure disorder who rolled into the open fire in his home while having a seizure. His burns are all quite deep, and cover about 20% of his body. I think he will make it, but he has a long way to go. Finally in the corner is a young girl, about 20 years old, who poured tar all over herself and set herself on fire. Sadly, this is a common way for young women in Nepal to attempt suicide, and it is all too often effective. Just before she came we had another young girl in the same bed (incidentally with the same first name as this one) who had done the same thing, only with kerosene instead of tar. She didn't make it. But this girl seems to have regained her will to live, and is quite motivated to get better. I think she will do okay in the end.
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| The boy who lost one arm went home. He was a really sweet kid and always made us smile. |
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| Metal ladder, multiple wires, bare hands...no wonder we see so many electric burns here! |
So that was our morning rounds. In the afternoon I had to do an emergency C-section for a lady with twins who had "fetal distress" (indicated by an abnormal heart rate of the babies). Both the babies I pulled out were "flat" (i.e. really floppy and not showing many signs of life), but thankfully were resuscitated and seem to be okay now. Mom, however, bled a lot, and I had to resort to almost every surgical maneuver for post-partum hemorrhage that I know. Thankfully it stopped before I had to do an emergency hysterectomy. So I guess that story had a happy ending.
Not so the next C-section, which was for a lady who was 31 weeks pregnant and had come in with bleeding. Baby seemed okay, and the bleeding wasn't too extensive, and so the team had decided to give the mom steroids to help mature the baby's lungs and just observe her closely, hoping to be able to wait a couple days before delivery so that the baby would have a better chance of surviving. Things went well for several hours, but then at the early evening check, there was no heartbeat. An ultrasound confirmed that baby had died. She was breech (head up instead of head down), so needed a C-section. It's an awful feeling to pull out a dead baby! The operative findings confirmed the suspicion: that the placenta had separated from the wall of the uterus (placental abruption for all you medical types). All in all the mom seemed to take it well. I can't imagine!
Finally, just before I went to sleep I got a call that my little burned boy had died. I could hear wailing in the background while I talked to the resident on the phone. A sad day on many counts!
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