“28, 29, 30… Good compressions, 2 breaths please”
How did this happen?
“Good, back on the chest Hanitra. Rodolphe, where’s that adrenaline?!”
She was completely well when I saw her in outpatients this morning, why did she arrest?
“OK, I’ll take over the airway, could you find the glucometer please Nadia”.
Edmet will be devastated, what’s he going to do with their 2 young kids? The youngest one is only 2 months…
“OK, pulse check please. Hang on, I think I feel a pulse……”
Name of patient? – Honorine. Wife of Edmet who works in pharmacy, and a good friend of every single person here.
Diagnosis? – presumed post-partum heart failure, and until about 5 seconds ago, in cardiac arrest.
Time without a pulse for which she was technically dead? – 8 minutes.
Number of adults who’ve survived from this point in the 5 years and 40-50 adult resuscitations I’ve led here at HVMM? None. Zero. Nil. Not a single one.
How good is our God? – very, very, very good to us indeed! …
… but a pulse is just the beginning. That needs to be maintained. We lose it for a couple more minutes and have to start compressions again, but get her back once more. This time we start an adrenaline infusion, which keeps the heart pumping by itself, at least for now.
Next her breathing: Sarah Evans (short term doctor at the Good News Hospital) inserts a proper airway, which allows us to ventilate her more effectively, and Juna (Malagasy nurse) brings round a working ten litre oxygen concentrator so we can maximise the oxygen we’re getting into her. 10 minutes pass by, then 15.
OK, the heart’s still going, blood pressure more or less stable, but she’s not breathing for herself in anything more than a few gasps. Which means we have a decision to make – where do we go from here? For the 27 of the last 28 years of the Good News Project, the answer would be nowhere. But in March 2022, the High Dependency Unit opened in the new theatre complex and so we call Ted Watts, our head surgeon.
And he calls Joel Chin (the anaesthetist who set up the HDU but who is now on holiday in Malaysia!) and we have a conversation: could we intubate her? And then attach that tube in her lungs to one of the ventilator machines in High Dependency and let the machine breathe for her whilst she recovers? What drugs would we need? What settings for the machine? We’ve never done this before but we all agree, if ever were going to give this a go, then the wife of a staff member who’s had a sudden arrest would be the time to try…
So, we try. It feels like the whole hospital is here watching/trying to help or pray by now. A call is made to High Dependency to prepare the bed, the oxygen machines and the adrenaline infusion. Louise Little (head nurse of HDU) has just got back from her holiday so HDU is all ready in less than 5 minutes. Trolley comes in, we’re as stable as we can be, so one two three, hup! And she’s shifted over. Sarah desperately rechecks/secures the airway, everyone’s ready, so we disconnect the oxygen (as we have no portable cylinders) and race her round as quick as we can.
On High Dependency Lou and the team do their thing, then Ted and Artino (nurse-anaesthetist) do theirs – ketamine and pancuronium as per Joel’s advice, tube into the trachea, bingo. To tolerate that we’ve had to sedate and paralyse her, but the blood pressure’s OK and the oxygen levels are holding as we ventilate her by hand. Now to get her onto the machine. No-one in this room has ever used this ventilator before on these settings, but Joel again answers his phone despite it now being 1am in Malaysia and together, after 3 attempts, we do manage to switch her over, the machine takes over, and her chest is rising and falling and there’s air moving in and out.
And we pause for breath ever so slightly. Our HDU nurses Haja and Roazy have just started their rotation and have never looked after an intubated patient before so Lou and I decide we’ll divvy up the night between us. I get first watch, but am also on call so just have to check on a couple of sick children on the Medical ward first. Also use that opportunity to run home, ingest some pasta, grab my emergency packet of hobnobs and head back for what could be a very, very long night. I take Edmet aside and explain that though she’s stable for now, this is totally uncharted territory for the Good News Hospital, and her chances of survival from this point could be anything from 1 in 2 to 1 in 100, and all we can do is hope and pray and wait and see what happens over the next 12, 24, 48 hours – to see if she breathes again, if she wakes up again, if she stabilises. He understands. He’s so grateful that we’re trying.
And so, I sit there at the end of the bed, listening to the beeps, watching the chest, and willing her oxygen saturations to climb from 87% where it seems a bit stuck, just barely compatible with life. Honestly, I’ve seen so many people die out here that I don’t let myself hope, I can barely even pray, because to think someone’s going to recover and then have them slip through your fingers and die despite everything is painful like I cannot describe, and if that were to happen here, to Honorine, my friend Edmet’s wife, my friend’s wife who I saw in outpatients that very morning, I don’t think I could bear it.
And so, I sit there and build another wall around my heart, and prepare myself for the worst case scenario, and absorb myself entirely in the technical details of urine output and pressure vs volume settings on the ventilator.
Fortunately, this project is full of people with far more faith than I possess, and our God is far, far kinder than I ever dared believe. They weren’t allowed to visit because we were in High Dependency, but you were always aware of them outside the windows, hoping, helping the family, praying, until well after midnight – members of the project, friends of the family, anyone and everyone it seemed, looking for news, but above all just being there, and suffering alongside Edmet through that night as Malagasy Christians are so, so good at doing. And praying with them.
And little by little, our prayers were answered. By midnight the sedatives were wearing off and she’d begun to breathe for herself again. The oxygen saturations number climbed gradually, 89%, 93%, 97% - normal! And little by little we were gradually able to reduce the amount of support the machines were giving her and let her do more and more. And little by little she woke up. So that by the time I came back in at 7am, after 3 hours’ sleep, she was alert and seemed to be responding to what we were saying. And so, we checked in with Joel, and took the tube out. And she breathed! And she spoke! And she asked where her baby was and immediately began to breastfeed!
And yet still I couldn’t let myself hope. She was still on adrenaline, her urine output had tailed off, there was still an absolute mountain to climb before she’d be out of the woods. And yet climb it she did! 48 hours later she was off adrenaline. 72 hours later her kidneys had recovered. And 6 days and 21 hours after she arrived in cardiac arrest, Honorine walked out of the hospital and went home, a smile on her face, and a trail of rejoicing in her wake.
And so there I was, having been asked to update the hospital staff at the Thursday meeting of all the project workers, trying to explain to everyone what a miracle this was, what an incredible effort this had been from so many people to get her through, how grateful we were for their prayers and most of all how great is this God of ours who’d used our little efforts to bring her back from death to life and restored her to her family, when the walls began to crack, and then they crumbled, and I just cried. Overwhelmed by how completely she’d recovered, overwhelmed by the way so many, many different things had come together to make this possible, overwhelmed by my lack of faith and how good I’ve got at anticipating the worst and not really daring to hope/trust, and most of all, overwhelmed by Jesus’s willingness to act anyway, to answer the prayers I didn’t dare to pray, and this astonishing display of His love for her, and for us, to spare us sorrow upon sorrow.
We serve a very great God!
Thank God for preserving Honorine and restoring her to health. Pray that her health may be maintained and that she and Edmet might continue to serve Him and make known to others what God has done.
Pray for the HDU team, that they may grow in confidence in their work, and that patients and relatives may hear the Good News of Jesus through their lips and see God’s love in their lives.
Pray for the equipment, that it might be well maintained and continue to function well.
Pray that the Lord might continue to supply committed Christian staff for all aspects of the project.
Pray that all the staff here would be so amazed at seeing God's mercy and love in this particular case, that we'd be overflowing with the desire to share His love and mercy, shown to us on the Cross, with every patient we see, and that these amazing events might renew the passion with which we speak of our Saviour.