Friday, October 2, 2015

COULD IT BE DIFFERENT?

As I write this I'm feeling pretty down.  This afternoon a 54-year-old man was brought in who had had a couple episodes of vomiting blood.  He was stable and alert, with a soft, non-distended abdomen, and with good vital signs.  I had just finished a gastroscopy, so asked Mchonkhwe, our tech, to go ahead and quickly get the scope reprocessed to do another EGD.  We brought the man into the endoscopy room, and just as we were about begin, the patient vomited a massive amount of blood and clots, and then dropped his blood pressure and became unresponsive.  We squeezed in some IV fluids and he came around a bit, but I decided we had better transfer him quickly to Kamuzu Central Hospital, as we can't get blood very quickly at our facility and they have the major regional blood bank over there.  So I called Dr. Varela, the chief of surgery at KCH, and arranged a transfer.  We quickly bundled him into the ambulance and he was taken over to KCH.  About three and a half hours later I received a text message that the man had died.  So I'm thinking of the "if only's".  If only I had blood bank capabilities here.  If only we had anesthesia coverage, and, if only we had an operating room --  then maybe we could have saved him.  This strengthens my resolve to try and develop a better facility here.  I felt bad about having to transfer him to KCH, which I know is a dysfunctional facility, but at the same time their capability should be better than ours here at Adventist Health Centre.  We need our own OR, anesthesia and better lab and blood bank capability.  I hope that someday, not too far in the future, we will have that.  This just isn't right.

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