Day 16 - A Day of Firsts

Today was something else! I experienced 2 new firsts for me, neither of which were good things.

First, I saw a case of tetanus. Actual tetanus. Lock jaw. Opisthotonos. Real tetanus. A 2 year old child came in seizing, for how long we aren’t entirely sure. Once we calmed the seizures down a little bit, we were able to note the posturing. It was so distinctive that I actually asked out loud if this was tetanus and Dr. Bule confirmed what I had only read about… well no… not really. I haven’t even really read much about tetanus because it really doesn’t happen in the US. I’m pretty doubtful that this child is going to survive based solely on how long he was seizing because I really don’t know much about the survivability of tetanus.

My other first was that I called my first time of death today… on a baby. Dr. Bule was getting an IV on the child who was seizing with tetanus and sent me to examine the patient that they rushed back to the department. It was that kind of day. The baby, a 1 year old, was extremely pale and not breathing. I had the nursing student bag the baby while I checked for a pulse. No femoral pulse. No carotid pulse. No notable heart movement in the chest. I checked each site at least twice. Nothing.  Pupils fixed and dilated. I remember taking a step back and shaking my head. Despite the fact that the child’s mother didn’t speak my language and I didn’t speak hers, she understood what was happening, burst into tears, and crumpled to the floor.

I don’t think I have the words for how badly I felt. Like I was personally responsible for the death of this baby. Like if only I had done more or tried harder or been there sooner, maybe things would have been different. In retrospect and with a little reflection, I know that isn’t true. The reality is that this baby was dead when he came in.

The biggest thing where I’m still not sure if I did the right thing was when I asked the nurse to bag. At the time, I was thinking that if this baby had a pulse and a beating heart… ABCs. Airway and breathing. They come first for a reason. I didn’t want to neglect the airway while looking for pulse. The options here are so limited. Despite running through my ABCs, I know that intubation isn’t really much of an option here and somewhat mitigate the way I go about handling serious conditions like this. But now, I’m not sure if I mistakenly gave the mother hope where none was warranted by bagging the baby. Although I somehow can’t get myself to believe that not bagging was the correct choice either.

Afterward, I took a moment and walked outside still keening aware of the mother’s cries inside. I needed to clear my head and think. Think about the things I have reflected about here and also pull myself together. I have seen people die before. I think it is always harder to lose a child compared to an adult, but it had never before been my call. My call to stop and say that this person is gone. Tough call.

I made a point to talk to Caroline and Charley about it on the way home because I knew that it would be better to talk about it than just clam up and dwell on it myself and that helped. I felt like once I told them what happened it wasn’t all mine to bear anymore. I was tempted to skip out on the plans I had made earlier to go to Fort Jesus with the girls because of the rough shift I had in the Accident and Emergency department, but once again thought better of it. If I went home, I would just dwell and rethink every decision I had made. So, we went off to the center of Mombasa and Fort Jesus.

Charley, our guide, and Caroline taking pictures inside Fort Jesus

View out of the fort over the entrance to Mombasa port

Fort Jesus is a fort built originally by the Portuguese and taken over during different points in history by the English and Arabs. The guide told us everything in order of how it happened but I think I was too busy taking pictures to keep up with the finer details and dates. It is rumored that the place is called Fort Jesus because the actual shape of the fort looks like a person with a head, 2 arms, and 2 legs. I’ll admit that sounds fishy to me… I mean Jesus wasn’t the only person to ever have a head, 2 arms , and 2 legs. Cool fort, but kind of poorly preserved which is a bummer. Then we had some ice cream on the way home. Certainly a better end to an unforgettable day.

One of the remaining British cannons in the fort

One of the beautiful Arab doors in the fort (The carvings around the outside document the fort's history.)

Another view from inside Fort Jesus