ICU and CSI

This morning, I was trying to run an ICU and Scott was trying to run a CSI . . .

Well, we were wishing for those two things. An Intensive Care Unit conjures images of glistening equipment, beeping monitors, tangles of IV lines, humming oxygen. Picture instead, a listless cold baby in shock, wrapped in a filthy cloth, unconscious and grunting, on a bare mattress with a litter of spent IV cannulas as two nurses use a razor blade to shave his scalp and a rubber band to try and pop up his empty veins, his mother and aunt seated on a low wooden bench anxiously watching. When they were unsuccessful after ten minutes, I decided to try an intra-osseous line. In a baby the tibia is not all that hard to penetrate, and inside the bones there is a spongy sinus of tissue that absorbs fluid well. The trick is to jam a needle into the bone, which takes more courage than fine motor skill. I do not have any more sturdy short needles designed for this task . . . so instead I used a lumbar puncture needle and merely held it in place in his floppy leg, trying to keep clear of the copious and odiferous diarrhea flowing out. We also don't have any syringes bigger than 10 ml, so it took 45 refill-and-push refill-and-push procedures, counting out loud, to get a half litre of fluid into his body. When we started I could not feel any pulses, by mid-way his heart was racing, and by the end he actually put out a little urine and began to move his arms, warming and looking a little more life-like. All the while I was praying him back from the edge. At first his mother claimed he had become sick only that day . . and I worried about cholera, which can rapidly kill. But towards the end he vomited a brown mixture of herbs, and I slowed down enough to look at him more closely and suspect that he had been dosed from above and below with local enemas which are part-witchcraft and part-local lore. Delick still may die, but I left him on antibiotics and anti-malarials and with a bag of blood warming for transfusion. And he was next to another baby with severe malaria (an advanced case with very high parasite counts) and another with severe anemia (from sickle cell disease), any of whom would attract a bevy of specialists and thousands of dollars of care if they walked into an ER in America, but who will hopefully limp through on a ward of 30 patients staffed by a couple of nurses and me.

Scott, meanwhile, was investigating a crime scene, as if he had nothing else to do with half his day. The thievery spate continues with this time someone who KNEW THE COMBINATION opening a lock in a temporarily vacated house. Interestingly the thief "borrowed" a bicycle and pair of crocs to lug the loot, and Scott and others were able to follow the characteristic tread in the muddy road (it rained hard last night) for about a mile up the road before losing the trail. The mud-caked bike and shoes were returned, and the door closed and locked by morning. We had already initiated a night-watchman plan (which starts tonight, unfortunately too late to prevent last night's episode) and invited the local community leaders and police chief to lunch on Wednesday to express our collective team distress.

These two mornings starkly remind us what we are up against: our enemy is not the desperate parent who nearly kills her baby with herbal enemas, or the desperate person who takes sugar and a mattress and dishes from a house full of much more valuable things. Our enemy is the force of evil itself in this place, the strongholds of disease and ignorance and greed and jealousy and hatred and laziness and fear. And our enemy is not only external, but we have to deal with our own self-righteousness and self-protection and entitlement and judgmentalness. A tall order for sure, which is why the cross had to be so gruesome and bloody, so serious and painful. God's ICU for our own CSI.