I’ve never been a big fan of snakes. There’s something about them that has always seemed creepy, and they’re certainly not snuggly. I actually had a pet boa constrictor as a child. Despite my best efforts to cuddle with it, it never seemed to return my outreaches of love. In fact, one day it bit me!
Moving to Tansen, we heard that snake bite victims would come to the hospital, but somehow I thought that we wouldn’t have any personal encounters with snakes. Denial, perhaps? About a month after moving here, we saw our chowkidar (groundskeeper/gatekeeper) killing a small snake in the yard outside. No big deal, I thought, because small snakes are less dangerous. Then I attended a lecture on snakes: it turns out the small ones tend to be more poisonous!! And they don't all have diamond heads or nice rattles to warn of their poisonous nature or presence.
A couple of weeks ago, I was walking home via the “pleasant” route, enjoying looking at the flowers, when suddenly the “hose” started moving! It slithered into the bush in front to my right, its tail out one end and its head out the other end, the end that I needed to walk past in order to get home. It was rather fat, all black, and definitely long, maybe 4-5 feet. I figured it was one of the less dangerous ones, so I stomped my feet—having learned that snakes feel vibrations more than they see things—but it didn’t move. I contemplated walking back down the hill, through the hospital, and up the hill on the other side, but that would mean an extra 10 minutes to get home, not to mention yet another walk up the sweat-inducing hill. I decided to trust what little I’ve learned about snake identification and walked past the snake. Although my heart rate was fast, the snake was not and just watched me with its beady eyes.
The day before this encounter, we sent home an adorable 8-year-old girl who nearly died from a snake bite. Miraculously, when she left our hospital, it was as if nothing had ever happened. Two days after my personal encounter, a 13-year-old boy arrived too late. We did CPR, but once more details from the story were gathered, it was clear that our efforts were futile. He simply lived too far away from help to have survived.
Last week at 2:30 in the morning, while I was on call, I had my first chance to care for a snake bite victim from the start. So I called for help from a wonderful physician who willingly came. Typically the ones who are bitten at night in their homes are at highest risk because these snakes tend to be the Kraits. They cause almost no reaction at the bite site but send the person into a deadly neurotoxicity. That's too sneaky for my liking. This woman’s husband first took her to the local health post, where the man told them to wait until morning to go to a hospital. Thankfully the husband went against that poor advice. They found a car and drove the two hours to our hospital.
She arrived just in time. She was having ptosis—difficulty opening her eyelids—and was starting to drool, indicating an inability to swallow. The next step is inability to breath, and she was already having difficulty doing that. Yet she was alert and answering our yes-or-no questions. How incredibly scary to not be able to breath, yet be totally aware!
We attempted a round of neostigmine and atropine, which saved the prior 8-year-old girl’s life and also spared her from being intubated. Unfortunately for this woman, it didn’t work. We needed to intubate. What followed was a series of life-saving events that don’t happen very often in our hospital since there is only one ICU bed, so there were some stumbles along the way.
The resident wanted to pre-oxygenate, but we hadn’t yet prepared any of the intubation materials. He removed the nasal cannula and put on a mask meant for bagging someone who’s not breathing. The patient began thrashing and her oxygen level dropped. I had to mention a few times that the mask was making her suffocate and feel anxious before he believed me and replaced the nasal cannula. Her oxygen recovered, as did her calmness. (The appropriate mask for this situation had been bitten by a rat, apparently.)
The anesthetist—a nurse trained in anesthesia—skillfully intubated the patient, praise God. Then we had to transfer the patient from the ER to the ICU. The oxygen tank is a huge metal thing that sits on a trolley that is I-don’t-know how many years old with a turning radius of almost nothing. One of the ER sorters (sort of like a nurse who sees all the patients before the doctors) was in charge of pushing the oxygen while others pushed the patient’s bed. As we were rolling through the final hallway, there were other patients sleeping on the “beds” on the floor since our hospital is in the busy season and overflowing. In fact, the ICU bed was the very last one available, a blessing not to be missed.
Given the immobility of our mobile oxygen, the sorter rammed it into a trashcan. Trying to use its impressive turning radius, he attempted again to move around the trashcan but couldn’t, knocking the lid off. The bed, meanwhile, kept moving, nearly yanking the oxygen tube off the tube going down our patient’s throat! There were some yells, some backing up, some more wheeling, and the crisis was averted.
The next obstacle was one of the patients in the hallway: another snake bite victim, the result of a different snake whose venom causes a lot of local reaction but less systemic reaction. So her arm was in a sling, hanging in the air, attached to an IV pole, looking similar to the hangman drawings from childhood except with her hand instead of a body. One of our security guards ran ahead and attempted to reorient the IV pole so our patient’s bed could role by. It was quite a site as the hallway patient awoke, her hand swinging through the air, and our sweet guard trying to figure out how to move the thing.
