mulyantiapollo

One afternoon at the daycare centre so sad it happened that this boy was knocked down by the school van. The driver was reversing not knowing that this young playful man was behind the school van. He sustained blunt chest trauma meaning the pneumo-haemothorax. The first 72 hours were really not easy to the medical staff and the parents. The mother is pregnant in the last trimester taking care of the poor boy in the hospital. The chest drains, cardiac monitor wiring systems, were terrifying to the relatives in the first one week of hospitalization. The Doctors/Nurses had to play great roles in the care of the boy and the parents. All the time in respiratory distress, resuscitating, carrying out different investigations, re-insertions of tubes/invasive lines and many other procedures were not easy to the parents and the medical team. Now the boy is due for discharge to the paediatric ward but keeps on getting setbacks as it's not easy to wean him off the ventilator. He is still on T-Piece and CPAP alternating then DAY and NIGHT respectively. The parents have got a lot of medical information from the doctors and nurses as it's their right to know what is happening their child. Because of this, sometimes they make medical decisions which challenge the medical team at times. The parents are so depressed, and recently we had to involve in the clinical psychologist to help. They keep on blaming each other for taking the child to day care when he is still young. The parents really want the boy to leave ICU but the setbacks make them more depressed day and night. The boy gets episodes of depression and this really affects him as he happens to experience severe respiratory distress but after sometime he stabilizes and becomes jolly, playful and welcoming. As the medical team we expect this to happen but to the parents it's not. You can imagine seeing your patient laughing at you then the next few minutes is crying. It challenges everyone and raises many questions. When I see a pregnant woman sleeping in the hospital, it makes me sad because I know what happens when someone is pregnant and how vulnerable that person is. She said she can't sleep at home when her child is in the hospital. She reached a time when she forgot the unborn and focused on the sick child, it made me realize the love of a mother can't be compared to any love on this planet earth. Whenever the boy sees the mother, he cries not because he is not happy but demanding love from her which upsets both of them. I had to talk about it with the hospital psychologist and my colleagues as at one point I could get depressed whenever the mother comes in. She could look annoyed not wanting to listen to any one in the Unit. I could just look at her and keep quite without saying any word especially if I'm not the one nursing her child. The boy is now better able to communicate using gestures and eye contact as verbal is limited by the tracheotomy tube. Hope with the help of everyone close to this boy, he will be able to resume his daily activities of living. The school if to meet the hospital bill which has now accumulated to about $ 40,000 so far at International Hospital Kampala-Uganda. The school administration is now sweating looking for this money of which they can't raise and parents have pulled out of anything concerning the hospital bills. The hospital is now looking for ways of helping through other sources and well wishers. I had to share this story with you as it has been on my mind always because there is another way to go in most cases. Any person can help in different way, spiritually, advise and financially.

One afternoon at the daycare centre so sad it happened that this boy was knocked down by the school van. The driver was reversing not knowing that this young playful man was behind the school van. He sustained blunt chest trauma meaning the pneumo-haemothorax. The first 72 hours were really not easy to the medical staff and the parents. The mother is pregnant in the last trimester taking care of the poor boy in the hospital. The chest drains, cardiac monitor wiring systems, were terrifying to the relatives in the first one week of hospitalization. The Doctors/Nurses had to play great roles in the care of the boy and the parents. All the time in respiratory distress, resuscitating, carrying out different investigations, re-insertions of tubes/invasive lines and many other procedures were not easy to the parents and the medical team. Now the boy is due for discharge to the paediatric ward but keeps on getting setbacks as it's not easy to wean him off the ventilator. He is still on T-Piece and CPAP alternating then DAY and NIGHT respectively. The parents have got a lot of medical information from the doctors and nurses as it's their right to know what is happening their child. Because of this, sometimes they make medical decisions which challenge the medical team at times. The parents are so depressed, and recently we had to involve in the clinical psychologist to help. They keep on blaming each other for taking the child to day care when he is still young. The parents really want the boy to leave ICU but the setbacks make them more depressed day and night. The boy gets episodes of depression and this really affects him as he happens to experience severe respiratory distress but after sometime he stabilizes and becomes jolly, playful and welcoming. As the medical team we expect this to happen but to the parents it's not. You can imagine seeing your patient laughing at you then the next few minutes is crying. It challenges everyone and raises many questions. When I see a pregnant woman sleeping in the hospital, it makes me sad because I know what happens when someone is pregnant and how vulnerable that person is. She said she can't sleep at home when her child is in the hospital. She reached a time when she forgot the unborn and focused on the sick child, it made me realize the love of a mother can't be compared to any love on this planet earth. Whenever the boy sees the mother, he cries not because he is not happy but demanding love from her which upsets both of them. I had to talk about it with the hospital psychologist and my colleagues as at one point I could get depressed whenever the mother comes in. She could look annoyed not wanting to listen to any one in the Unit. I could just look at her and keep quite without saying any word especially if I'm not the one nursing her child. The boy is now better able to communicate using gestures and eye contact as verbal is limited by the tracheotomy tube. Hope with the help of everyone close to this boy, he will be able to resume his daily activities of living. I had to share this story with you as it has been on my mind always.

We made all these diagnoses but the postmortem showed nothing pointing to the obvious causes that we thought caused this patient to die.

A calm night it was, a colleague of mine is taking care of a post-op patient after spine surgery. We had a good night and the patient was fully conscious with GCS-15/15, jolly and communicating well his concerns to the medical team. This gentleman was the most stable patient in ICU for overnight monitoring. He had a chest tube because of a pneumothorax. It was no longer draining any air after the 12 hours in ICU. He was not able to feel the lower limbs before and after surgery. But we had hope that he will improve after the operation. We always offer a bed bath in the morning and he was informed about it. As my fellow nurses were bathing him, his wife came in and talked to him but he told her that he was not breathing well but she was told to move out to give the nursing team space to do their work. The patient stopped breathing within 3 minutes and a CODE was called. He was resuscitated for over 2 hours but no ROSC. I know most of you now are guessing the diagnoses which might have causes the 50 year old man die despite of all our efforts. The post-mortem report said there was no much that was found to have caused this gentleman to die. This left us guessing and wondering what could have taken his life. We made so many diagnoses as you have made so far but nothing pointed at what caused death in this patient. Sometimes, as nurses us get traumatized when a patient dies and no conclusive diagnosis that points to what caused the patient to code and leaves fear in our hearts always. The lesson learnt is that any patient can die any time and however much the cause is known the patient is dead. Many questions but no answers at times.