Wednesday, April 23, 2008

So you we think we have it bad.

The following was sent to me from a colleague. I find it disturbing and puts suffering into perspective. I've included the entire email:

Thought I would share with you all.

This is an Email from my cousin to his mom back in NYC.

He is a peds resident at Columbia U. He was on a medical mission trip in Uganda.

some of the profanities, but I believe it adds to the overall feel of
the Email and what he is trying to express. I am sure he would die if
he knew I was forwarding this on, but it shocked me back awake today
and I thought I should pass it along.


Subject: thoughts on lilian

hi pretty girl. its 5pm
here - sitting at the computer lab in the mulago hospital library.
feedback was good on the first update, so i added some more people to
the shout out list.

feeling pretty broken down...

on rounds, we met lilian, a 10 year old girl whose dad brought her in
the day before w/ severe belly pain, fever and an inability to pass
urine. at that time, a short discussion was had about renal failure,
blood pressure control and how she needed dialysis but wouldn't get it.
her father helped her to the floor and placed her over a plastic tub. i
heard a whimper and a small splash - dad turns to us and reveals what
looks like milk inside. i realize that she is peeing frank pus and ask
whats being done to control her infection. after a bit about the
utility of urine studies, i was reassured that she was receiving the
proper antibiotic therapy.

per routine, the attending dictates her 'findings' and 'impression' to
the resident, and we move on. the 'plan' is also transcribed but
remains nebulous "continue antihypertensives, monitor urine output". i
remain stunned and fall behind in rounds.

morning she looked awful. her face was swollen such that her eyes were
2 black creases. she was foaming at the mouth; unresponsive. apparently
her potassium was in the 6's and the serum urea was through the roof.
Dad was instructed to go to the pharmacy and buy lactulose (to induce
diarrhea so she stools out some of the potassium she is unable to
excrete by urinating). Dad says in a soft voice that he is afraid he
will get lost. He is reassured that he will not, and rounds continue on.

figiting with my camera when i notice the nurse pushing a clear liquid
through a syringe into the IV in lilian's hand. i ask what it is and
she replies 'adrenaline'. i grab lilian's wrist and feel for a
pulse...none. i grab the medical student who had been examining lilian
- "what the hell is going on?" He looks at me wide-eyed and stutters:
"we were listening to her chest and she just stopped breathing. I asked
for help and they brought this adrenaline."

group, which had moved on to the next patient, was slowly and without
any hesitancy making its way back to lilian's bed. i raise and place my
hands on lilian's chest (as in "news flash people i think we need to DO
SOMETHING" here) but before i even apply pressure, i realize that i'm
the only one moving. the attending reassures me, "there's no point in
resuscitating her. even if we did, we have no ventilator". she then
chastised the resident for ordering the adrenaline and moved on with

believe doctors care for patients to the best of their ability given
the availablity of resources. but i'm like "F you lady, you could have
at least tried!"

know i don't know jack about their world. i'm a american white guy,
raised in the suburbs who has no concept of the reality of life for
doctors and patients in
uganda. and who am i supposed to hate for the fact that they have no ventillator?

father never left for the pharmacy and saw the whole thing go down. i
tried putting my hand over his shoulder and muttering "i'm so sorry",
but i never saw one break in his face. the man just lost his daughter
and he was completely flat. not shocked, just flat. he told me in a
quiet voice that he was going out to make a call. two sisters
(nurse-nun types) dressed all in white came and wrapped lilian up in
her bed sheet. i remember them tying a piece of gauze around her head
and chin to keep her mouth closed. they folded the mattress and carried
her out of the ward, the other parents following with their gazes.

is so different for different people. you can never, ever judge or even
claim to really understand. the only truth i consistently come back to
is this: life is fucked up sometimes. it is not our fault - situations
may be made worse by generations of damage and corruption, but to
expend energy on assigning blame is wasteful and non-constructive. and
it is most certainly not God's will, for the sun shines on both the
righteous and the wicked.

i have faith in the perseverance of the human spirit. we should strive
for a world where basic needs are met and where people can share their
thoughts and feelings freely. i'm probably just on some
africa shit right now, but i believe that we can achieve this goal in our lifetime.

weird but even though the context has changed, it hurts the same way -
i feel awful for lilian's father. no parent should ever have to bury
their child. not in
new york city, not in uganda.

you've made it this far, thanks for sticking with. i miss you tons and
will be in touch. as emily would put it, expect more politicking. hit
me back w/ thoughts (like dude you talk to much..!)


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