2AM Emergency

"M.L. is here again, in distress." said a voice outside my window. "Can you come down to the clinic?" My sleepy brain realized this was Teresa talking. I threw on a dress and grabbed my stethoscope and a flashlight. It was just after 2AM and i had only been asleep for an hour and a half.

I could hear Mr. M gasping for air even before my flashlight lit up the scene outside the clinic's back gate. He was kneeling on the flat bed of an ox cart and asking for a shot in between gasps. His wives and two daughters were fanning him and the boys were keeping the oxen from moving.

Teresa was already getting the epinephrine out of the cabinet and i drew it up. Mr. M is too big to move so i went back outside and gave him the injection by flashlight. His oxygen level was under 90% and he was very agitated. It was also obvious that he was drunk. He was crying out to Allah and yelling, "I'm going! I'm going!" I asked his family to keep him quiet and i went back inside to see what else i could find that could help him. He vomited so we found some nausea meds and i told him he needed to the road to the main hospital. H refused and asked for the head nurse to come. Even though i am sure the whole village could hear him bellowing from there, we sent someone running up the block to the nurse's house. We also sent someone to wake the ambulance driver as his house.

I gave a third injection of steroids and then reviewed the case with the head nurse who agreed referral was urgently needed. He set to work convincing Mr. M while i finished up the paperwork Teresa had prepared. When he finally agreed they loaded him into the back of the ambulance, amidst his protests that he wanted to sit in the front seat. Teresa and i prayed as they pulled out of the clinic parking lot.

I could not sleep for hours after that adrenaline rush! In the morning we heard that the hospital did have the IV aminophylline he needed but no oxygen!! (Yes, this is a major medical center!!) They did give him a few nebulizer treatments which were more effective than the multiple, inadequate puffs he was taking on the back of the ox cart! He will stay in the hospital for a few days.