It was a typical clinic day, busy, but no emergencies so far. I was then asked to come look at a lady. I am led to the bench outside the dressing room. There is a woman sitting there, I will refer to her as “M”. She appears to be in her early 30s. She looks dazed. She has a deep cut at the corner of her mouth and she is drooling. When I ask her questions she grunts in response. She has an older woman with her, who turns out to be the patient’s mother-in-law.
I ask the patient’s mother in law what happened to M.
Mother-in-law: “She fell”
Me: “Did she have a seizure”
Mother-in-law: “I don’t know, I didn’t see her fall.”
Mother-in-law is holding a baby.
Me: “Who’s baby is that?”
Mother-in-law: “M’s. She is 15 days old.”
Me: “Did M receive prenatal care?”
Mother- in- law: “Yes, she went to the government clinic one time.”
Me: “What did the clinic tell her?”
Mother-in-law: “I don’t know. They gave her 2 different pills.”
Me: “What were the pills or what were they for?”
Mother-in-law: “I don’t know.”
Me: “Has M been sick since the baby was born?”
Mother-in-law: “I don’t know.”
Meanwhile a set of vital signs have been done and are notable for systolic blood pressure of 184. Eclampsia after delivery is not very common but has been documented. Hmm. The patient’s mother in law is asked to go get the patient’s husband and someone who witnessed her “fall”. The patient is taken to the dressing room to rest and for stitches. Awhile later, a number of people arrive- maybe 4- none of whom provide much meaningful history. But the history is interrupted by the patient having a tonic- clonic seizure. We give her IM diazepam and load her with magnesium. Seizure stops. Has another seizure 15 minutes later. Give her more diazepam and magnesium. Seizure stops. The patient needs to go the maternity hospital. The family lives in the mountains. They have no vehicle. This patient is not going to be able to take a moto. Casey and Henoch are in town already. Mr. Zach is doing some work with the bulldozer. Someone runs to get him and tell him he needs to drive a patient to a hospital 2 hours away. The patient’s husband still isn’t present. Someone has to go with her. People who are admitted to the hospital have to have a family member with them to fill prescriptions and bring the medicine back to the hospital.
Meanwhile, the patient has 2 more seizures. More meds. A whole lot of magnesium. A referral form is completed. I call a hospital administrator to tell her that an emergency is coming. I am asked to call back later. Henoch’s sister is a nurse and sometimes work at the hospital we want to send the patient to. So Licia calls her and she just happens to be working in the maternity ward that day and will not go home until she sees the patient.
Keverly, is an RN and visiting from the United States. She rides in the back of Mr. Zach’s truck with the patient and her mother-in-law to administer maintenance magnesium and to give more meds if she has another seizure. She does not have another seizure on the way to the hospital but becomes very combative. Henoch’s sister is waiting at the hospital and M gets transported directly to a bed- this is pretty much a miracle.
At the end of the day, we find the patient’s baby in the ICU. Apparently, a family member had deposited her there. Seriously?. A few days later a lady we have never seen before shows up and asks for the baby. Don’t worry, we didn’t give the stranger the baby.
The patient’s husband has never been to Port au Prince. So he sends the patient’s brother to the hospital to buy medicines, etc. But he has to pay him. Long story short, the patient’s brother ends up taking her out of the hospital before she is ready (against medical advice).
The patient shows up at clinic again with her mother-in-law. Oh my. The patient’s mother-in-law is sent to get her husband and all the medications she was discharged with. Husband turns out to be a real nice man. He was working in his garden the day the seizures occurred and had no idea what was happening until the evening. No one told him. He said he loves his wife, and that when he found out, he wished he was a butterfly so he could fly to his wife. The patient’s blood pressure had normalized. She was alert and happy, though I think would qualify for hypomania. She has had several follow up appointments and is little better each time.