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In the hospital, army neurosurgeon Col. Four hours later, though, her condition deteriorated. Khan realized the bullet had caused Yousafzai's brain to swell and that she needed emergency surgery to remove a portion of her skull to relieve the pressure. But Khan had to fight for permission. According to Drs. Javid Kayani and Fiona Reynolds, a pediatric intensive care consultant from Birmingham, who was also in Islamabad that day, Yousafzai's family did not trust Khan because he looked so young.

Malala's father, Ziauddin Yousafzai, wanted a civilian doctor to see her. There was also a push to evacuate her immediately to Dubai. But by late evening, Khan told Malala's father there was no choice: Khan had to perform the surgery to relieve the pressure on her brain. The risks were high. Khan pushed Malala's father for permission.

The craniotomy began after midnight.

Khan and his team removed a portion of her skull, removed blood clots on her brain and put Malala on a ventilator. To this day, Reynolds and Kayani say that without Khan fighting to perform that surgery, Malala would not be here. He's a hero. As Kayani put it in an interview: "Malala is alive today, and two people can claim credit for that: One is the surgeon who operated on her in the early hours of Wednesday morning, and the other is the chief of army staff.

If he had not been personally involved, Malala would not have survived beyond Swat. The surgery saved her life, but she was not out of the woods. And that is where Kayani and Reynolds' portion of the story begins. Wednesday: 'The quality of the care may actually cause her not to survive'. As the sun broke through on Wednesday morning, Kayani and Reynolds woke up in Islamabad on a prearranged visit to help the Pakistani military set up a liver transplant program.

They met with the army chief just hours after Malala's initial surgery. As they spoke in his office, two very large TV screens showed news footage of the young Pakistani girl -- whom Reynolds had never heard of. The meeting ended without any mention of Malala, and Reynolds was about to go shopping. But that's when -- at Dr.

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Kayani's urging -- the military asked for their help, changing both of their lives forever. Kayani had been given conflicting stories about her condition, and he wasn't sure about what to do next and whether he should move her and where he should move her to," Reynolds said in an interview. Reynolds was told there was some risk in flying to Peshawar, but Reynolds didn't hesitate: "[Malala had] been shot because she wanted an education, and I was in Pakistan because I'm a woman with an education.

So I couldn't say no. Twenty-four hours after Malala was shot, Kayani and Reynolds flew to Peshawar on a military helicopter to evaluate the situation and meet Khan. Both praised his decision to operate, but Reynolds was shocked at the hospital's facilities.

Everyone Must Be Prepared For Emergencies

The intensive care unit had one sink, which didn't work. The doctors were measuring Malala's blood pressure with a cuff every few hours rather than with an arterial line, which measures the pressure every few seconds. Reynolds worried that the lack of modern facilities were putting Malala's life -- and her ability to recover -- in jeopardy.

The visit ran into the afternoon, and Reynolds was running out of time. She needed to decide on a course of action before the sun set. Pakistani military helicopters do not fly at night, and she was not allowed to spend the night in Peshawar. As she left, Reynolds urged Malala's doctors to change the ventilator settings to raise her carbon dioxide and increase blood flow to the brain. But more important was to get Malala out of there, fast.

Kayani and Reynolds flew back to Rawalpindi and met with Pakistan's surgeon general. Reynolds urged him to bring Malala to the state-of-the-art hospital in Rawalpindi.

Manual The Last 72: Essays on Living the Last 72 Hours of Life

Her life was "absolutely" in danger, Reynolds told the surgeon general, "and so was the quality of her recovery. The swelling that the bullet caused was very close and it would have been quite easy for her to have ended up looking like someone who'd had a stroke. But the doctors in Peshawar refused, believing her condition too fragile. So Reynolds and Kayani urged the surgeon general to dispatch his best doctors from Rawalpindi to Peshawar. Just before midnight, he agreed.

The head of Rawalpindi's intensive care unit and another doctor drove the two hours to Peshawar to look after Malala for the night.


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The doctors' fears proved true. Malala's condition had rapidly deteriorated. Reynolds recites the long list of ailments Malala was suffering from: She had a serious infection, her blood was not clotting properly, her blood acid had gone up, her blood pressure was unstable, her heart and circulation were failing, her kidneys had shut down and the doctors believed she had gone septic. Get A Copy. Paperback , pages. More Details Other Editions 1. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about The Last 72 , please sign up.

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Get PDF The Last 72: Essays on Living the Last 72 Hours of Life

For your loved one's safety always check with your nurse before feeding or offering fluids. When your loved one is nearing the end of their life the amount of urine they make is less and their urine color turns darker.


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  • If your loved one has trouble passing urine, a urine catheter a tube placed into the bladder may be put in. There may be a few seconds of discomfort while it is put in but often they will not know the catheter is being put in. A loss of control of the bladder and bowels may occur as the muscles of the lower body relax. Incontinence pads may be used to keep your loved one clean, dry and comfortable. If your loved one is constipated and seems to be uncomfortable, laxatives or an enema may be given to help pass stool.

    If your loved one asks for water you may give water but please give it slowly and carefully. Raise the head of the bed a little or support your loved one's head and offer ice chips or small sips of water using a spoon.


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    • If the fluid causes coughing or trouble breathing stop right away. If your loved one asks for water, but cannot drink or your health care team feels it is unsafe for them to drink, good mouth care will keep their mouth and lips moist and give comfort.