Day 94, As a doctor you always wonder about the day when you may be called into action for the man on the street. I’d never considered that it could be a beach rather than a street, but yesterday the nightmare scenario became reality.
I was sat on the beach soaking up the Mozambique sunshine, taking pictures of waves crashing over my friends who were in the water. One of them had started to struggle with the strong current and was calling for help. The others managed to get to her as commotion started breaking out on beach. They came back in swiftly and then we realised that there was a mozambiquean man who was out far in the water and couldn’t be seen. One of his group ran past me saying he was dead.
I couldn’t quite comprehend what was happening. Some other locals, good swimmers, dived in to try and find the man and I turned and ran towards the beach lodges to call for help. I ran over the sand bank past a young woman stood looking out to the sea, she was wailing and bawling. I managed to get someone to try and call for a boat and ran back to the beach to find that the man had been brought ashore and my friends had started CPR.
As expected there was a throng of onlookers without much productivity. People had been sent to find equipment and call for an ambulance. Without any pocket masks or ambi bags we were unable to give him any of what he really needed, oxygen. Our main focus became to continue giving chest compressions. His pupils were already not reacting and he had spewed copious amounts of vomit. This likely meant that he had aspirated this into his lungs along with the salt water already in there.
With bizarre and unhelpful suggestions from the bystanders we continued on with what was shaping up to be increasingly futile. I swapped into the compressions position and realised for the first time how young he looked. He was barely in his twenties if not his teens. My hand kept slipping with sweat in the heat of the afternoon sun, the vomit smell became more pungent. We stopped at regular intervals to check for a pulse but continued on each time we found none.
Eventually a trickle of equipment arrived; I rummaged through one bag with 2 IV cannulas amongst other things and attempted to site it. I was sharply reminded by my friends that I should use the gloves which I had forgotten in the commotion. I didn’t get a flash back and as I withdrew the needle it pierced through the cannula. We were left with no oxygen and no means giving any fluids. Time was passing and he was receiving no oxygen to his brain. It was at least 25 minutes before a portable defibrillator arrived and confirmed that we should continue chest compressions.
With no ambulances within an hour’s vicinity the crowd murmurings started towards getting the patient over the border to Manguzi hospital, 45 minutes driving on sand roads. Our murmurs were more concerned with the purposefulness of resuscitation given the likely prognosis. Yet we continued, we could not do otherwise under the circumstances. Eventually more kit arrived that would allow us to start oxygenating him but he had been deprived of oxygen for too long.
A bakkie (pickup truck) had been mobilised and we manoeuvred him onto the back and continued with the compressions. As we set off the beach we reviewed the reality facing us, that it was unlikely that he would ever have a pulse again and in the event that a miracle were to occur that he would be in a horrible vegetative state. I continued with compressions on the back of the truck with difficulty as the bumpy road it made it nigh impossible to be consistent. We took him to a local clinic, a two room hut with very little staff or equipment, and reached a consensus. After close to an hour of continuous CPR, being attended to by 6 doctors, and given whatever drugs and oxygen was available we would not continue with our resuscitation attempts.
In a matter of minutes the idyllic weekend getaway had become another patient we were powerless to help despite our best efforts. In the aftermath I was left to reflect on the cruelty of fate and the fragility of life. It could have happened anywhere in the world, but in Africa I’m beginning to expect the unexpected.
You're like david Hasselhoff in Baywatch
ReplyDeleteLife can be so cruel sometimes..
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