Wonderful

It has to happen one day, to anyone here. It was my turn 4 weeks ago, on the second day I was rounding on the pediatric ward. I had taken on the intensive care unit, a sideward to the pediatric department. It only resembles ICUs in the north in that it harbors very ill patients. The care is not really much more intensive than in other wards and definitely not more technologically enhanced. Mostly, children are suffering from severe malaria, pneumonia or meningitis, and many make an astounding recovery.

The third boy I was seeing that morning had a positive malaria test and had been admitted the day before with the usual medications and hydration. He looked very sick, was comatose, and breathing rapidly. He’s intravenous drip was dry and had probably been dry for a while. I have come to appreciate a phenomena much like the picture books that have three dimensional fold fold-out illustrations when you turn the page – when I examine a patient it sometimes feel like slowly turning a page in a medical text book. Signs and symptoms I have read about years ago suddenly manifest themselves in reality.

This boy had a Cheyne-Stokes breathing pattern, an irregular respiratory rhythm that promises a bad outcome. I realized that I was seeing the complications of malaria that kill children here. Further investigation completed the picture: he was febrile, tachycardic, dehydrated, hypoglycemic and probably in cardiac failure. The canula in his vein was clogged up, so I could not give him fluids or glucose. I struggled to find another vein on his cold extremities, one of the clinical officers tried to find one on his scalp, I considered his jugular vein – invisible – his femoral vein, a bone screw….. The intervals between breaths were growing, he started gasping and I knew that I could not keep this boy alive. I looked for confirmation to the nurse and thought that I read agreement in her eyes when she verbally obviously did not disagreed with me. Within minutes the boy stopped breathing, I put my stethoscope to his chest, thinking of a friend who had told me only the week before how desperately I would be trying to hear a beat, feeling my own heart in my throat. Silence. I completed the ritual, shone a light in his dilated pupils and saw no contraction. I turned around to the mother hovering behind me and before my hand touched her shoulder she broke out in the wale of mourning, announcing death in my stead. Thunder crashed over our heads and the lights went out for a split second – his name was Wonderful.