Tuesday, my last full day, was a busy, crazy day of things similar to the rest of the month. 2 of the short term MD's had left monday, though, so J was on OB call, leaving me to most of the peds without him. the afternoon shift, however, seemed to cluster several pediatric seizures, blood transfusion needs, a general spirit of chaos and desperation with the death of one of my patients. it happened, for the first time this month, while i was actually on the Ward - the relative came to the nurses station where i was sitting and said the child had died, could she have their papers.
when she said the name/bed number (ER24 - a bed on the floor in a hallway, see photo) - i immediately knew who it was. it was Bassirou. a 5 month old boy who i had seen on several occasions - first in the clinic, treated for diarrhea and malaria, sent home. he had come back still ill, and i admitted him. i had been caring for him the 5 days since, and during that time learned his mother was on ARV's (i.e. on medication for HIV/AIDS). so i tested him, and he was positive for the antibody, which could have been because he had his mother's antibodies from her breastmilk, but his condition seemed to not respond to our antibiotics nor anti-malarials, making me/us suspect he actually did have HIV. the CD4 counts are only run on thursdays, so we were waiting until yesterday for that to come back, to determine where he was on the spectrum of disease. when i saw him on tuesday morning, he was kind of whimpering and didn't look well, had been febrile again, and mom said wasn't eating well. she thought he was whimpering because of the IV that had been in his foot. i again prayed for him as i examined him, at a loss to know how else to treat him.
he died that Tuesday afternoon, 29 october 2008 at 5pm.
as soon as i heard the bed number, i went to see the family - again, the first time i had been nearby when a patient died. i found the mother and other relatives, packing up their few belongings, the mom with tears on her face. an older woman kept saying something in Hausa which i think included "Allah..." - which i had heard is what they say when someone dies, "it was Allah's will, it was Allah's will..." and that they usually don't cry or wail or mourn visibly. they don't even say "i'm so sorry". if you read my earlier post, they say, "sanu."
well, on top of the chaos of the afternoon already, i was in tears, and wanted the mother to know that i had loved her child, too, that he is precious to God and that his life mattered. i gave her a hug, kept saying "i'm so sorry, i'm so so sorry you have to lose your son to this ... "
the family kept saying things in Hausa, packing up, walking toward the door.
i looked for the baby - he was strapped on the older woman's back, as any other child is most of their first few years... yet now unlike all those living, breathing, squirming children. his little feet were sticking out like any other child, still warm. but his head was covered by the cloth, and not sticking out. the mom's eyes met mine, both with tears, and she made a small brief smile. they took their papers, their belongings, their Bassirou, and left. sanu.
my grief was interrupted by the phone - i answered to hear, "Doctor, emergency in OPD". so i went running to the clinic, to find another child seizing, looking horribly pale... the chaos continued to swirl.
(the photo is not of Bassirou, but of the way children, even babies, are carried on the mother's backs. please pray for the chilren of Niger)
clearing the fluid and such out of baby's nose and mouth to help him breathe. and then went on to how important it is to rub, rub and dry the baby to help him stay warm. i was trying to think about how to explain the whole concept of 'heat loss', 'body surface area' and 'thermoregulation' to these Hausa women with minimal schooling/training (who had left numerous babies in the open air, wet and cold...). then i heard coming out of my mouth:
