I arrived at the hospital last week and was immediately pulled into the kind of scene that forces your brain to shift into high gear – the kind where time warps and your senses sharpen. A group of nurses were at the bedside of a restless patient, physically restraining him.

“He’s trouble,” one of them muttered, clearly exasperated.

That phrase – it stuck with me. Not because it was unusual, but because I’ve heard it before. And too often, “trouble” is shorthand for something deeper. Something misunderstood. Something missed.

I walked over to the patient, hoping to understand the situation myself. Before I could say anything, he turned the nurse next to him and blurted out, “I like the white woman.” It’s not the first time I’ve heard something like that here – uncomfortable, inappropriate, but not uncommon. But I didn’t dwell on the comment. What really struck me was the tone. His behaviour was erratic, disinhibited.

This must be a head injury patient I assumed, having witnessed this kind of behaviour several times before. But then his abdomen caught my eye – it was grossly distended. What was going on here?

I found his chart and scanned it.
“Abominal trauma secondary to RTA” – a road traffic accident. Okay. That explains the abdominal distension. But what about the confusion? The bizarre comments? Could he have hit his head during the accident? Was he hypoxic? Septic? Or worse?

I didn’t want to waste time. I called my mentee over. I’ve spent countless hours teaching them the ABCDE approach to assess patients – and now we were going to use it, live, under pressure.

A – Airway: Clear. Good start.

B – Breathing: Immediately worrying. His respiratory rate was sky high. He was working hard to breathe – using every accessory muscle. The pulse oximeter wasn’t reading. I hate that. It’s never a good sign. Sometimes it’s just a tech issue. But sometimes, it means things are worse than they look. I asked the charge nurse to get some oxygen ready. We had to move fast.

C – Circulation: This was the moment things got scary. I could barely feel a pulse. We checked his blood pressure: very low. The kind of reading that makes your stomach drop. He was in profound shock.

“Does he have an IV line?” I asked.
“No.”
“Do we have one?”
“No supplies.”

No fluids.
No cannula.
No medications.

I asked again – sometimes things are tucked away. Nurses know how to be resourceful, especially here. But this time, they all shook their heads.

I looked at my mentee.
They looked back at me.

And in that moment, I didn’t know what to do.

Then the patient looked at me and said:
“I’m dying.”

And I told him, “You’re going to be fine, yah. A don tek car a yu”
Trying to convince him.
Trying to convince myself.

D – Disability: He was alert, but his behaviour was definitely abnormal. Disinhibited, inappropriate, confused. We checked his blood sugar – normal. His pupils were equal and reactive to light. No immediate signs of raised ICP, but his altered mental state couldn’t be ignored. Possibly hypoxia. Possibly sepsis. Possibly trauma. Possibly all of the above.

E – Exposure: When we fully examined him, it was obvious: the abdomen was massively distended, tense and clearly painful. And his temperature was 39.4°C – a fever, and a high one. Sepsis couldn’t be ruled out. In fact, it was looking more and more likely. Shock, fever, distension, confusion – he was crashing from multiple angels.

That’s when she walked in – a senior anaesthesia resident. A familiar face, and a brilliant one. She assessed the patient quickly and confirmed my fear: this man was in hypovolemic or septic shock, or some mix of both. We needed to act immediately.

She asked for supplies.

The nurses gave her the same response: “No money. No stock.”

But she wouldn’t accept that. She started moving through the ward, speaking to other patients and their families, asking for donations of spare supplies. She reassured them she would replace whatever she used. This wasn’t her first time working in scarcity. She knew what to do.

Within minutes, she returned with an IV cannula, giving set, and fluids. We had what we needed – or at least, enough to begin.

We tried for a peripheral IV. It was difficult – the patient was shut down, his veins collapsed. The anaesthesia resident decided he needed a central line. We needed better access. She sent someone to the ICU to get one.

“Do we have sterile gloves?”
“No.”

She didn’t flinch. She put on non-sterile gloves, sanitized the patient’s neck with hand sanitiser, and inserted the line. Not ideal. Not safe. But necessary.

We started rapid fluid resuscitation. I kept glancing at his chest – watching for the rise and fall, making sure he was still breathing. With no working pulse oximeter and a fading pulse, that was all I had to rely on.

I asked the charge nurse what resuscitation equipment we had.
“One ambu bag.”
Better than nothing. I told her to have it ready.

We added a second peripheral line. Fluids kept going in. Then, a noradrenaline infusion – something I’ve never seen administered on the ward before. It’s rarely available, even in the ICU.

And then – slowly – the tide began to turn.

The patient’s vital signs began to stabilize.
The oxygen finally arrived.
His pulse became palpable again.
He was still sick, still fragile – but no longer actively dying.

His family managed to pay the surgical fee and buy more supplies. He could finally get the surgery he needed.

And for the first time all shift, I felt hope.
He might live.
He really might make it.

And he did!

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It’s hard to describe what it feels like to nurse in a setting where basic supplies are often out of reach – where your decisions are limited not by knowledge or skill, but by economics and infrastructure.

But it’s also in these moments that I remember why I keep showing up. Why we all do.

Because sometimes, with a little grit and a lot of teamwork, we turn it around.
And someone lives.
And that makes all the difference.