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Now what?

The euphoria passes. Matron looks at me.

"Hauw! Doctor! I did this at nursing school but not for years now! It is coming back to me but slowly!" And there is the problem: I have a paralysed, intubated teenager (see Brown Trouser jobs). But our hospital has no ITU, no reliable ventilator and it is midnight – it will be several hours before a transfer is possible. As the girl begins to stir and cough on the tube unceremoniously thrust through her larynx I am also aware we have no intravenous infusion pump and I need to keep her unconscious somehow. I give her another injection of sedative – it will last 15 minutes.

I pick up the phone and call our referral hospital. I finally find the doctor in charge of ITU. They have only 1 bed and do not want to take our patient. Try Durban. I try one of the big teaching hospitals. I speak to the ITU registrar. He asks a lot of questions and demands tests which we cannot perform here. I get a little angry and tell him not to be ridiculous – does he have no idea what rural hospitals are like? I instantly regret it – I am supposed to be talking him into doing me a favour. He has only one bed and doesn’t want to put my patient in it. I try Albert Luthuli Hospital. They are full. I phone Addington Hospital and finally find a friendly registrar – they only have one bed but sure, no problem. I must just ask the surgeon's permission. A further 4 phone calls later I have an ITU bed - the whole process took three quarters of an hour.

By this time the girl has begun to stir again – I stick a big dose of sedative into a bag of saline and try to guess a rate to run it at that will keep her asleep. Then I phone the ambulance service. I give the details and then they phone back 20 minutes later. She will need to go by helicopter but it does not fly at night (our heli pad is dangerous at night - what with the trees and gravestones and all) so she will be transferred after 7am.

I hang up and look at my watch – 2am. 5 hours to go.

___________________

It is morning. We are sitting in our pre-work meeting. I am experiencing the euphoria of the sleep deprived. I cannot stop talking about last night – I am little over excited. Suddenly a roar fills the air. I nip outside and look up. The helicopter is circling.

Having sat up most of the night with this girl I find myself getting a little emotional. I grab my camera and run to the graveyard. I am told afterwards my “little boy” enthusiasm was infectious - 4 of the others are running behind me. We all pull out our cameras and get a great sequence of shots of the helicopter descending through the trees. 20 minutes later the patient is loaded up and on her way. Suddenly I feel knackered. But tremendously peaceful. In the mass of people with HIV and TB and the death we see everyday it can be hard to see that we make a difference. But today we did.

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