Score: 1-1 Good Guys Win!.......well maybe

This has unfortunately become the same "song and dance" at several district hospitals wherein:

1. a desperately ill patient is presented at morning report with vital signs that are
2. incompatible with life or
3. indicate life is near an end or
4. well, you know the story by now.

So there I was at morning meeting and listening as a department head nurse reviewed the patients admitted from the last evening and those that might be of interest. She mentioned a woman "with HIV, in critical condition with PCP (now called PJP) pneumonia". She had an unrecordable temp and, well, the same song and dance. I know what doesn't work by now, and since that voice in my head was as loud as the last time, I thought I'd just saunter on over to the female ward and have a look.

By now of course her vitals were worse and she was gasping. Generally in these cases simple fatigue due to the stress of breathing leads to death as a patient is so sick that they have no calories to use on respiration . I asked her nurse if her IV was working. "Yes" And how did her O2 come off her face and why is she in the far bed with the curtains drawn so no one could keep her under observation? Cue the panicked look on face and shrug. So I calmly (no, really) went and asked the charge nurse and her charges if they could please come to discuss our patient.

We assembled around the bedside and I again inquired about the vital signs, IV, 02, general condition, and why she was alone, gasping and basically circling the drain. She was an all too familiar room as of the four beds there each has hosted an unnecessary (at least unattended, missed, or otherwise ignored) septic death. We were close to batting 1.000. As I reviewed the situation I asked if some one could get a new IV, some normal saline, another 02 line and something to warm her?

Inertia. Now it may be an overstatement that there isn't a notion of accountability in this culture but this situation spoke volumes to me. So I quietly did a slow white hot fizz, got some vicious heart burn, and gathered all the equipment myself and away we went. To their credit everyone started treat her. Not sure why it took so long but there you are.

She died 3hrs later. Score: Death and frustration-1, Patients-0

I went to male ward and found a nurse who could recite the pathophysiology of each disease process we encountered and knew her patients to the nearest decimal place. No one was going to destabilize on her watch without her knowledge of it. Her patients were just as sick yet they were in much better hands. Just like every place I have been, the culture of a particular ward can vary widely within an inpatient environment. In this case: Death-1, Patients-1. Tie goes to the home team. Good guys win. We'll take it.

Today Lynne and I went for a drive into the bush. I doubt most expats realize how near the bush is to Gabs. When I fly to outlying areas I can see it as close as a km from the airport. What I love about it is the quiet, the smiles, giving people on the road or trail a ride and taking them to their home. Many think this experience can only be had in the middle of nowhere and yet these people live and thrive so close to here. We wound around and saw some amazing homes, huts, cattle posts and giggling kids. The bush in winter is thinner and therefore easier to see through. The vistas will be only one of the amazing things I will always remember about Botswana.