Deep Breaths

This morning a 12yo little girl rolled onto the wards in the middle of rounds. She had a frilly purple dress on and a big bow on top of her head. Her lips were abnormally pink and her palms were abnormally yellow. History of Sickle Cell disease, mom said in Pidgin English. Has not been seen by a doctor in 10 years because they lived far and she was doing well. Tachycardic to 160, afebrile, O2 sat was 38% on RA. Sent off a Hgb and it was 1.8. Didn’t even know that was possible. Quickly hung a unit of blood. She became increasingly obtunded, at one point requiring me to lay my entire body over hers just so that she wouldn’t pull out her IV’s. She looked like she was possessed by the devil. I tried to calm her by shushing in her ear and patting her head, but only valium did the trick. She finally calmed down and we continued on our rounds.

Came to see her again after a quick lunch and she appeared much calmer. Was able to tell us her name. Blood was still running, it was starting to rain outside. Went to my house to grab an umbrella and a snack, returned to the most horrendous sound I’ve ever heard. There are a lot of kids on the unit that are at the brink of death, but the wail that I returned to was that of the mother of the little girl in the purple dress. “She just died,” the nurse told me, “she didn’t even fight it”. Within 10 minutes her body was in a bag and I was holding the door as her corpse was wheeled out, purple bow and all.

Death is everywhere around us on this compound. We’ve all had multiple of our own patients die, we hear the wails multiple times per day. One of the docs said to me, “It’s really easy to die in Cameroon”, and I’m beginning to believe him. I don’t know if I’m only seeing the worst of the worst, but it seems like everyone I take care of is walking a fine line. Dying is such a part of life here it seems. You can tell by the way the staff reacts to death- like they’re pros at it. No wonder everyone looked at me like I was crazy when I was running the code on that baby; they knew it was futile. But the truth of the matter is that the baby would have lived if he had had a cardiac repair, and this little girl would have lived if she lived closer to medical care.

So we take a big breath and move on with our day. After all, there are plenty of other patients to take care of, to scratch our heads over, to lose sleep over.