Kurrant Part 2

At ServeHaiti I've been incredibly spoiled with a touch of the U.S. luxuries I'm very accustomed to.  They are outfitted with solar panels that charge a battery throughout the day, a wind-powered generator and then the traditional fossil fuel powered generator.  Most of the time I have wi-fi access while I'm in the clinic, which is helpful.  It's one thing to not be able to communicate with the patients, but then factor on the fact that I can't even access my medical resources to help with treatments and I would be basically worthless down there.  

But the ServeHaiti clinic is the exception, not the rule.  When I was doing my surveys a common request was for "kurrant".  If you want electricity in Haiti you have to buy a generator and then the fuel to run it.  Needless to say, most people just do without.  So, if you have one you can be big dog on the block, charging people a day's wage just to charge their cell phone.  Can you imagine what it would be like for there to be zero power #WalkingDeadStyle?  Complete darkness.  No street lights, just the occasional stray moto headlight zooming down the gravel road.  It just seems unfathomable for anyone to expect a country to develop, or rebuild after a series of major natural disasters, when there is no water security or electricity for the people to use.  #RantOver

Puerto Rico to the East, Domincan Republic, and then Haiti.

I think I fall asleep around 10 pm.  I had an alarm set for 1030 just to get the jump on my hourly checkups.  Fortunately, or unfortunately, the neonatal resuscitation table has a sensor that will detect the surface temperature of whatever is underneath it.  And anyone who has worked with these darn things can tell you, they’re a fickle lot.  Even if the baby is there and is at a normal temperature the alarm may still sound.  Well our baby isn’t quite back to normal temperature, so sure enough the alarm sounds.  1015.  Almost.  Guess I can cancel my hourly alarms.  I get up, hit the reset button and take a quick listen to her heart and lungs.  Stable. 

Suddenly the room is filled in darkness.  The oxygen machine begins alarming.  The resuscitation machine lets out an awful howl.  There is a faint beeping heard in a far off room.  The power went out.  This is new.  Since my time in Gran Bois I’m not sure I ever dealt with a power outage.  I swaddle her with the blankets and begin some breathing assistance with the ambu bag.  Dad and grandma come back in to check on her.  “Fils cop bay tete?”  “No, pa capab.”  She just wasn’t breathing comfortably enough for me to suggest her to try and breastfeed.   Maybe when we get power and she can get her oxygen back.  Yeah, I didn’t try and tell him my thinking cause that would have been a communication nightmare. 

I hear Prophet’s name called out and then about five minutes later the power kicks back on.  Hallelujah, I’m not sure how much more of the mindless bagging I could take.  I turn the table and oxygen back on.  While I’m awake I give her a little more IV fluid PO.  She actually does a great job with it.  Breathing?  Labored but stable.  HR?  110s.  Back to bed.

Thirty minutes later the resuscitation table alarm sounds.  No problem.  Check on her, things are looking good.  I lay back down on the bed and just as I’m falling back asleep, the power goes off again.  I turn off the oxygen machine and the resuscitation table, cover her back up in blankets, and watch.  She’s breathing okay.  This time the power is back up in short order.  Machines on.  Still stable.  Back to bed. 

Another table alarm comes and goes without incident.  And then the power goes off.  Three times for those keeping track at home.  I turn off the machines and lay back down.  I don’t really know what else to do.  This is the time when you start to question whether your effort is misplaced.  Is it really worth me staying up all night for this patient?  No one else certainly seems like it's worth it.  I must’ve drifted off because I was startled awake ten minutes later when dad and grandma came back to check on her.  I get up.  She’s blue again.  Her body is limp.  Her respirations are infrequent and irregular.  And her HR is 15. 

I take off the nasal cannula to ensure that the mask gets a good seal and deliver two rescue breaths before starting CPR, pumping my thumbs where there already is significant bruising.  30:2.  30:2.  Five cycles and a pulse check.  Still 15.  No respirations.  The flashlight in my mouth offers the only light in the room.  My skin glows in the dark down here, but to watch her chest for movement I have to have the light.  What am I missing?  Neonatal sepsis?  Is she so early that her lungs aren't developed?  Did I give her a pneumothorax with my first rounds of CPR?  What's her blood sugar?  Medicine is much more fatiguing when your questions outnumber your answers.

My jaw is sore.  My mind is tired.  My spirit is exhausted.  And then I feel the vibration in my pocket from my phone.  I’m sure everyone has had the phantom vibration syndrome, where you constantly feel like your phone is going off.  Well, I’ve had that too, but I was certain this was legit.  Not sure how though.  I haven’t had service or Wi-Fi since I’ve been here.  I mean, I’ve been connected to the router, but the connection to the internet has been down since before I arrived.  Maybe, just maybe, in some strange twist of fate, my phone is connected to the internet and I can look up a formal flow sheet for neonatal resuscitation.  Maybe Youtube how to intubate a neonate with a tongue blade and a straw.  Anything to change the impending outcome.  I pull out my phone.

Calendar notification.  Two days until “Bedica’s birthday.”  I fumble as I try to quickly resume compressions.  My hopes dashed and what a crushing blow.  Her lips and eyelids are a faint blue hue.  Grandma has already left the room and only dad is standing there to watch this white man beat up his newborn baby girl.  Ten minutes past the hour and I’m done.  I look at the father and can’t imagine that I would want to keep seeing the same trauma inflicted on my baby girl.  The outcome isn’t going to change.  Not without epinephrine, atropine, IVFs, an incubator, and a real NICU team.  A family medicine resident in his second year that is terrified of sick neonates cannot win this battle with a flashlight.  I stop.  I swaddle her in her blankets and carry her to her father.  I don’t even know what I would say if he spoke English.  “I’m sorry.”