A bad day

We had a patient who stopped breathing today.

We had a patient who stopped breathing today.

The poor little guy was sick from the start.  He was four and he had kwashiorkor, the kind of malnutrition that causes swelling.  The swelling is mostly salt water, and as we treat the kids all that extra salt water makes its way into their blood stream and has to get pumped around by their heart and then eventually peed out.  The problem is that the poor heart hasn’t been fed either and is barely capable of dealing with its normal job, let alone all that extra salty water.  So sometimes the pump fails, the fluid backs up into the lungs, and they end up in heart failure.  Unfortunately, kids with kwashiorkor are just as susceptible to all the other illnesses as all the other malnourished kids.  This little one came in with low haemoglobin last week, got a blood transfusion, and seemed to be doing better for a while.  Then he got nauseous and started vomiting, and we noticed that his liver seemed to be enlarged.  So we sent him for an ultrasound. It basically said his liver was inflamed, but didn’t say why.  We ordered some liver tests then, but first the lab was closed, then we didn’t have a ‘tube sec’ to draw into.  This is the way of it.

Yesterday, the little guy was retching.  His abdomen was distended but soft.  We checked his blood counts again and gave him some symptomatic treatment as we waited for his liver tests to come back.  Modeste, the other MD, who was on call yesterday, put him on some broad spectrum antibiotics last night because he was looking worse.  His urine output had decreased too.  We figured he had an infection in his bloodstream.

He didn’t pee overnight. We were called when he didn’t wake up with the AM vitals.  We walked in. he was breathing, but his level of consciousness was decreased. His sugar was low.  We did everything we could.

It is not a good feeling to watch a child stop breathing.

Kids don’t die in my medical world.  My husband is a year away from graduating from a Canadian paediatrics residency and has had to rush to every resuscitation done in the hospital, to be one of dozens of spectators, all in an effort to practice what almost never happens.  He just ran his first resuscitation two weeks ago.

I glanced over.  This child’s mother had been sitting just behind the curtain on another patient’s bed while we tried to resuscitate her child.  She had her leg up beside her. Silent.

The mother came over.  Quiet.  Neither matter-of-factly nor stiffly nor agitatedly did she draw the blanket up over her child’s face.  She simply kept breathing and did that while she was breathing.