One Sunday in January

 

 

Before you read this, I have an announcement. My good friend Kim Turley, out of the good will of his heart, has kindly constructed a website for Holy Cross. It is still a work in progress, but do have a quick browse.

http://www.holycrosshospitalza.org

***

The weekend was coming to a close: it was Sunday night, I had triaged all the patients in casualty, maternity was quiet and the wards were sleeping. I got to bed at around one am and drifted immediately into slumber land. Within the hour I was awoken by the extremely unpleasant screeching of my house phone– the sound is far worse than any bleep I have ever carried back home.  The sister in casualty had some urgency in her voice – there were two young children with, as she put it: “serious burns.” Now, the staff at Holy Cross see burnt children all the time and they are well versed at managing the less severe cases. On that basis, I knew that I wouldn’t be going back to bed for some time.

I threw on my clothes and ran down to casualty in the rain. What lay before my eyes were two sisters of five and nine years old who were in a really desperate state of affairs. A candle had fallen on their bed whilst they were sleeping and set fire to some extremely flammable bed sheets. Both had deep burns covering almost 60% of their little bodies, which in itself carries a poor prognosis. However, to confound matters both children were freezing: they had been brought by their family through the pouring rain and were sodden.



This is the younger sister, all wrapped up in
 a red bin bag and ready to get in the ambulance.

The girls were in a state of shock, but still alert, talking and crying. I turned the heating on to “full” in our resus department and proceeded to get very sweaty whilst I resuscitated them. With burns, one loses a lot of fluid, hence, what goes out must be put back in. I placed a femoral line (a drip in the groin) in both girls and filled them with warm intravenous fluids as well as catheterising them. Now, I thought, how can I keep them warm? I looked around the department and came back with two large red clinical waste bags. The idea, in burns management, is to reduce the amount of fluid that is lost by creating a synthetic skin; hence, cling film would have been ideal. With my girls relatively stable, lying in bin bags and under several blankets, I referred them to our burns unit.

My colleague on the other end of the line was reluctant to take them at first, given the severe degree of their injury, but eventually agreed to have them transferred. The ambulance took eight hours to arrive – our commonest and most frustrating rate limiting factor. The sisters both got into the ambulance and seemed relatively stable, but neither made the 4 hour drive.

Deep down I knew that their prognosis was poor, especially with my limited experience in such cases and the sub-optimal facilities that we offer. However, I had to try; we had to try. The nursing staff at Holy Cross really do try hard, despite all the barriers that they are faced with. Those few times when it works and when things go well, even if there’s an unhappy ending, at least we can say we did the best we could; we achieved something.

***

This fella has a massive pericardial effusion (fluid around the heart).
Normally the heart (the big white thing in the middle) sits snugly in the middle of the rib cage and is rather small. He was exceptionally short of breath as the fluid was causing a cardiac tamponade (squeezing his heart so it cannot function correctly)...

 

...The only way to relieve the tamponade is to remove the fluid. Under ultrasound guidance I inserted a cannula (large needle) into the sac around his heart: a rather frightening, but lifesaving, procedure....

...Out came over 2 litres of blood stained fluid. This is the classic for TB pericarditis. The guy was started on TB treatment and steroids and is now doing very well.