Of Helicopter Rides and Bacterial Meningitis... (Part two)
By Rick Fischer
"Let's go, the chopper is here. They can land it on the field, beside the bullring." Said Espitia, as he signaled for the door. The patient was loaded into the hospital's ambulance and taken there. Sanchez felt hope for the patient's life, for the first time. Espitia followed closely, in the colonel's jeep. "We need smoke for the signal" he said, as he and the recruits with him were building a bonfire. He started throwing green leaves and branches into the fire and rapidly a column of thick white smoke elevated. "Yeah, smoke grenades are for call of duty fan boys", thought Sanchez. There was no wind, as the smoke showed. But thick clouds were covering the mountainous landscape. "The pilots can't see us. They are going to have to dive blindly into the clouds and hope they don't hit a mountain top on the other side." Said Espitia. Soon they all heard the sound made by the huge blades of the Russian Mi-17 and started feeling the huge gusts of wind. "GET TO ZE CHOPPA!" thought Sanchez, as he rushed the gurney with Paula and Alcazar under the helicopter blades to load the patient into the Helicopter's cabin. Alcazar, though by no means a big man, had a huge strength for a man his size and loaded the gurney with only the help of the third crewman of the helicopter. Sanchez hopped up second and realized the helicopter had no oxygen supply. "We need oxygen!" He said, still surprised himself. This wasn't an ambulance helicopter, it just happened to be around at the moment. Alcazar almost singlehandedly loaded the 150 pound oxygen tank they had with them. His eyes met with Paula's as he was sitting at the patients head on the helicopter. She wanted to go with him, not everyone gets to do an air transport. He knew this and felt happy. They both smiled, as the crewman closed the helicopter's gate.
After the gate closed, he could hear the faster movement of the rotor blades and feel the whole beast started ascending. He couldn't enjoy the view, though, this was no communist-throwing joy-ride. Alexander, the patient, though obnubilated and disoriented, was still wake enough to fight the mask-bag. His O2 saturation and BP started dropping again. He had to administer another shot of epinephrine like the one Paula did. Though glad he got to ride a helicopter, this wasn't what he wanted. A borrowed oil company helicopter and a patient dying of a totally preventable disease right in his hands, because he didn't have the equipment. "I didn't sign up for this shit!" He thought, as much cliché as the phrase could be. But still, he tried to enjoy the moment of happiness in the whole mess.
The huge helicopter turned the 2 hour ambulance dirt-trail road-trip into a 30 min ride. They landed on the parade ground in the division's head-quarters in San José. They did have current year ambulances. Well, at least current decade ambulances. They left the by now empty oxygen tank there and continued their trip towards San José Central Hospital. Thirty more minutes. Luckily one ambulance had a full oxygen tank, so they carried on. Sanchez was out of fluids and out of epinephrine. The boy was on his own. He only continued to mask-bag him. At the entrance of the hospital the boy had an apnea episode. He stopped breathing. He felt his pulse. His heart kept going. He continued mask-bagging until the boy started breathing again. Sanchez was terrified. He had lost patients, but this was ridiculous. "He is a 19 year old perfectly fit lad. He even looks like he used to go to the gym before conscription" he thought. "If there was anyone fit to survive this, it was a boy like him" he added, as the thought of losing such a patient was simply too wasteful.
Upon arrival at the overcrowded central hospital, the critical state of the patient was evident. They were directed to the crash room immediately. There, he was greeted by the on call internist: an elderly man with professorial demeanor. To Sanchez's surprise the man didn't blame him for the patient state and addressed him respectfully, as to call him "colleague". Sanchez proceeded to present the patient history and physical. He explained the physician why he hadn't supported or intubated the patient. And then proceeded to explain why he haven't been able to find the cause of the patient's shock. The senior physician listened to him patiently and carefully. He said: he doubted this had started just this morning. Sanchez admitted that was possible, but he didn't have any more information. While they talked. Alexander, already laying on one of the crash room's gurneys, started bending his knees and bringing them towards his chest, while lying on his back. At the same time, he was trying to put his chin as close to his chest as possible, while grunting in pain. "Look at him" said the older physician. "It could be meningitis" he added. Sanchez opened his eyes wide as he felt a stabbing pain in the pit of his stomach. "Fuck!" He thought, as the grim realization overcame him. The blotted skin. The rigid neck. Military base. Of course, it was fucking meningitis! One look at his fingernails was enough. He could see the black-red hemorrhaging, that and the blotted skin were typical findings. It wasn't just any meningitis. It was meningococcus. It was aggressive and potentially deathly, but above all contagious as fuck. "It is meningitis, all right, Doctor." Said Sanchez as he face-palmed at his own nearsightedness. He then proceeded to extend the patient's knee, which caused him to bring his chin towards his chest in pain. It was positive Brudzinsky's sign. Clearly meningitis. But this sign would only appear when the patient was severely compromised. "Yeah, I saw the hemorrhages in his fingernails as well. We'll wait for the tests. Thank you, Doctor." Answered the internist. Sanchez left in terrible realization. "This shit is contagious as fuck! Alcazar, Paula, The hospital staff, shit! The helicopter crew. This is going to be a fucking mess."
