10 pm. The child arrives in his father’s arms. He has been comatose for 4 hours already. Maybe 11 or 12 years old, he is handsome and well nourished, on the cusp of adolescence. His father said a snake bit him while he was swimming.
“The red one,” the father says shakily in English.
“Cobra,” says our Sudanese staff, a chill in his voice.
The child is struggling to breath. His respiratory muscles are becoming paralyzed by the snake’s venom. I can see him trying to expand his lungs using the muscles of his abdomen. We start an IV and decide to hang snake anti-venom. It takes us at least 30 minutes to get organized. The snake anti-venom is back at the compound, in the locked fridge, in the locked logistics room. We don’t bother with the oxygen; it hasn’t worked for a few weeks. His respirations become shallow and we try to help him breath with a mask and bag. The mask fits over his nose and mouth and is attached to a rigid rubber bag that is squeezed by hand. There is no equipment to insert a tube into his trachea or to ventilate him by machine. We do this for….how long….I don’t know. The men of the family stand around the examining table, quiet. When the boy’s heart stops, it becomes clear that our efforts are futile. His pupils are ‘fixed and dilated’, the medical equivalent of ‘no real hope’.
I don’t think I have watched a child die before. At home we would call ‘a code’. We would have a team of doctors and nurses who would come running with the crash cart. The feeling of impotence would be camouflaged by a flurry of activity, the actual process of dying lost in sea of lines, tubes, monitors, drugs and electrical shocks. “Clear….” And the flat ECG miraculously jumps to life.
Afterwards I say, “Malesh, malesh.” (Sorry, sorry.) The father nods.
The men gather up the boy’s body. The father asks if he can borrow a lamp, and the MSF shovel.
“Of course,” I say. “Of course.”