Tuesday, January 10, 2012

Hope changes everything

Thank God today was a better day.
 I spent yesterday in the Treatment room, which is like an acute care room, where sick kids and kids that require admission go for evaluation and treatment. The clinicians rotate through about weekly, and (as anyone who knows me can imagine), it is my favorite place to be.  It’s like my very own little ED: I have my own stash of meds to give, and have become more proficient with procedures, having even given ketamine a few times.  The day was busy, and I was in the middle of consulting with a colleague about a puzzling clinical case when a nurse approached me and said that there was a baby who was not doing well who had just arrived.  I rushed to the Treatment room and saw a woman with a 2 ½ year old on her lap. The child was fully dressed and wrapped up to his chest in a blanket and chitenge. He was staring straight ahead. I put my hand on his chest to rub it, put my finger on his pulse, and looked in his eyes simultaneously. He was warm, but I did not feel a pulse, nor did he react when I moved in front of him.  I put my stethoscope on his chest, expecting the worst, and heard nothing. It was a very odd sensation. I have put my stethoscope on the chests of a hundred children a week for eleven years (give or take), and only very rarely do I hear silence.
“Annie,” I said quietly to the nurse, “this child is not alive. You need to tell this mom that her baby is not alive anymore.”
The woman must have suspected, for she did not wail as is the custom, but cried to herself. I spent last night in a flat mood, refusing to find any joy in a day that consisted of examining a dead toddler.
But, oh thank God, today was better. Since leaving little Thokozani feverish and vomiting at the beginning of my vacation, I had been without phone access for a few days in the mountains. While at the beach later I texted and called Mwawi (too) frequently, and when she answered my calls she assured me that the baby was doing fine. Experience had proven, however, that our definitions of “fine” differ, and I was anxious and afraid to hope. The baby’s mother had been doing well at PIH, and was reportedly eating and had had no fevers or diarrhea for days.  They were ready to start her on anti-retrovirals and send her home, but I delayed them, waiting for our social worker, Mrs. Chisale, to return from vacation. Unfortunately, I learned today that she would be extending her vacation until next week. Chrissy’s older three children were already supposed to have been removed from the transitional orphanage where we had  begged to keep them, and Chrissy could not keep staying in the wards. So today I drove to PIH to meet with her myself, and discuss her discharge options with her.
When I walked into the ward she sat up in bed, shirtless as most of the women were, due to the oppressive heat. She smiled at me, and it was one of the most beautiful things I have seen in a long time. She has gained about 5 lbs, and proudly showed me her lunch plate, empty of nsima. She is still so terribly thin, and when I awkwardly attempted to touch her shoulder during conversation I felt its sharp edge, and it startled me. Poor Chrissy has no family, which is the safety net of the impoverished Malawian mothers and children, especially those with HIV. Most of these women have never been to school (Chrissy finished 3rd grade), and have no employment options unless they sell a few vegetables, find a few pieces of laundry to do, or occasionally turn to prostitution.  That hovel that she lived in cost about $5 per month (which I consider overpriced), and she struggled to pay that and feed her children. I told her that she needed to find a suitable, watertight home to bring her children to, and advised that she organize herself for a day or two before she brought the older children home. We also agreed to have Thokozani stay in the nursery for a few weeks.
So Chrissy will be discharged tomorrow, and I will retrieve her children from the orphanage on Friday. The family literally had nothing but a few metal bowls and a handful of tattered clothes, so together we will get some outfits for the children from a nearby orphanage and buy some plastic dishes and metal pots for her to use. Dave and I agreed that, in order to help her get on her feet, we will buy some chickens and maize and soy for the family and hope that she can, as she assured me, “manage”.  I considered buying her seeds and fertilizer, but planting season has passed, and she has no land. I asked her to promise to send her children to school, and to take her medicines and to eat. Again, she smiled, and my heart nearly broke with happiness.
Buoyed by Chrissy’s improvement, I went to the nursery to see the baby. I entered nervously, and was shown which room he was in. On the floor, propped up with pillows, were three tiny babies, two of them smiling up at me, and one crying. None looked like Thokozani.  Then one of the smilers caught my eye. Was that him? But this child’s cheekbones did not protrude. This baby was grinning. I lifted his head off the pillow and examined his occiput. Thokozani had a very unusual, distinctive head shape, and so did this baby, who grabbed at my nose as I examined him.  It was him. For the second time that day my eyes filled with tears. He has gained about 1 ½ pounds (about 20% of his body weight) in the 10 days since I had last seen him. His belly was distended with food, and his smile was gummy and enthusiastic. 
As I may have mentioned, and at the risk of alienating many of my friends (most of whom already know this about me), I have a complicated idea of what God is. I do not subscribe to any religion, yet I feel strongly that my entire experience here is intended as a sort of living prayer of gratitude for all that I have been given.  Today, every cell in my body was grateful to that God for the chance to have witnessed these two people transformed from near death to life. What I saw in Chrissy’s eyes (I imagine), was hope. There is a tapestry on the wall of PIH that says “Hope Changes Everything”, and it seemed almost prophetic when I noticed it today. Although I recognize that poverty is unrelenting, and I fear that Chrissy’s family does not have a sustainable means for survival, my belief that I am here for a reason has been repaired, if not entirely restored. I sometimes ask myself…would it be worth all the time and effort and money to have come here if you could only save just one life? Looking at that baby’s sweet smiling face today I believe the answer is yes.