This time it's Cole Part II

Part II

By the grace of God another missionary, a seasoned pediatric ER doctor, was awaiting us in Bujumbura.  He had prepared a spot for Cole at the primary teaching hospital for Hope Africa University.  Cole wouldn’t officially be admitted, but would have a bed to use as a waiting area until the medi-evac plan arrived.  It was amazing how many doctors were available to participate in Cole’s care.  Brain power was not the limiting factor.  It was resources.  Even at this university teaching hospital, there was no ICU, no ventilators, one tank of oxygen, and very basic lab tests.  By going to Nairobi we were trading control of Cole’s care for better resources in case he got worse.  I was ok with that, but knew it would be hard to give up the ability to order the drugs/tests/surgeries that I thought were best.

In good African time, the plane arrived a little later than expected, around 10:00pm Burundi time.  It had been a little more than twelve hours since we made the decision to evacuate, and the plane was finally here.  Erin and I realized how American we are, and that we are spoiled.  In the US, a quick 911 phone call gets you an ambulance within 10 minutes.  It took me at least 20 phone calls and we were frustrated there wasn’t a plane there for us immediately.  “What if Cole had continued to get worse and was dying?” she asked.  “How would the evacuation people explain their delay?” 

I responded by saying, “Well, they would say, ‘You shouldn’t travel to such a remote area.  That’s a risk you take.’”  In all honesty, mobilizing all these resources within twelve hours is pretty good.

A Kenyan nurse, and a young British Doctor staffed our winged ambulance ride.  By this point, Cole had not gotten worse like we thought might happen.  His oxygen level was better, and his pulse had returned to 100.  Therefore, he might have been the healthiest patient this ambulance had transported.  All he needed was some oxygen in his nose.  I was ok with this.  Better to be safe than sorry.  Without the Vancomycin and the prayers, he could have been struggling.  The airplane could fit two patients, the two staff, and one passenger.  It was my first international travel without having to go through luggage XRAY, security and/or pat downs.  I could take my 1L water bottle with me!! I wanted to sit in the cockpit, but it was filled with two Kenyan pilots.  Instead I got my sleep for the night, two hours.

Upon arrival at Kenyatta airport in Nairobi we were met by an ambulance that took us straight to the ER of Gertrude’s Children’s Hospital, the only children’s hospital in East Africa. 

Day 6 Thursday March 22

At 5:30am we found ourselves half awake and in the “ER” of the children’s hospital.  We didn’t see any doctors, just a nurse who asked, “Who is your doctor?”  I wanted to say, “Whoever YOUR attending doctor is for this shift.”  But, I quickly realized that this was not an American emergency room ready to triage everyone who walks into the door.  It was more like an outpatient clinic that did intake for the hospital.  Thankfully, my support system from the days in Kenya at Tenwek Hospital had made me a recommendation for an orthopedic surgeon in Nairobi.  I told the nurse his name, Dr. Murilla, and it worked.  She said she would call him. 

We got admitted with some verbal orders, and by that time Cole had started to feel ill again.  His fever started coming back and he was teary that they wanted to draw blood from him.  He was complaining of more pain in his leg and I could see some redness.  I knew it needed opened, but I couldn’t do it.  I had the nurse call the doctor, and she said he was in surgery…at another hospital…an hour across town.  “He will come in about four hours.”  I knew what that meant.  I’d see him in six or eight.  There are three lies that surgeons tell all the time.  “This won’t hurt, I’m almost done, and I’ll be there in ____ amount of time.”  I got pretty anxious as I felt helpless. 

Small miracle…the doctor actually came in four hours.  Dr. Murilla was tall, thin, well dressed, and confident.  A true Nairobi surgeon.  After examining Cole’s leg, he wanted to give it more time and see what it looked like the next morning.  I strongly disagreed as he had all the markers of continued infection.  Fever, pain, redness, elevated WBC count.  I “calmly” stated my case…which in reality wasn’t very calm.  He told me I was acting like a father and not like a surgeon.  It was true, my sleep deprived emotions were that of a father…but my judgment was the same as if Cole were a strangers child.  We compromised that he would come back after his day of surgeries and wash him out at 10:00pm.  Deal.  Now I just had to sit back and wait nine hours. 

Meanwhile, Erin and the kids had just arrived in Nairobi and were met by a friend from Tenwek named Theresa.  Theresa was an answer to prayer. As soon as she heard about our situation she immediately decided to come help, and arrange the logistics of lodging and transportation for the family.  She was the perfect Ying to Erin’s Yang.  Erin was an emotional basket case, and Theresa was a familiar face who could provide comfort as well as take charge. 

If you have ever waited for a loved one during surgery, you know that it is not fun to wait alone.  While I waited, God had provided for me the perfect companion to wait with.  Dr. Mike Ganey, a pediatric surgeon who had arrived to Tenwek just after we left in 2015, was not only an expert I could run things by, but he was also a calm presence that was the Ying to my Yang.  He didn’t have to come, as we didn’t even know each other that well.  Later, he told me that he and his wife were having their morning devotions on the back porch when God told both of them that Mike should come to Nairobi to support me while I cared for Cole.  Thankfully he obeyed and we had a great evening together. 

There were two things that had to happen that night (in my mind) for Cole to get better.  First, the surgeon had to keep his word and actually show up for the 10:00 surgery.  I had a suspicion that he would delay it until the next morning.  Secondly, I was on a mission to get Cole on the proper antibiotics, recommended by several textbooks and one of my best friends Mike Davis, an expert trained in infectious diseases.  Cole was on clindamycin, but I thought he needed to be on a penicillin like cloxacillin or flucloxacillin.  In my sleepless anxiety ridden state, I was pressuring everyone I could find to give him the proper antibiotics.  Finally I found a loophole in the system.  If ever a nurse was “concerned” about a patient, the ICU doctor could leave the ICU and come evaluate the patient.  I convinced the nurse to call the ICU doctor.  My friend Mike Davis texted me that he was fervently praying about how Cole could get the right antibiotics.  At the exact moment he sent the text, the ICU doctor walked in and agreed what the first line antibiotics should be.  I was thankful.  In retrospect, I was probably a little overzealous about the antibiotics issue, but I saw it as being “an advocate.”  The whole time Mike Ganey just calmly watched Cole and his breathing pattern.  Without the emotional attachment of being his father, he knew that Cole would survive to the washout with the antibiotics he was on. 

Ten o’clock came and went, and still no surgeon.  I didn’t get more worried, because almost none of my surgeries start exactly on time.  Eventually Dr. Murilla showed up and Cole went back for his second surgery.  He was nervous but bravely left me at the door this time.  No longer was I his surgeon...I was a only a father now who had to wait in the waiting room.  The ortho doctor opened up our stitches, washed out the wound, and put on a dressing.  Cole did well and in recovery room, his fever had gone away.  Now, I could sleep.