Finally we were ready to enter the ICU. An empty bed for the OR was in the way despite having previously asked for it to be moved. A game of tetrus ensued to maneuver our patient’s bed, head first, into the one-room ICU, smaller than most bedrooms at home. Ideally the oxygen tank and its pusher would have entered the room first, but that didn’t happen. Instead he tried to cram the tank in alongside the bed through the doorway simultaneously. Again a few more yells and loud banging noises later, the patient, bed and oxygen all made it into the room.
Then the patient had to be transferred to the ICU bed from the ER bed. At home, the patient is laying on top of sheets. Everyone grabs an edge of sheet and transfers the patient that way. No sheet here. Three people got on top of the ICU bed and picked her up--talk about causing a physical therapist to cringe!--while others pushed her from the other side. Since the ER bed's brakes no longer work, others held that bed still to ensure it didn't swing away from the ICU bed, which would allow the patient to drop to the floor. And of course the breathing tube had to protected: can’t forget that.
She made it, breathing tube intact. We gave another round of anti-snake venom, a discussion in itself since the supply has been extremely limited. In a patient who is already intubated, perhaps she doesn’t need the ASV because a machine is breathing for her. But we decided to give it to protect her from cardiac effects of the snake’s venom. Since the ASV is made from horse serum, 20% of people have a severe allergic reaction. Thankfully, this patient was not one of them. But I learned that ASV doesn’t come in an easy-to-give form. No, it comes in little vials of powder. The nurse draws some fluid out of a little plastic thing--twice--then puts that fluid into the vial of powder--twice--shakes it, and does this nine more times for a total of ten vials. Then she takes an IV bottle, removes some of the fluid, then adds each vial individually by needle into the IV bottle. Finally, the ASV is ready. It took her a good 20 minutes!!
The patient’s husband sat by her bed, the sun now about to rise on a new day that his wife nearly missed. How terrified he must have felt. The nurses took him out of his trance by teaching him how to empty her urine from the foley, how to change her position every two hours, how to help clean her mouth while intubated. Ultimately he asked if he could leave for a short break to get some tea. Praise God this patient survived and did well despite all our fumblings. It’s a good reminder that God is in charge of all of this.
We don’t know how many people die from snake bites without ever arriving to our hospital or another hospital. I can’t imagine how devastating it is to family to go to sleep and wake up to the terror of a snake bite, facing the possibility of life being forever changed by such a small yet entirely life-altering event. Praise God for those who have survived; may they see His hand in their lives. And may He protect me as I walk through the night on call, stomping my feet and shining my little light into the darkness.
Moving to Tansen, we heard that snake bite victims would come to the hospital, but somehow I thought that we wouldn’t have any personal encounters with snakes. Denial, perhaps? About a month after moving here, we saw our chowkidar (groundskeeper/gatekeeper) killing a small snake in the yard outside. No big deal, I thought, because small snakes are less dangerous. Then I attended a lecture on snakes: it turns out the small ones tend to be more poisonous!! And they don't all have diamond heads or nice rattles to warn of their poisonous nature or presence.
 |
| The library of snakes in our hospital ER. Patients' family members or friends hit the snakes to stun them, then put them into jars to bring them into the ER to show us. Often the snake is still alive! Despite the lids, I stay away. Once the snake dies, someone--not me--pours formalin into the jar to preserve the snake. |
 |
| This is what my friendly snake looked like. I thought of taking a picture myself to show you but decided not to push my luck. |
The day before this encounter, we sent home an adorable 8-year-old girl who nearly died from a snake bite. Miraculously, when she left our hospital, it was as if nothing had ever happened. Two days after my personal encounter, a 13-year-old boy arrived too late. We did CPR, but once more details from the story were gathered, it was clear that our efforts were futile. He simply lived too far away from help to have survived.
Last week at 2:30 in the morning, while I was on call, I had my first chance to care for a snake bite victim from the start. So I called for help from a wonderful physician who willingly came. Typically the ones who are bitten at night in their homes are at highest risk because these snakes tend to be the Kraits. They cause almost no reaction at the bite site but send the person into a deadly neurotoxicity. That's too sneaky for my liking. This woman’s husband first took her to the local health post, where the man told them to wait until morning to go to a hospital. Thankfully the husband went against that poor advice. They found a car and drove the two hours to our hospital.
 |
| What a Krait looks like. Apparently these snakes are 15 times more deadly than cobras. I stole this picture off the internet and hope I never have the opportunity to take a picture myself! |
She arrived just in time. She was having ptosis—difficulty opening her eyelids—and was starting to drool, indicating an inability to swallow. The next step is inability to breath, and she was already having difficulty doing that. Yet she was alert and answering our yes-or-no questions. How incredibly scary to not be able to breath, yet be totally aware!
