Our Severe Malaria Patient Has Recovered! Some psychologic trauma remains from her ICU stay.

For days now I have referred to a young woman who came in with Severe Malaria and Severe Sepsis complicated by kidney failure. She is the patient who taught me about being prepared during an intubation for the failure of oxygen delivery. She is the patient whose physical exam findings didn't quite fit one diagnosis and the use of the ultrasound to look at her heart and lungs provided our team with a tremendous amount of information that has been helpful. Every day she has been improving, two days ago she was extubated, meaning she was taken off the mechanical ventilator given improvement in her respiratory failure. Her kidneys have started working again. She has a clear mental status. While rounding on her yesterday the team mentioned that she occasionally becomes tachypneic (meaning her respiratory rate increases) and they were worried that she would need to be intubated again. We examined her, looking for any indication of why her breathing was rapid. Of note, here at Black Lion Hospital gowns are not readily available for the patients. In the US we go through patient gowns sometimes multiple times throughout the day without hesitation. Here, patient gowns are limited. This means they are often covered by a sheet or sometimes not at all if linens are scarce. The ICU here and in most resource limited hospitals has an open floor plan. There are no curtains between patients let alone large private rooms like we have in the states. Imagine as a women especially, not having a cover over your chest--as multiple physicians, males included come in and out of the area you are staying in. It can be traumatic enough to be in an ICU with foreign noises and smells and people constantly probing you to check your temperature, to check your blood pressure etc. It occurred to me that this young woman was breathing rapidly from anxiety--her eyes were wide, she would shake occasionally as well and it seemed she was terrified, and OF COURSE SHE IS! Anyone would be terrified given what she has gone through, who knows what she does and does not remember of her stay here! What I learned is that Ethiopia has over 80 dialects!! Amharic is the most common language but many people that come to Black Lion do not speak Amharic and there is a language barrier--so I cannot even verbally help her to relax. In the interim I asked the team to make sure she is covered at all times, that she can see the sunlight and that family is at her bedside to help comfort her. In the midst of all the medical complications she had we lost sight of such an important fact that the patient we treated, and treated successfully is a PERSON and psychologic effects of an ICU stay are very common and have long term effects.

I am excited about her recovery and hope that she continues to do well. The team worked tirelessly to play the roles of physical therapist, respiratory therapist and physician as they often have to given the limitation of staff in those fields. They used every resource available to their advantage, from the new ultrasound skills they learned to their advanced physical exam findings.  They advocated for the patient and they are now recognizing more readily signs of pain, agitation, anxiety. The excitement for me is to see the application of the conceptual teaching that has occurred through out the last two weeks. I look forward hearing about their continued progress over time.