Friday, February 3, 2017

The Laundry Basket

Let me say straight off, this is not a happy post or an easy read.

I will write a happier post tomorrow recounting and describing everything I've seen and experienced so far (with some pictures) so please feel free to just come back another day for less serious things.

But for now, I just need to write about this.

Over the past year, I've seen some pretty sick kids. I spent a month in the ICU at the Children's Hospital of Pittsburgh. I spent time on the Neuro-ICU service at CHOP. And I spent last month on the Pediatric Rehab team at DuPont Children's Hospital. I've worked with children that I knew were going to die, that were abused, and that were permanently impaired simply due to bad luck. But as odd, as it may sound to some... these are the patients I love to work with. That doesn't mean I don't feel it or that it is by any means easy. I can't begin to describe how it feels. But I want to take on the really sick kids because they need the most help; they have the most to lose. And they are proof that no matter how bad it can get, they are still just kids first and foremost.

But the kids I've seen already in one week here are a different kind of sick. We do see the typical pneumonia and GI bug kids (although more likely to be typhoid than just a virus) but we also see TB meningitis, severe malnutrition, heart failure due to rheumatic heart disease, and severe anemia. These are kids who are sick due to severe poverty and lack of resources. And while the doctors and nurses that I have worked with are wonderful, there simply just isn't enough.

On Monday we admitted a 5 month old with an ear infection. But she was also so malnourished that she was smaller than most newborns I've seen. It turned out that she was a triplet and all three were malnourished since the family couldn't afford to adequately feed all three. We admitted and treated her and she moved upstairs to the malnutrition ward. All three babies were with the mom in the hospital and on Wednesday the mom came down saying one of the other triplets had been eating and then vomited and had trouble breathing. We admitted this baby to the ICU (just a room with less beds and and closer to the medicine and oxygen concentrator) and hooked her up to oxygen but she had a low heart rate and extreme difficulty breathing. She was also severely dehydrated from having several days of diarrhea which we were not previously aware of. She was a sweet little thing, responsive only enough to wrap her tiny hand around my finger.

We went on with the rest of morning rounds and admitting new patients. Shortly before leaving, a worried mother came in with her 9 month old. She had had a fever and decreased appetite for a little more than a week and was brought in after having a seizure. She was given a dose of Valium to prevent more seizures and so when we examined her she was asleep but still arousable and responsive. She fit all the criteria for meningitis. After crouching down to examine her as she slept in her mother's lap, she kept stretching out her legs and resting them on my arm. So I sat there and held her little feet in my hand as we finished the admission. I took her and her mom to an ICU bed where we planned to do a lumbar puncture to confirm the diagnosis of meningitis. I went with my intern to try to go track down some blood for another severely anemic patient (the intern ended up donating her own blood since there was none). When I got back, the girl was still calmly sleeping in her bed with her mom and it was time for me to go home.

When I came in the next morning, I didn't see her anywhere and I asked where she went. I was told she passed away the previous evening. All I could think about was her feet in my hand.

But work for the day had to continue. I went to see the triplets. The little girl who was really sick was struggling to breathe and not reacting at all. She did not move or make a sound as we tried to get blood samples. I kept thinking how she should have been intubated and placed on a ventilator the day before. But there were no ventilators. Children don't get intubated here.

I went upstairs to start rounds with my intern, and when we came back down about an hour later, we learned she had also passed away.

I don't want anyone to think that the doctors and nurses and families here aren't unfeeling. Everyone was upset. But child deaths are not uncommon here, especially for young babies, so it's not necessarily a tragedy, it's just another part of life. We carried on with taking care of and admitting other children.

In the afternoon, I sat in the ICU. The curtains had been drawn around the baby's bed but I could still see the small wrapped bundle laying on the bed. Then a man and woman came in carrying a laundry basket. I watched as they gently placed the baby in the basket and covered and tuckered her up with a black cloth. The nurse asked the mother, still caring for the other two babies in the ICU 2 beds away, if she wanted to see her one last time. The mother said no. And then they carried the laundry basket away.

I knew this was something I would likely encounter here. In fact, it's partly why I came here. To learn from and help with and see the difficult cases. But it hurts so much. It hurts that children dying are not uncommon here. It hurts that both of these sweet baby girls would likely still be alive had they been in a hospital or country with better resources. I don't even know how to describe exactly what I'm feeling but I don't think I'll ever get the picture of that laundry basket out of my head.

I apologize to anyone reading this. It's not fair to put this burden on others but I needed to say something for my own sake.

And I also hope it may serve as a reminder of just how lucky we all are. So go hug your loved ones a little tighter for me please.

No comments:

Post a Comment