As Sanchez and Alcazar were having breakfast in the hospital's cafeteria. Sanchez phoned in and reported to the colonel. Private Alexander's condition was ominous. All his company was to be isolated, quarantined, was the colloquial term better understood by the infantryman. He was worried about Alcazar and the hospital staff catching meningococcus from the patient. They went back to the division's headquarters. They took a cab to return the oxygen tank they had borrowed from the town's hospital. In the division dispensary Sanchez asked for rifampicin to give to those exposed to the patient, in order to prevent contagion. They weren't allowed to give it to him until the meningitis case was confirmed. After they said that, he didn't bother asking for vaccines. Blood cultures would take between 24 to 48 hours. He did got away with some ceftriaxone, in case other symptomatic patients appeared. After Alcazar somehow attached the 150 pound oxygen canister to the top of a cab, they set course for the base. "All this thing fucking accomplished was taking an oxygen canister on a helicopter ride" said Sanchez, sitting with Alcazar in the back of the cab.
They dropped the oxygen tank on the town's hospital and arrived at the base after a two and a half hour trip. As soon as Sanchez reached his dispensary, he brought all the personnel who had felt feverish in the last week from the boy's company. Six privates in total, then he had their blood samples delivered to the town's hospital. They had a basic lab there. They could run blood counts with it. Four of them had elevated white blood cell counts. He sent them to San José, to be held isolated in observation. He issued mouth covers and soap to the isolated company and ordered regular hand washing and thorough wash of their cutlery. He also asked for their food to be readied apart from the rest of the battalion. During this, they received word of Private Alexander's death, at 1605 hours in the Hospital's ICU. Meningococcus was present in a blood smear. Meningococcemia: he was riddled with bacteria. The only way he could have stopped it was giving the antibiotic as soon as possible. But he didn't have it and he couldn't know back then. Division's HQ had to send someone with the rifampicin for the exposed staff to the battalion and vaccines for the whole company and the medical staff, but only after the order was given by the Army sanitary direction in Santa Fé. Despite the fact that he had requested them 8 hours ago. Then they proceeded to give orders to him. The First Lieutenant that was radioing him, had received commission at the same time as he had. Actually, his record score was superior to hers. She was a professional nurse. He was a physician. The reason why he was in the middle of the tropical jungle and she was in a cozy desk in Santa Fé, was simple: her exterior genitalia was aesthetically pleasing, his dangled. "So much for male fucking privilege" he thought, as he heard her uppity voice on the radio. She ordered him to do some of the things he had already done several hours ago. "Don't forget, the most important thing is to take pictures and get records signed" was the sentence she repeated over and over during the conversation, referring to the "prevention talks" that he was to give. "Roger, out" was all Sanchez said, disgusted. He was worried about a bacterial meningitis outbreak in his battalion and his staff catching some. And this overpaid slut was talking about taking pictures and signing records. "I've never seen a fucking meningitis treated or prevented by signing records and taking pictures of some fucking group talks" he told Alcazar. "They are always like that, Sir. Doing just enough to evade responsibility", he answered. "What I need is fucking rifampicin not pictures and records" he though, still disgusted by her annoying voice.
There is no virtue whatsoever from a cigarette, everyone is aware of it, even for heavy smokers, but in fact many people can not escape from tobacco smoke, in third country, smoking is a symbol of one's level of macho, it is just a suggestion and a mirage.
Healthy living without smoking is the best choice.