We attempted a round of neostigmine and atropine, which saved the prior 8-year-old girl’s life and also spared her from being intubated. Unfortunately for this woman, it didn’t work. We needed to intubate. What followed was a series of life-saving events that don’t happen very often in our hospital since there is only one ICU bed, so there were some stumbles along the way.
The resident wanted to pre-oxygenate, but we hadn’t yet prepared any of the intubation materials. He removed the nasal cannula and put on a mask meant for bagging someone who’s not breathing. The patient began thrashing and her oxygen level dropped. I had to mention a few times that the mask was making her suffocate and feel anxious before he believed me and replaced the nasal cannula. Her oxygen recovered, as did her calmness. (The appropriate mask for this situation had been bitten by a rat, apparently.)
The anesthetist—a nurse trained in anesthesia—skillfully intubated the patient, praise God. Then we had to transfer the patient from the ER to the ICU. The oxygen tank is a huge metal thing that sits on a trolley that is I-don’t-know how many years old with a turning radius of almost nothing. One of the ER sorters (sort of like a nurse who sees all the patients before the doctors) was in charge of pushing the oxygen while others pushed the patient’s bed. As we were rolling through the final hallway, there were other patients sleeping on the “beds” on the floor since our hospital is in the busy season and overflowing. In fact, the ICU bed was the very last one available, a blessing not to be missed.
Given the immobility of our mobile oxygen, the sorter rammed it into a trashcan. Trying to use its impressive turning radius, he attempted again to move around the trashcan but couldn’t, knocking the lid off. The bed, meanwhile, kept moving, nearly yanking the oxygen tube off the tube going down our patient’s throat! There were some yells, some backing up, some more wheeling, and the crisis was averted.
The next obstacle was one of the patients in the hallway: another snake bite victim, the result of a different snake whose venom causes a lot of local reaction but less systemic reaction. So her arm was in a sling, hanging in the air, attached to an IV pole, looking similar to the hangman drawings from childhood except with her hand instead of a body. One of our security guards ran ahead and attempted to reorient the IV pole so our patient’s bed could role by. It was quite a site as the hallway patient awoke, her hand swinging through the air, and our sweet guard trying to figure out how to move the thing.
Finally we were ready to enter the ICU. An empty bed for the OR was in the way despite having previously asked for it to be moved. A game of tetrus ensued to maneuver our patient’s bed, head first, into the one-room ICU, smaller than most bedrooms at home. Ideally the oxygen tank and its pusher would have entered the room first, but that didn’t happen. Instead he tried to cram the tank in alongside the bed through the doorway simultaneously. Again a few more yells and loud banging noises later, the patient, bed and oxygen all made it into the room.
Then the patient had to be transferred to the ICU bed from the ER bed. At home, the patient is laying on top of sheets. Everyone grabs an edge of sheet and transfers the patient that way. No sheet here. Three people got on top of the ICU bed and picked her up--talk about causing a physical therapist to cringe!--while others pushed her from the other side. Since the ER bed's brakes no longer work, others held that bed still to ensure it didn't swing away from the ICU bed, which would allow the patient to drop to the floor. And of course the breathing tube had to protected: can’t forget that.
She made it, breathing tube intact. We gave another round of anti-snake venom, a discussion in itself since the supply has been extremely limited. In a patient who is already intubated, perhaps she doesn’t need the ASV because a machine is breathing for her. But we decided to give it to protect her from cardiac effects of the snake’s venom. Since the ASV is made from horse serum, 20% of people have a severe allergic reaction. Thankfully, this patient was not one of them. But I learned that ASV doesn’t come in an easy-to-give form. No, it comes in little vials of powder. The nurse draws some fluid out of a little plastic thing--twice--then puts that fluid into the vial of powder--twice--shakes it, and does this nine more times for a total of ten vials. Then she takes an IV bottle, removes some of the fluid, then adds each vial individually by needle into the IV bottle. Finally, the ASV is ready. It took her a good 20 minutes!!
The patient’s husband sat by her bed, the sun now about to rise on a new day that his wife nearly missed. How terrified he must have felt. The nurses took him out of his trance by teaching him how to empty her urine from the foley, how to change her position every two hours, how to help clean her mouth while intubated. Ultimately he asked if he could leave for a short break to get some tea. Praise God this patient survived and did well despite all our fumblings. It’s a good reminder that God is in charge of all of this.
We don’t know how many people die from snake bites without ever arriving to our hospital or another hospital. I can’t imagine how devastating it is to family to go to sleep and wake up to the terror of a snake bite, facing the possibility of life being forever changed by such a small yet entirely life-altering event. Praise God for those who have survived; may they see His hand in their lives. And may He protect me as I walk through the night on call, stomping my feet and shining my little light into the darkness.
No comments:
Post a Comment