Emergencies on board

We have emergency crews on board for many different possible situations. We have a fire crew to take care of fires (we've had one since I've been here) and we also have fire drills about every two weeks to make sure we all know what to do. Fires onboard aren't good especially if you are out to sea. The fire we had last week was a small electrical one and no one had to leave the ship. But it's a scary thing when the PA system calls for the fire team.

We also have an emergency medical team that consists of doctors, nurses, stretcher bearers, chaplains and the captain. This alarm, unfortunately, has gone off more times in the last 3 1/2 months than it ever went off in the previous few years I'm told. The first time I heard this alarm was on July 29 when one of our crew drowned far from the ship. Our team went to see how we could help. Sadly, it was far too late when the team arrived. Ever since that day, the sound of the emergency medical team alarm makes me sick.

Since then, it has alarmed at least 8 times, usually because of patients on the ward and several times in the middle of the night - it is a horrible sound. Twice it has gone off due to the fact that someone has brought a very sick person to the dock - we aren't an ER but apparently people think we can help better than the local hospital. Both times we have been able to stabilize the patient and send them home.

The last alarm was at 10:40 on Tuesday evening. The alarm came on saying 'Emergency medical team report to Hope ward' and then it repeated three more times. Since I don't work on the ward anymore, I don't know the patients so usually I wouldn't be worried that it is one of my patients. However, this time was different - baby Joanna was on Hope ward (see post from Sept. 28 if you don't know who I'm talking about).

My roommate Amber (an ICU nurse) and I hopped out of bed, got dressed and rushed down to Hope ward. On the way, we stopped in ICU as they were preparing a bed and I asked what was going on. Someone said a one year old had stopped breathing. I was slightly relieved from the fact that Joanna was 6 months old so it couldn't be her. So I asked 'what bed?' and they said 21. My heart stopped - that was Joanna's bed.

I continued on down to Hope ward to find about 15 doctors and nurses around Joanna's bed. All the patients from that side of Hope ward, including Rebecca her mother, had been moved out to the other side. I stood outside in the hallway and watched the action and finally one of the nurses came out and I asked what happened. She said Joanna was in cardiac arrest (her heart stopped) and respiratory arrest (not breathing). She had a flat line on the heart monitor which means that you can't defibrillate (shock the heart) to restart it because there has to be some electrical activity to begin with. So they did CPR and gave drugs.

After a thousand prayers and what seemed like an hour (which was only a few minutes), I heard Joanna crying - crying hard, an angry cry. An unbelievable relief. They continued to work on Joanna to stabilize her for quite a long time. All the while, nurses would go to Rebecca to give her updates on what was happening. By this time, I was with Rebecca, along with Jean, one of our counselors and several other nurses who had come to know Rebecca.

Finally, Joanna was stabilized, intubated and on a ventilator in ICU. None of the doctors or nurses knew what had happened. It was two days after her surgery and up until the point her heart stopped, Joanna was doing well. For the next 3 days, Joanna remained in the ICU, on a ventilator and heavily sedated. We had a 24 hour pray watch for her by the crew. Clementine, our amazing discipler from Togo, spent countless hours (even sleeping in the ICU) supporting and praying for Rebecca and Joanna.

A CT scan showed some abnormalities in the brain but we will never know why she arrested. She has periodic episodes of sleep apnea (she stops breathing) and, at times, an abnormally low heart rate for a baby. Last night, they moved her to Peace ward and so now I can go and visit her.

She is doing well, is eating, breathing fine and her heart rate is usually fine. Hopefully, she will go home in the next few days. It is very likely that if she had been at home on Tuesday night, she would have died. So, while we are happy that Joanna is doing well now, we don't know what her future holds.

If this happened back home, we would spend tens of thousands of dollars on diagnostic tests so that the family could know for sure what happened and what future problems she would have. We don't have such diagnostics here so we won't know for sure what happened and we don't know for sure what Joanna's future will look like. We know her heart rate is far too low but she has lived six months with this problem. We know she has abnormalities in the ventricles of the brain as well as the cerebellum but we don't know how this will affect her (although we have some ideas).

So now I struggle with an ethical dilemma. If I was back home, we absolutely would give the patient and family all the information we have so that the family can prepare for the future. I don't know how to handle it here. Most of what we would tell her would be speculation. We are dealing with West African culture where there is no future planning even with information. Not to mention their lack of understanding of the human body (most people believe any medical issues are curses and the person with the problem should be shunned from the family so that the family will not be cursed also). So what's the purpose of telling Rebecca that Joanna may not be able to walk or perform any kind of motor skills due to her abnormal cerebellum or that Joanna's heart could stop at anytime (will Rebecca ever sleep again?). They have no apnea monitors to alarm if she stops breathing. They would have to have someone watching Joanna 24 hours a day and, even if they did, they wouldn't know how to resuscitate her.

So Jean and I will continue to support Rebecca and Joanna in the future but we really will have no answers for her. Joanna could live one more day or 50 more years (the same as any of us). My fear is that one day Rebecca will wake up and find that Joanna died in the night.

And by the way, her cleft lip is fixed. This may seem like a small thing compared to all her other medical problems but here it is very important. Because people think it is a curse, Rebecca has not been able to go out in public with Joanna. At least with her lip fixed, they can go out in public and not be seen as outcasts.

Anyways, I'm tired of emergencies and I hope to never hear that stupid emergency medical team alarm again for the rest of my life.

Peace,
Michele