The Boy Who Stays

The Pediatrics team on rounds


This is the little boy that we treated for heart failure (I used his photo last week, when he was on oxygen). He did well.

Dr. Matthews evaluating a child with pneumonia

The last two days at work have been intense - emotionally draining but still enjoyable most of the time. There were moments during the day yesterday that would be difficult to describe on this blog. The picture in my mind is clear and I go over it a lot in my head, and with Megan the med/peds doc who recently started volunteering at Selian hospital.

The day started without power. There were no lights at Selian and somehow, like turning off the lights in a kindergarten class, everyone seems to stop working when there is no power. You can hardly blame them - the lab machines don't work, the xray doesn't work and if you wait long enough the power will return. But the main problem was that no electricity = no oxygen delivery machine in the peds ward. And might i remind you that, most days, 2/3 of our kids have some sort of pulmonary tract infection.

...and so started the day. We walked into the peds ward and found our kid with severe pneumonia struggling to breathe. No oxygen. And who knows how long that he'd been breathing that hard. Transfer to the ICU. STAT (as if there is such a thing here).

But in the ICU there are no ventilators. So we thought please, God, let oxygen be enough to keep this boy breathing. 3 IV lines and 2 power losses later (the electricity kept turning on and off throughout the day), he looked ok - maybe even a little bit better. Today he is still struggling and all we can do is keep checking on him, give him fluids if he's dry (but not too much because there is no such thing as an IV drip here!!!) and hope that the antibiotics win out over the infection. We gave him what we had: fluids, antibiotics, oxygen and a lot of doting on behalf of Megan and I. I wondered why--on those nights at St. Paul Children's Hospital admitting 20+ kids per night with asthma and bronchiolitis, each complete with his own chest xray and a brand-spanking new oxygen mask shaped like a dinosaur which HASN'T been used by dozens of kids before him--I never stopped to appreciate how lucky we are back at home.

Shortly after that little boy was "shifted" (as they say here) to the ICU, we met a baby girl named Edna. She's one month old. She has a perfect little round face, which I might even say looks well nourished compared to other kids around here. She's been admitted earlier that morning and hadn't been seen by a doctor in quite a while. Edna is the one who got our adrenaline flowing. She was so small and weak and just didn't want to breathe. After a long discussion with the nurses about what we do and don't have in the peds ward (which is not easy in Swahili-English) Edna stopped breathing altogether. While Megan was called away to another resuscitation, Dr. Matthews and I resuscitated her, scooped her up and ran (well - walked briskly) across the campus to the ICU. Let me tell you - due in large part to the lightness of my skin i already feel a little bit like a fish out of water here sometimes. Imagine the looks when the locals sitting around the grounds (they spend a lot of time sitting and waiting here - the most patient people on the planet i think) saw us sprinting down the sidewalk with an infant and a confused mother, trying to hold on to her skirt and her shawl, trailing behind us.

In the end, Edna did okay although she's still not really out of the woods. But i feel good about her, and so should Megan and Dr. Matthews. It's good to know you did your best.

And sometimes it doesn't.

Shortly after we resuscitated Edna, an adult woman was wheeled into the ICU. An admission for the adult medicine team, who must be on their way. She couldn't breathe either and in the midst of taking care of our kids, I wondered if she needed help too. The nurses eventually got her hooked up to oxygen, but before she really stood a chance, her heart stopped. We tried to resuscitate her too...but she died. And all of this happened in one big barren white room, in front of Edna and her mom, as well as our boy with pneumonia and his mom too. It was sort of strange and sad and tragically uneventful after that. No one really said anything. A reminder that this is Africa and people here aren't strangers to death.

I don't know that lady's story, or if we could have done something to help her before that critical point. Initially I felt sort of angry about it. Who was responsible for her admission? (Answer: probably someone who had 2 dozen other sick people to tend to). Why wasn't she on oxygen already? (Answer: because we were using the oxygen cylinder for our babies and the nurses needed to figure out a way to rearrange the lines without a consistent power supply). And what would we have done for her if we had gotten a pulse again without ventilators or central lines? (Answer: nothing more than was already being done). But, again, this is Africa. Things are different here. You do what you can with limited resources and then you leave the rest to fate or God or luck or whatever you prefer to rely on.

But boy did I mull that over in my head. What could we have done differently...

Dr. Megan Shaughnessy and Avelin the Intern with one of our best peds nurses

One last thought for now: After all of that drama and disappointment, we returned to the wards today and saw Issaya again - the boy with probably TB causing liver problems. He was discharged on Tuesday, but every day when we get to work, there's Issaya and his mom, waiting. They are waiting to have the money to pay for the hospitalization, so they can go home. Until then, he remains in the ward. And each day his smile gets a little bigger, and he's always clutching the white car that Brenden and I gave him 2 weeks ago-- back when he wouldn't so much as look at me. He makes my day. I'll be sorry to see him go, even though he was discharged 4 days ago. How ironic - a discharge is so much more satisfying back home...

Here is a photo of Issaya, his mother and I. Notice he's holding a white car in his Left hand.