My Patients and My Patience

As my Nepali improves, and my knowledge of the hospital routine, I have had some really good experiences taking care of patients. Kalpana is an 8-year-old girl who came in with meningitis/encephalitis – an infection of the brain that can be caused by bacteria or viruses (some of them mosquito-borne). When she arrived, she was unconscious and paralyzed on the right side. During her two weeks in the hospital, she made very slow but significant recovery. She woke up, responded to commands, was able to move her right arm and leg a bit, eat, and sit up (with assistance). However, she still isn’t talking and has not recovered full strength in her limbs yet, so her prognosis is guarded. The occupational and physical therapy team worked with her and her parents, showing them exercises to do with her to re-teach her brain to coordinate movement and hopefully strengthen her muscles. I enjoyed being a part of her care team and learned a lot about encephalitis and meningitis in the process. It was great to write her discharge and see her parents take her home. Please pray that she recovers fully. A child with physical handicaps is a tremendous burden on a rural Nepalese family.

Sisir is a 5-year-old boy who presented with a huge lump under his right jaw. It looked like mumps, but mumps is generally on both sides of the face. He had a low-grade fever and tenderness in the area. It could have been an enlarged lymph node or a developing abscess. The lump measured 7 x 5 cm on admission, but quickly shrunk to less than 2 x 2 with IV antibiotics. He was very happy to be able to go home for Dasai! Sisir’s dad spoke a little English, which made my daily interview and exam much easier. And I heard Sisir counting to ten in English on one occasion, so I entertained him by trying to count to ten in Nepali.

Bikram is a 3-year-old boy who came in with 15 days of fever, decreased appetite, and general malaise. He had a huge liver and spleen and was diagnosed with typhoid or enteric fever (caused by Salmonella typhi – not the same Salmonella that causes food poisoning, but related). His mother was beside herself because day after day, Bikram kept spiking really high fevers and not eating well. One day she was in tears with worry and asking why he wasn’t getting better. Typhoid is like that – it can go on for days or weeks, even with antibiotics. I told her in very bad Nepali that I was praying for her – no idea if she understood or not – and asked the pastoral care team to visit and pray with her (I don’t know how it was received or what effect it had). However, the next day, mom was all smiles and reported that Bikram was better, the fever was much less, and he was eating well. They went home the next day, very grateful for a good recovery. I hope that somehow they experienced the love and healing of God during their short stay here.

Other stories are not so happy. I have seen so many children die the past four weeks – of meningitis, overwhelming infection, and respiratory failure. This week, I was taking care of a preemie born at 31 weeks (about two months early) weighing 1700 grams (normal 3000-3500). He was jaundiced and had to be placed under a special lamp. And he had a heart murmur from a patent ductus arteriosus (a shunt between the aorta, which pumps blood to the body, and the pulmonary artery, that channels blood to the lungs to pick up oxygen). A PDA is normal and useful before birth, and it usually closes within hours to days after birth. But this baby’s stayed open for some reason, causing his little heart to work harder, pumping more blood through his lungs, and decreasing flow to the rest of his body. Then, unfortunately, he developed necrotizing enterocolitis (NEC) – a condition in which portions of the intestine become injured and die, causing bleeding in the stool and even perforation of the intestines at times. Premature babies are at higher risk of NEC and are less likely to recover. This poor little guy just couldn’t overcome all of the problems he faced. He started having trouble breathing and finally just stopped. It was really hard to see him in the end, but it was even harder to see his mother’s reaction. She was beside herself with grief from the moment he began to go downhill, sobbing, wailing and even falling (or throwing herself) on the floor in agony.

Perhaps even more troubling to me, though, is the lack of emotion from parents. One night in the emergency room, a 2-week old baby was brought in blue and not breathing. We tried to resuscitate him unsuccessfully, and he was pronounced dead on arrival. The parents did not show any sign of distress. They simply signed the paperwork and took the body home. Some people say that parents here don’t get “attached” to their babies too soon because death in infancy and early childhood is so common. In fact, many babies are not given a name until some days or weeks after birth. It is hard for me to believe this is truly the case. Surely any woman who has carried a child in her womb for nine months and nursed him at her breast for even a short time would feel some grief if the child died. Perhaps those parents who don’t appear to grieve are simply hiding their pain deep inside until they can express it in private. I suppose doctors do the same thing. I certainly felt like weeping and wailing for that baby – so cute and chubby like all babies are, but lifeless – and yet I simply went on with my work.

Seeing children die is a challenge to my spiritual and emotional equilibrium. I am forced to grapple with the reality of death and disease while attempting to show empathy, compassion and love to my patients and their families. How do I feel their pain without succumbing to it? It is such a joy to see a child get well, to see a baby smile and coo or a 5-year-old running down the hall of the pediatric ward. But to see a child in pain, gasping for breath or delirious with fever defies everything that is good and right and beautiful. I am so thankful that we have medicines and procedures that make people better, and that God in his mercy has given us bodies that have remarkable healing capacity and the knowledge and ability to harness that capacity to speed or assist the healing process. Ultimately, however, life is not ours to give or take, and even as a doctor I can only wait on God and plead for his mercy. It’s humbling. But I have been meditating on his promise that one day he will wipe away every tear, and there will be no more sickness, no more death, no more pain or grief. In the meantime, I find I need to go to him every day to renew my capacity to love and show compassion.