Adam update

These last couple days have been particularly rough, mainly because of patients I am taking care of on the ward. Yesterday on rounds we had a 20-year-old woman with HIV and TB pass away in front of us, as we debated and tried to decide if there was anything else to do. The answer was clearly no, and as she died, her mother stood in the middle of the ward wailing inconsolably. I felt helpless in that moment as she ran out of the ward. A mother should not have to witness the death of her own daughter. Her daughter had been sick for some time, being treated at another hospital without improvement, and Tenwek was their last hope for a cure, for recovery. I never saw her with any level of meaningful consciousness, and we knew from the moment that she was admitted that she would probably not make it. Still, it hurts to see.

This morning prior to rounds, my intern pulled me into the ward because there was a 62-year-old lady who was barely conscious and clearly struggling to breathe. She had been admitted overnight, and had been previously healthy prior to becoming suddenly sick. It was unclear what had happened on our first assessment, and labs were unrevealing. The differential for her problem included sepsis, stroke, or even poisoning, and we were treating her with antibiotics. The hard part about this case is the uncertainty we have to deal with when faced with limited resources. In the US, we would have obtained CT scans, extensive labs, and maybe reached a diagnosis. Unfortunately, with the limited abilities we have, she passed away this morning prior to rounds. Who knows, even with all the resources in the US, she would have died anyway.

Then on rounds we were faced with another lady in her 30’s, previously healthy, who came in with fevers and had become unconscious overnight. Again, our best guess was meningitis, based on findings from a lumbar puncture done the day before, and she was placed on appropriate treatment. Again, we spent significant time on rounds trying to decide if we should move her to our limited ICU, intubate her and place her on a ventilator. With the severity of her condition, the doctors here said that the chance she would survive was almost zero, and that would tie up resources for someone who had a better prognosis. I had to explain this to the family, who continued to insist that she had swallowed something that was blocking her airway, and if we could just get it out, she would be fine. I don’t even know how to deal with that one, and rested on the help of my intern who was translating for me.

This afternoon I saw a patient who tried to commit suicide by organophosphate ingestion and was in status epilepticus. While pushing phenobarbitol, we transferred the patient to the ICU. I intubated the patient after the tube dislodged on the way to the ICU. We will see, but he is the most likely to recover as the poison wears off.

So, I haven’t figured out how to deal with suffering during this month. One option is to be overwhelmed with grief. Here this can be very crippling as people die every day. Another option is to become callous, and even complacent, which I have become to an extent to protect myself. These last two days have broken down this wall in my heart. Seeing the families’ desperation as their daughters die in their arms is enough to do that. I suppose the real answer is somewhere in between, accepting those things that are inevitable, striving to change those things which you can, and being filled with compassion at all times. It seems an impossible task, but thankfully with God all things are possible.

Adam