Wish I had some Propofol...

I'm getting better at my lumbar punctures. However, in Africa there is no such thing as routine sedation for children that go through these procedures. So, I've been faced with the challenge of a rapidly moving and screaming target. Today, I've been trying to sedate a girl who is 8 because the intern was unable to successfully do the procedure earlier. I'm trying, giving her dose after dose of IV versed with her not seeming much sleepier. Where is a child life specialist when you need one?! Or a dose of Propofol... That would be nice.

In other news, baby Cecilia is doing much better. She is the little girl who came in with the wound infections the first day I was attending on the ward. She had her chest tubes taken out today and her sounds were closed! After just a few more days of antibiotics she will get to go home. Bryan mentioned several of my kids who have passed away. There was a baby with a type 4s neuroblastoma which is a rapidly growing tumor in the abdomen. Typically, in the states the baby would be intubated to avoid respiratory compromise caused by the tumor making it hard for it it breathe. Then, after a few weeks the tumor would begin involuting  on its own (isn't that crazy?). Sometimes, a small dose of chemotherapy would be given to help the tumor shrink faster, but this puts the infant a risk of tumor lysis syndrome, where the dying tumor cells release certain things that are very harmful to the body. For this baby, she stopped breathing because the tumor had compressed her lugs so much. I and my team were able to resuscitate her, but she started having seizures and repeated episodes of respiratory arrest. It was impractical for us to intubate her and wait several weeks because there are only two ICU beds in the hospital for children. It would have take the bed away from many children who would need it during that time. We also were unable to and her to another hospital that does chemotherapy because her parents didn't have the government insurance. Her parents decided that given their financial situation it would be best for us to provide their baby with comfort care until she passed away. She died the next day. The other child who passed away this morning had severe malnutrition and a skull abnormality that is very rare. At 7mos of life, he weighed less than his birth weight. He went to surgery yesterday to start repair of his skull abnormality. This is really important for normal brain development. We were treating him appropriately for his malnutrition as the medicine team, and after he went for his first surgery yesterday to repair part of his skull he did very well. However, as the night progressed he seemed to be dehydrated as he wasn't making urine. You have to be very careful giving fluid to a malnourished child because you can overload their heart. But he got some small amounts of fluid and initially did ok until his heart rate just precipitously dropped. He initially was resuscitated but had another event about one hour later. We aren't entirely sure what happened, but we speculate that his malnutrition made his body so weak that it couldn't handle the stress of surgery. His mother was so stricken with grief. 

There is definitely more death here than what we are accustomed to, and often times you don't have the comfort of knowing "why." It's hard, but we are doing the very best we can to take good care of the patients and their families seem to know And be thankful for that.

Tonight we are going to a missionary family's house for dinner and I am getting ready for a presentation on congenital and acquired syphilis for tomorrow based on a recent case I've had. I'm doing it morning-report style for those of you who know what I mean! I think and hope it will be interesting :) 

Love you guys! Thanks for staying tuned.

Sb