A few young boys

If you look to the right when walking onto the children’s ward, you will notice that there are five young boys, all ages 10-14, eyes wide as the other children come and go. I wonder if they are horrified by the deaths that occur bi-nightly or if they feel defeated as the other children heal while they are nailed to their beds. I wonder what is going through their heads when there is a mother wailing one bed over. I wonder if they are thinking about soccer or holidays or catching lizards.

I wonder if they are aware of each other. Do they track each other’s progress or demise? I wonder if they would be friends in other circumstances. The truth is that they are all very different, bound by the same terrifying experience, caught somewhere between being a child and trying to breath.

And so I have gotten to know them all over the last week. To speak their names and write their stories will perhaps immortalize them in some way. If I can paint their pictures in the minds and hearts of strangers, then they have transcended their little corner of the world and maybe they have a fighting chance.

In the far end of the room is CEDRIK, who struts around the ward with a basketball under his shirt, not a care in the world. He doesn’t seem to notice that people stare at his enormous abdomen, he doesn’t seem to notice that he even has one. He has a crooked mischievous grin and always looks like he just put a bug in someone’s sandwich. He giggles when I let him listen to his own heart. It is the same heart that has grown stiff with tuberculosis, the same heart that is at risk for tamponade. But he cares more about “slap hand” than heart failure, as every child should. Of all the boys, he’s the one that hasn’t yet realized that he’s sick.

One bed over from him is DERRIK, he is quiet except for when he screams during dressing changes. He is on every possible antibiotic, but his fever continues to climb. Today he started the hospital’s only stash of Vancomycin. Stay tuned. He is stoic, never complains, barely ever smiles. His face is young and soft, with big eyes and long eyelashes. He has both pericardial and pleural effusions, on top of all his abscesses. He hates the oxygen that we make him wear, but he wears it because his mother will kill him if he doesn’t. His mother and baby sister sleep on the floor under the hospital bed. He has difficulty breathing due to the accumulation of fluid in his abdomen, and he isn’t able to get out of bed much. Half of his head is shaved for an IV placement. This evening he had a temp of 40, sweating from head to toe, breathing heavy and with his heart making visible beats against his thin chest wall. I placed a cold compress on his head and propped him up against my body, one hand on each side of him. I could feel the heat radiating from the back of his head onto my face and feel his sweat soaking the front of my shirt. Then he took his tiny peeling hands and put them on top of both of mine. Such is a thing that a small child does. Still wanting that human touch, a mother’s coddle, a warm embrace. Then I placed him back down on his bed and fanned his face with my notebook until he fell asleep.

RUDOLPH is closest to the door. His mother is strict and gets him out of bed every day whether he likes it or not. He is finally looking a bit better, despite all his bandages and occasional fever spikes. He is dark and thin and wears a red soccer jersey instead of the hospital gown. It’s funny how his face has begun to looks softer as he has begun to heal. It strikes me that you have to transition from patient to child for that to happen. Perhaps I will encourage Cedrik to play “slap hand” with him.

Next to him is JUNIOR- tricuspid vegetations, DVT, polymyositis, severe pulmonary HTN, you name it. He has these transient episodes of severe abdominal pain that are quite alarming when they happen. My guess is that he is throwing septic emboli and possibly having small infarcts in his bowel, but who really knows. These kids are so sick and unpredictable, any day without a major event is a good day. Two days ago I didn’t think that he was going to make it through the night, today he was sitting up eating mango, tomorrow he may be gasping for air. It’s a rollercoaster, you learn to take one turn at a time.

And lastly, there is HILAIRE. I have a heavy heart for this child. When he rolled onto the floor last week, I knew that he had either AIDS or Cancer. Fever, night sweats, weight loss, abdominal distension—multiple palpable masses in his abdomen. Completely cachectic, I could see every rib, make out the full skeleton of his face. His legs were swollen with fluid and his arms were as thin as broomsticks. He most likely has lymphoma, but both the oncologist and pathologist were out this week. We took a sample from one of his abdominal masses and mother made a trip to Bamenda to leave it with a pathologist. She tells us that she will pick up the results on Tuesday, but I know that those results may be irrelevant by Tuesday. This morning he awoke gasping for air and I removed two coke bottles worth of fluid from his right lung. He grabbed a handful of sheets and gritted his teeth as I stuck a large bore needle into his rib cage. The kids here are so tough, I wish that their lives didn’t make it so necessary. ECHO today showed dilated cardiomyopathy with an EF of 20%. Started him on Digoxin and held my breath. I know that whatever type of cancer he has, it is probably way too advanced for us to have much to do. The day he came in I told him we were going to take a sample from his belly and when I was walking away he grabbed my wrist and said “you take out the cancer?”. I’m afraid that he is too aware for his own good. It’s a strange feeling taking care of a child that you know is going to die. It’s like I have this heavy knowledge that I am keeping from him. Does he know? Does he think he will get better? He is suffering so much and he is so tired, but he is still alive. He can still say that he is thirsty, he can still sit up in bed, he can still take a deep breath when I listen to his lungs, he can still squeeze my hand when he is getting his IV replaced. I want to capture every movement, listen to every heartbeat, remember every grasp of his hand. I want the suffering to stop, but I don’t want him to take that last breath. But I know that one needs the other. There is nothing else that we can do, and it is the worst possible feeling. He is a child. He is his mother’s son and his sister’s brother. He climbed trees and did chores and went to school. What is he thinking right now? Is he scared? Every time I leave his side I know that it might be the last time I feel his warmth against my body. I dread his mother’s wails and the cold parted lips that I have become familiar with since coming here.

I’ve decided that I can’t avoid getting to know these boys just to protect myself. We have to celebrate their lives rather than fear their deaths. Make them comfortable, hold their hands, fan their faces. There is no greater sadness than losing a child. Is it truly better to have loved and lost than to never have loved at all? It’s certainly harder. But to be a part of a child’s life, to provide comfort in times of fear, well that is a blessing. I am blessed by Derrik’s sweat on my shirt, Cedrik’s fingerprints on my stethoscope, Rudolph’s evening high five, Junior’s tears on my gloves, and Hilaire’s hand in my hand. I am blessed by the triplets, the whimpers of a once comatose child, and the sound of new heartbeats.

And so it goes, on your mind and in your prayers, are the names and stories of five boys in Mbingo, Cameroon.