The Other Side of the Story

For reasons that I am not sure even I understand, I have been very reluctant to write about the patients that I have encountered here in Malawi.  I think I feel like it is voyeuristic, in a way.  All Americans have cable and internet.  We all know about the poverty and desperation that exists in the world.  We all choose to change the channel or avert our eyes, focusing instead on the minutiae of our comfortable, excessive lives.  You do not need me to tell these stories. I wrote the following after a particularly hard day, in order to help purge myself of the overwhelming sadness that I felt at the futility of the day's efforts. Please do not write to tell me about the difference I can make here. I am learning to find my sanity in small successes. Write to tell me what you have given up, how you are sacrificing so that these babies and mothers will suffer less. Give me hope.

There shouldn’t be such a difference between the world these mothers live in, and the one that I come from. In the states my patient's mothers worry about exposure to mold and delayed vaccine schedules. Here the they worry about having enough food for their babies, and watch them die from treatable and vaccine-preventable diseases. Today was my first day attending in the hospital.  It is like a war zone. Multiple times over the course of the day the low-level chaos of the hospital corridors would be interrupted suddenly by the sound of a mother wailing incoherently at the death of her child, a guttural deep-throated wail that transcends language and culture in its raw anguish.

The first time I heard this sound was when I was bent over the wrist of listless, dehydrated 2 year old, whose fontanelle (soft spot) was sunken to the point of being taut, sweating while trying for the 3^rd time to place an IV.  He had developed profuse watery diarrhea overnight, and had grown lethargic, although he sucked greedily on the 5 cc syringe full of oral rehydration solution his mother had stayed awake dutifully all night long, giving every 5 minutes. We attempted multiple times to put a catheter into his veins to give him IV fluids, but were unsuccessful, despite his minimal effort at fending us off as we tried.  We requested help from the nurses, and were told that they were at lunch.  We requested help from one of the nurses at Baylor, and were told that they were on their way, although they preferred that the hospital nurse be consulted first, so as not to offend anyone.  Finally, as I watched this pathetic child cry weakly in front of me, I decided to put a large-bore needle into his lower leg to give him fluids. This is a procedure I imagine to be incredibly painful, as the needle is literally drilled into the bone marrow in order to give life-saving fluids, and is something I had only ever done in comatose patients.  This little boy, although pitiful, still felt pain.  With a visiting resident from the States assisting me, we held his little leg down and put the needle in,  waiting for a sickening pop as it pushed into the inside of the bone.  I tried not to hear his cries, and told him again and again how sorry I was.  For the next hour we pushed fluid into his tiny leg, having to push so hard against the syringe to get the fluid into the bone that our hands shook. The needle, made for drawing blood from an adult, stuck three inches from his shin at a right angle, but he barely reached for it.  And outside of the small, airless treatment room, littered with IV wrappers and cotton balls, blood on the floor and bugs in the sink, I could hear the childless mother crying.

The second time I was in the NRU, which is a refeeding unit, where children with kwashiorkor and marasmus come to be refed.  I was trying hard to determine the history of the malnourished child in front of me from the mother, who is what we doctors call a “poor historian”.  Suddenly a woman appeared in the doorway and emitted a howl of pure grief, then fell backwards, limp, into an empty crib.  It was clear, although she spoke Chichewa, that this was her child’s bed, and that she had returned from the treatment room where her child had died.  The women around her, whom I assumed to be aunties and a grandma, began to wail, and rock back and forth holding each other, as they sat on the floor in front of the sobbing young mother. In front of me was a baby who looked like the pictures of children in Somalia being shown on CNN recently. He is 20 months old and weighs what some newborns do, 10 lbs. His eyes were huge and watery, and the skin across his scalp was tight. His arms and legs looked like sticks. His young mother had been bent down in front of him feeding him fortified milk with a spoon from a plastic sippy cup, but they looked up when the mother of the dead child came into the ward.  All conversation stopped briefly as we, all women, listened to and absorbed her pain. Her cries echoed through the corridors as she gathered her child’s belonging, and was half-carried out by her family. And then, slowly, the chaos of the ward resumed.                 

She lay in the arms of the other woman in the hallway outside the ward, for what seemed like an hour, and cried.  I did not see her leave.