A Day of Rest

Hilaire die last night. It was quick and peaceful and there was no wailing. He took one large gasp and closed his eyes, and his mother was at his side. Just two days before his pathology results. It’s so hard to walk by his empty bed, but I’m sure that it won’t be empty for long. The last thing that he said to me was that he was hungry. Only in Africa is there a child gasping for air, keeled over in pain, paralyzed by fatigue, burning up with fever who is asking for food.

The ward was peppy this morning, despite the events of last night. Bed 14 was clean and empty for the first time since I’ve been here. Derrik is still spiking fevers, Cedrik is going for pericardial stripping on Tuesday. The baby in Bed 1 is slowly coming out of a coma.

On Sundays we only round on the very sick or unstable patients. I briefly examined the new patients--- one with a huge facial mass that I’m assuming is Burkitt’s Lymphoma, another probably with malaria, and another with fevers and splenomegaly. Everyone is stable for now and I am not on call tonight, so we’ll see what tomorrow brings.

The way that the hospital is set up is fee for service. The patient/patient’s family is responsible for every lab test, every imaging study, etc. If they are unable to pay, they have to stay on the compound until the family provides enough money to foot the bill. There are tons of people sleeping on benches, in the grass, along the sidewalks, hanging laundry on posts and cooking in a community kitchen. I’ve really learned to think long and hard before ordering routine labs and ask myself “how will this result actually change management?” The charges add up. We order so many labs back home, do we really need to trend a hemoglobin every day? If a patient needs a blood transfusion, it is the family’s responsibility to find someone to donate a unit of blood for replacement. The parents hold down the children for IVs and administer the oral medications. The mothers and siblings sleep on the floors under the hospital beds. But you walk through the wards and the mothers thank you like you are giving them a gift of gold. It’s a far cry from the patient who walks into the ER back home and not only doesn’t pay, but simultaneously exudes a sense of entitlement. I don’t mean to rant, but practicing medicine in the U.S. does a good job of jading you. I could go on, but I won’t.

Today I saw one of the mothers chewing her food and dropping it into her baby’s mouth. It struck me as sweet as opposed to gross. I think that means I’m getting used to this place.