Tuesday, May 7, 2013

Ray of hope, literally

Our EC ( Emergency Centre) is absolutely stunning. Without a doubt, one of the most beautiful ECs I've been in (Government-funded or private). It's a beautiful place, situated in an area with extreme poverty, extreme violence, and some of the highest HIV and TB rates in the world. (Yes, in the world)

If you peep through the windows of the resuscitation room, like I did last week, and look  past the electric fencing on the perimeter of the hospital,  you will see out over the, grey, sandy, treeless plains of this township. The  monotonous landscape is covered with a sprawling mass of informal tin shacks, and low-cost brick houses, home to an estimated population of almost 2 million. Far off in the distance,  40 km or more, the unmistakeable shape of Table Mountain reminds you that you are still in Cape Town.

The resuscitation room  is the most intense part of the EC, where the most severely ill patients are kept. Most are intubated and on ventilators, awaiting transfer up the public health system to a tertiary institution for specialist care or ICU.

The beds are normally arranged in specific ways. Except that on this day, one of the beds was at a bizarre angle, totally out of whack with the regimented bed-placing system.

In it, was a comatose women in fulminant, life-threatening liver failure. We weren't entirely sure why. She came in unconscious, and stayed that way.  We know she was on a cocktail of HIV and TB drugs, that although life-saving, can also be devastatingly liver toxic. She needed specialist care at the tertiary hospital on the other side of the highway. Except that they had refused to take her as their ICUs were full, and they had no beds to accomodate her.

So we kept her in our resuscitation room, giving her the best treatment we could, even though there was nothing more we could possibly do.

Dr W, who was stationed in resus that day, did what some of us are compelled to do when we feel there is nothing left to try: we do things that we know won't work, but try them anyway to make ourselves feel like we never gave up.

Which is why Dr W had moved her bed so that it was aligned perfectly with the shafts of afternoon sunlight beaming through the Resus windows.

Her bed, at odds with the other resus bed configurations, was positioned to gain maximal solar illumination.

Perhaps he wanted to make her stay in resus a bit more pleasant.

Or it may be that her helplessness reminded him of a newborn with neonatal jaundice that is treated with phototherapy, and decided to try it on her even though  phototherapy in adults  with liver failure has no proven benefits.

Touching, but also tragic.

A literal  final ray of hope.

One last luminous celestial caress - an appeal to the heavens for help because the doctors could do little else. 

She was still in a coma the last I heard. The African sun is no match for drug-induced hepatic encephalopathy.

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