Today I want to tell you a happy story. It is about a small malnourished boy, 18 months old and only 6 kg. I met him about 2 weeks ago, on my usual morning rounds. His mother had come in during the night because he was breathing fast. When I assessed him, he was working hard to breath but still let me know who was boss by firmly shoving me and my stethoscope away! Reassuring, I thought. I checked his oxygen level, started treatment and continued with my rounds.
Not more than 30 minutes later, I was called back urgently to see the child. He was barely conscious and his breathing was MUCH worse. I grabbed him in my arms and started to rush toward Intensive Care. I called out "Mama, Kariboo" which was the only thing close enough in Swahili I knew to indicate that she should follow me (it means: Welcome). I was sure he would stop breathing in my arms.
A million thoughts passed through my head. How would I feel if the child died in my arms, what would the mother think about the crazy Muzunga grabbing her child away from her and speaking in broken Swahili!
We made it to Intensive Care, but he was comatose and without a pulse in his wrists (a sign of severe shock). Here came the difficult decision: malnourished children are at high risk for fluid overload, if I aggressively gave him fluids and he wasn't actually dehydrated, the fluid could go into his lungs and kill him. I started the fluid and called Raghu, the other doctor. I asked him to bring his bed-side ultrasound machine with him. We used it to look at the child's IVC (the large vein that brings all blood back to the heart). If the vein was compressible, it meant to child needed fluid and we could potentially safely give him a bolus. It was compressible and we proceeded to give him repeated boluses of fluid, each time checking with the ultrasound. His pulses came back, but he was still on oxygen and in a coma.
When I looked down at my MSF T-shirt at the end of the day, I noticed 2 drops of blood that had come from the child's IV site. I took it off, folded it and gently placed it on my shelf with a sense of superstition.
The next morning on rounds, I was told he had had a seizure. I tried to look into my crystal ball of medicine. Was it low sugar, low sodium levels? I felt blind so I treated both. Over the course of the day he started to move. Then he started to open his eyes!
I checked on him several times a day and slowly he recovered and was well enough to go back to the ward. He rapidly progressed, gained weight and 10 days after his dramatic collapse, was ready to go home!
I only now have washed that shirt...