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Remembering Mary, gone too soon

Posted on Jun 01 , 2011 in News & Events

This is a very difficult story for me to tell but I want to share it. During a vacation back in Kenya in 2004 at the coastal area of Kilifi island, my niece Mary, who was 18 years old at the time, came to me with concerns that her feet and ankles were hurting when she was walking and felt slightly swollen. I assessed her curiously. She appeared to have symptoms of claudication; pain caused by too little blood flow, which is technically a symptom of a blood circulation disease. I checked her pulse and it was abnormally high. I was concerned, this girl was barely 18. There is no reason why her heart rate is racing at rest. I rechecked her pulse over and over again at different intervals and she was still beating approximately 120-130′s a minute, at rest. I called her mother, my sister who was not with us and asked her if Mary had any heart condition. The mother was not aware of any medical problems. But Mary did mention that she had had a chest x-ray a long time ago and the doctor had told her she had an enlarged heart. So I asked what the doctor had recommended and she told me nothing. Nothing, nothing, no follow up or referral was done. I was beyond pissed.

As soon as we arrived back in Nairobi, I consulted a cardiologist and had an EKG done. She was in sinus tachycardia at a rate of 126. I insisted on a Echocardiogram which reviewed minimal mitral regurgitation with a small pericardial effusion, which basically meant some of her heart valves were leaking and there was fluid accumulating around the heart. The cardiologist thought she had an old rheumatic valvulitis that was stable and he was not concerned. Due to her age, the cardiologist thought her tachycardia was secondary to an underlying problem like infection or malaria and not necessarily the heart itself. She had extensive blood work done and the results indicated an infection with brucellosis, an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals like sheep, goats, cattle, and they cause disease in many different vertebrates.

The most common way to be infected by brucellosis is by eating or drinking contaminated milk products. When sheep, goats or cows are infected, their milk is contaminated with the bacteria. If the milk is not pasteurized, these bacteria can be transmitted to anyone who drink the milk. She was placed on antibiotics for two weeks and was supposed to follow up after completing the antibiotics. The theory was, after completing her antibiotics, the infection was going to be resolved and the heart will therefore beat normally. I had to come back to the US and she went back to boarding school.

A month after I left Kenya, Mary was running in the school tracks when she bacame dizzy and passed out. After she regained consciousness, she was told to go home to seek medical treatment. she spent the night at her grandma’s house (my mom), where she braved symptoms of intermittent chest pains throughout the night. She left for Nairobi the following morning by public transport, approximately three hour ride where her parents lived, so they could take her to the hospital. She was still having chest pains radiating to her shoulder. She had no cell phone or anyway to contact me. Enroute to the hospital, that is when I got the call from my sister and I was made aware of the above events. I was working nightshift and it was early morning local time. I spoke to Mary on the phone. She was having shortness of breath. I told them to take a cab and I will call ahead to the cardiologist so they can be seen immediately. I called the cardiologist’s clinic and asked the receptionist (there are no nursing staff with any medical knowledge on the desk), to relay the message to the doctor that my niece was enroute with symptoms of heart attack and needs to be seen immediately. Do you think she relayed the message? Nope!

After about an hour, I called back and my niece was waiting on the waiting room. I insisted she needs to go in immediately and the receptionist reluctantly complied. An echocardiogram reviewed she had severe pericarditis and EKG showed she was having a myocardial infarction (heart attack). The doctor started consultations with a Cardio-thoracic surgeon on the nearby Kenyatta hospital, and she was sent back to the waiting room, while the doctor wrote his letter of referral. She collapsed while waiting to be admitted while I was on the phone with the mother. She had cardiac tamphonaded. Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and the pericardium (outer covering sac of the heart). I knew then that she will not make it. They bagged her (supplied oxygen), and transported her to Nairobi hospital which was less than 5 minutes away. She was intubated on arrival and the doctors started pericardiocentensis, a procedure to drain the pericardium and started fluid resuscitation. I could hear the so very familiar sounds of a code in progress and I just slammed the phone to the wall. The next few minutes felt like eternity. I screamed in pain and anguish. And even though deep inside I knew she had no chance of survival, I silently hoped when I called back she would be fine. Well, she did not make it. According to her cardiologist, Mary could not get an emergency surgery which she so desperately needed because the operating room (theater), was occupied by a patient who had another two hours to go.

I was angry. Oh I was so angry. A lot of things went wrong and I felt that she did not need to die like that. Was there no nitroglycerin, morphine, aspirin or oxygen (MONA), in a cardiologist clinic? And what is it about a heart attack that should not be considered an emergency by the receptionist? The work "heart attack" should invoke fear and action right away. Why did Nairobi hospital, a renowned private hospital in Kenya not have enough operating rooms? And why did the school send Mary home instead of straight to a hospital? I blamed everyone, and especially myself.

Mary is in heaven now, and I know I will see her again someday. I feel her presence all the time. She was the most humble selfless teenager I have ever known. Like me, she wanted to be a nurse. She wanted to help people. When she died, I knew I had to do something. Ever since I was personally diagnosed with hypertension, I have always wanted to do medical outreach in Kenya. But never really acted on the dream. But with Mary gone, MMK was born. If I had been screening my family, I would have picked up her symptoms a long time a go. I could not save Mary but perhaps when I am screening people in the communities, I will be able to save a life. And so can you. These communities are in dire need of medical services, health education, and medical screenings in places where medical services are inadequate or non-existent. Join us as we volunteer in the villages of Kenya.

“It has been said, ‘time heals all wounds.’ I do not agree. The wounds remain. In time, the mind, protecting its sanity, covers them with scar tissue and the pain lessens. But it is never gone.”

— Rose Kennedy

Notes by Millicent Mucheru (Manyore)

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