Shedding Mud

 Chana with little patient on discharge day, after a very long healing process

Chana with little patient on discharge day, after a very long healing process

by Chana Schaffer

It had just rained.  My morning walk was weighted with layers of thick red mud stuck like glue to the bottoms of my sneakers.  I had been at FAME for just over a month and I could feel my inner pace of life slowing with every sunrise and walking meditation each morning. The heaviness of my life in the U.S. seemed to lift with each layer of mud shed.  It would build, one, two, three inches thick on my heels, and I would excitedly wait for the step when it would all fall off and I would feel 10 pounds lighter.  What a relief.

Every day at FAME was different than the last.  The anticipation and unknown was similar to that which I experienced working in the Coronary Care Unit (CCU) at home.  Added cultural and language differences made it even more interesting and challenging.  I had already learned so much in such a short period of time; yet I had only scratched a miniscule area of the surface.

It was my last day and I was working in the ward with Safi, one of the many amazing nurses employed at FAME.  We admitted a young woman who was very lethargic with a blood pressure that is considered “incompatible with life”.  Dr. Luigi informed me that she had a large pericardial effusion- fluid accumulates in the sac surrounding the heart, putting pressure on the muscle and making it difficult for the heart to beat properly.  Dr. Luigi asked me if I knew how to do a pericardiocentesis- a needle is used to puncture the sac surrounding the heart and a catheter is thread over the needle so that the fluid can drain into a bag.  This procedure relieves the pressure and is often lifesaving.  In addition to the dangerously low blood pressure, the woman’s heart started to show signs that it was giving up.  Her heart rate would “brady down” (become very slow) and then speed up again.  Her heart was threatening to stop.  I knew that if we didn’t do something heroic and fast, the woman would die. 

Dr. Luigi and I found Dr. Frank and told him that we had a patient that needed a pericardiocentesis.  Dr. Frank heard the urgency in our voices, took one look at the worry on our faces, and came immediately to our aid. I have watched and assisted with this procedure many times in the CCU, so I thought setting up would be easy.  The nurses and I brought the crash cart into the room, gathered the sterile supplies and the ultrasound machine…but where was the pericardiocentesis tray?  It was time to get creative.  FAME has a lot of medical supplies available and at hand, but some specialty items are not readily available.  Everyone mobilized.  When something unfamiliar is happening at FAME, everyone (both nurses and doctors) is ready to step up to the challenge, learn quickly, and contribute any skills and expertise he or she has to offer.  The teamwork and sense of community never ceased to amaze me.  I felt so blessed to work side by side with such intelligent, resourceful, and caring individuals.  I always felt like I was learning far more than I was contributing.

With many hands at the bedside to help, Dr. Frank successfully performed a pericardiocentesis and drained almost 1200 ml of fluid that was compressing our patient’s heart.  The patient’s heart rate was still intermittently dropping, and the blood pressure remained dangerously low.  We began administering life saving medications, and I taught the nurses how to mix and titrate them to support the patient’s blood pressure and heart function.  It was a long night.

The nurses rose to the occasion and provided a high level of ICU care that was new to them.  Everyone worked together and supported each other to keep this woman alive, and we succeeded.  I was in partial disbelief when I walked into her room 3 days later (I came back to visit with my dad during our safari travels) and she was sitting up at the side of the bed talking to her husband.  The cardiac supportive medications had been weaned off, and the drain was removed.  The joy that I experienced after witnessing her recovery was unparalleled.  I knew that my knowledge and skillset, paired with unending support from my FAME colleagues, helped to save her life that first night. 

My time at FAME was profound.  The environment demanded self-reflection and growth in a beautiful way.  I was outside my comfort zone of fancy cardiac ICU monitoring and toys, immersed in a new culture, and trying to understand an unfamiliar language.  I was helping to care for patient populations very unfamiliar to me (i.e. burn victims, children, pregnant woman etc.).  I could feel the layers of self-doubt and hesitation shed with each passing day.  I realized that everyone was doing his or her best to provide excellent healthcare to an amazingly resilient community in need.