The week started off pleasant enough. I had a plan, subject to change at a moments notice based on emergencies, weather or various other factors. You always need to be flexible and adaptable in an environment like this.
I generally do not ride in the ambulance when there is a patient transport but we were called to pick up someone critically ill from a home (very unusual) and since she was not coming from a health facility, no staff would be there to go with her. I should say that our ambulance is equipt with a driver and very basic medical equipment, no one staffs the back of the ambulance because staff from whatever facility calls will go with the patient. The ambulance is basically for rapid transport and not care enroute.
I remembered the patient from the first day I started work. She had been referred to the maternity here in Baama because she was in labor but needed isolation due to co-infections of TB and HIV. When I met her, she was very thin, coughing a lot and in early labor. The midwife would care for her, administer the requisite medications and assist her delivery and she would be discharged a few days later with her baby boy.
When I received the call about the patient who was 4 weeks post partum needing transport to the hospital because she was in declining health, I knew who it was straightaway based on the village location and her description. Her baby had died, they said, and she had a worsening cough. Her family had tried traditional healers to help her but it was not working.
The ride in the ambulance alone was an experience. The breakneck speed at which the driver took the perilous gravel path was rather impressive and although no goats or chickens were harmed as we passed through villages, I did fear for a few here and there.
Once at the pick-up location (1.5 hours later!), we needed to find the patient. We were given a general area. There are no street names or addresses or anything else identifiable. We were told the husband would be looking out for us. So we parked in the middle of the village and waited in the swealtering heat; not difficult to miss since there are literally no other vehicles around, let alone an ambulance.
Finally someone comes to take us to the patient. When we arrive, I walk up to the porch where she is sitting, drinking tea and eat a piece of tapalapa (French bread). She was far thinner than she had been a month prior, in fact, she was skeletal. She had open sores all over her mouth and lips, candida inside her mouth and a horrible cough. When I looked at her all I could think was, this poor woman has end stage AIDS. I knelt down beside her and asked if she could walk. She said she could, so we got her into the ambulance. A large crowd had gathered in a matter of minutes, so I wanted to get her out of stare of onlookers. I took her blood pressure, pulse and temperature. Low BP, high pulse rate and high fever. I started an IV with antibiotics, although I knew it would not help. Her tiny, fragile body lay on the cot and she closed her eyes as we began the ride to the hospital 40 minutes away.
As we rode in the back of the hot ambulance, windows open to catch what little breeze we could, I looked at her lying there and wished I could do something. I saw how scared she was. I wished I didn’t need gloves and a mask. I wanted her to see my face, my expressions. I could not speak her language so this non-verbal communication was important but personal protective gear is also important. I wanted her to know in this moment, she was cared for. I got the feeling she hadn’t gotten much compassion in recent times.
As we drove, she kept spitting up blood tinged mucus and I knew aside from TB and without a chest X-ray, she had pneumocystis carinii penumonia and that it would eventually kill her, as it was a common killer of AIDS patients. I was so sad for her. At various times during the ride she would open her eyes very wide and get a wild, almost primal look about her – a look that begged the questions, what was happening? What was going in in her body? It is a far-away look, almost like she was glimpsing the other side. I have been with other dying people and I recognized this look.
The ambulance was loud and I hum to self-sooth as the ride continues. I put a gloved hand on her bony leg, her legs were the size of my arms – and I kept singing under my breath. A one point she put her hand on my knee and she looked at me. I could feel her fever through my scrubs. I smiled through my mask and nodded and said it would be okay. I kept singing softly because in that moment it was the only language we both understood. She finally closed her eyes. She kept her hand on me the duration of the ride.
When we arrived at the hospital and I did the hand-off to the doctor, she agreed with my assessment that the patient was in shock and had PCP. They were very busy so I wasn’t able to ask all I wanted like if they would make her comfortable and if she would be treated well. I knew she was going into isolation because I had requested it but that was all I knew.
I went back in to see her a last time and say ‘goodbye’. She grabbed me. She was frightened and did not want me to leave. In truth, I did not want to leave her. I told her it would be okay and they would care for her here. As I walked away, I hoped to myself that the latter was true. I knew I would never see her again. I knew she would die soon and I prayed death would be swift and as peaceful as possible. But I lived through the 80’s and I knew that, particularly in this environment, her death was not likely to be an easy one.
The ambulance driver and I rode silently home the entire 1.5 hours over the same perilous, rocky terrain that got us there. My day was only half done and I had no idea how I was going to find the energy to finish the second half. But after a cold shower and a change of clothes, I got back to it.
A few days ago I was informed she had died. She left behind a husband and 3 children. She was 30 years old. Although I could not do anything medically to help her, I hoped the 40 minutes we spent together in the back of the ambulance was some comfort to her, it was all I had to give.
One Response
I find myself at a loss for words, so many feelings…sadness, heartache, awe at the magnitude of the life and death situations surrounding you, and gratitude that you were there to give her some comfort in the depths of her suffering and fear.