Out of the Woods

Today has been a super intense day. It's pushing midnight but I know if I don't write right now it won't happen. This morning a friend and family member of William and I attempted suicide. One of the challenges of being a medical provider in a small community that has two medical providers is that you frequently have to care for friends and family.

The patient arrived at the clinic just a few minutes ahead of me this morning. As I walked towards the clinic I saw a vehicle and a crowd. Never a good sign... I heard there had been a suicide attempt and the other nurse was with the patient. When I heard the patient's name my initial response was "no way!" But when I walked in the room I found it to be true.

Our friend had diluted a large volume of a poisonous pesticide in water and chugged it. I honestly don't have much experience with poisonings. His pupils were pinpoint, he was vomiting and dripping sweat. My colleague, Kiptoo had given him a shot of Atropine and induced vomiting. I went to work tracking down the poison and it's treatment.

Kiptoo was running mobile clinic today so less than an hour after I arrived he left me back at the main clinic with the lab tech and pharmacy tech. Everything I read up on the poison said that the first 24 to 48 hours are critical and that respiratory failure can pretty much happen at any point during that window of time.

Throughout the morning we continued to induce vomiting and get him to drink milk to help neutralize things. I was running an IV of normal saline. He continued to be very out-of-it with slurred speech, impaired motor function and pinpoint pupils. His breathing however was holding stable. By lunchtime I was getting pretty frustrated that there had been no improvement and kept thinking about the possibility of respiratory failure. I had given him another dose of Atropine but that was the last dose the clinic had.

I kept wishing that I just had someone with a lot of poisoning experience who I could talk to and get advice. Then it hit me, I have a friend who is an ICU physician at Kijabe Mission Hospital (about five hours from here). So I called her up. And boy did she know poisoning! It seems that in Kenya when someone wants to do him/herself in they typically take poison. She talked me through everything I needed to do and I went back into the patient room with a renewed confidence.

She had encouraged me to keep giving frequent high doses of the drug atropine through his IV. I called our driver (who happened to be picking up a body from the morgue) and asked him to bring Atropine back with him.

During the afternoon I also saw several malaria cases, infected wounds, did a sports physical and removed a bean from a four-year-olds nose! Oh, and we had another critical patient who had to be transferred to the hospital.

At 6:30 this evening my patient's eyes dilated then became reactive to light. I could have jumped up and down for joy. I wanted to shout "He's out of the woods!" but quickly realized that no one would know what that meant. So many people were praying for him today!

The other nurse and myself are taking turns checking on him throughout the night. At my last check I found that he was stable enough for me to remove his foley catheter. We will likely discharge him in the morning.

I spent a few minutes talking with him and sharing with him how important he is to William and I. I told him that when I moved to Africa I didn't know I would find a family here. But that he has become my brother and he means a great deal to me. I had been praying with him throughout the course of the day as I wasn't sure if he would live to see tomorrow.

Please join me in praying for this friend. Pray for healing of his body, mind, and spirit. And pray for wisdom for myself and Kiptoo as we continue to encounter difficult situations like this one. Thanks for reading and thanks for caring!