When we have very seriously ill patients requiring advanced ICU treatment, or more than simple surgery, we have to refer them to our specialist centres. There is a reluctance to use our local ‘centre of excellence’ and for the very seriously ill any excuse which allows us to send the person to East London is permissible. For patients who need intubation for severe breathing difficulties or those who need to be deeply sedated and ventilated, a trip by ambulance for many hours is far from ideal and the helicopter team can be called in. One young pregnant lady with eclampsia and a blood pressure which put her into flash heart failure was sent off a few weeks ago. Sadly neither she nor her baby survived.
This week the helicopter was in action again. Everyone’s favourite security guard David (see Domesticity at Zithulele) arrived at the hospital late in the evening with a severe attack of asthma. Providentially Ben Gaunt was still in the hospital on call and bumped into him on his way home and found him barely able to breathe. Within a short time David had collapsed and in the outpatient clinic late at night, surrounded by staff who are, to put it kindly, not ATLS trained, Ben set about resuscitating him, aided by a continuous stream of advice by cell phone from a colleague anaesthetist in Pietermaritzburg.
Everything conspired against him. No clinic room was thought to have two functional electric sockets said the staff, who had to be told to go round and test the sockets until they found one. There is no nebuliser in the hospital; luckily a staff member has one at home for their own use so this was summoned. The oxygen cylinder which was temporarily disconnected from David while he was moved was twice dutifully taken away and put in its storage position and had to be recalled. To keep his airways open David was sedated with hefty amounts of unconventional and conventional drugs, and pure adrenalin used by infusion – no other intravenous asthma drug was available. Eventually he was transported to the theatre suite where the halothane gas was able to ease the breathing a little. The staff priority on hearing that he was to be moved there was to go and fetch green scrubs….
Despite this (and much more), aided by Becky Kemp from the early hours, and with a telephone lifeline of practical textbook and non-textbook ‘tricks of the trade’ advice from afar, Ben kept David going, against the odds, through the long hours of the night.
We arrived for the morning meeting and it was all hands on deck. The helicopter had already been called and reputations put on the line for demanding East London over Mthatha (you would be amazed how often the local weather round Mthatha makes helicopter landings there impossible). Building work had left boulders on the helipad so a team went off to clear these. The sense of desperation to save someone so universally loved was palpable. Becky said David was the only guard her son liked, referring to all the others as ‘Not David’.
There was some Heath Robinson rigging of the ventilation tubes and a moment of panic as his oxygen level fell inexplicably, relieved when the sharp eyed Karl noticed that in his last tube manipulation the oxygen had been temporarily switched off.
The helicopter had arrived by now with the competent paramedical team. David was still struggling for breath but perhaps slightly less so and he was as stable as it was likely could be achieved. He was strapped on to the stretcher and the trolley was wheeled down the bumpy path to the chopper. As we approached the pad the door of the pathology lab swung open; a delivery boy emerged with a large box leaving the open door completely blocking the way. We shouted, he looked and ignored us and went on down to his van to load up. We negotiated the obstruction and after some sharp exchanges the van, which was parked perilously and stupidly close to the helicopter, was ushered away. David was strapped in.
Everyone wanted to wish the unconscious figure well, whether or not he could hear them. I whispered ‘Good luck umhlobo wam (‘my friend’, a phrase he had taught me the previous morning as he greeted me on my way to work), see you soon’.
The helicopter rotor gathered speed and the doors slammed shut. The wind from the blades blew in our faces and then achingly slowly it lifted from the ground and suddenly, as if becoming unstuck, rose up, tilted forward and swept off.
People stood round watching it disappear into the distance, lost in their own thoughts and prayers
The news is good. David was extubated later that day and is now awake and talking. Ben sent round an email saying God is amazing. Another view is that he works through some amazing people.