Give me beads over blood any day.
This morning, blood. My sickest little patient, a comatose 1 year old, lay jaundiced and limp. After two days of antimalarials and powerful antibiotics, his feverish convulsions had quieted, but he remained weak, obtunded, jaundiced. As we made our way around the ward, the attentive dad pointed out the bloody stool that this baby had just passed. I suspected this was a pre-terminal sign, and labored over his exam, to find anything we had missed. I pulled down his eyelids: now frighteningly pale, the combination of malaria and chronic anemia and now gastrointestinal bleeding conspiring to drain his life. Our most competent nurse quickly took a blood sample to the lab to get blood as we prepared IV fluids, but within ten minutes he was dead. This boy’s mother is mentally retarded, she sat expressionless on the bed, perhaps unable to comprehend the loss. But his father, the one who had carried him in, who had sat by the bedside, who had managed his care, understood. He began to sob. I rarely see a man cry here. The usual post-mortem scene is of wailing screaming women, writhing on the ground, while grim men gather the body and stride off towards burial. But this mother did not react, and this father had those shoulder-shaking heaves as his tears began to flow. Mine too. This boy needed an ICU, instead he had us, and we were not enough to hold on to him in this world.
This afternoon, a bead, the far opposite end of the spectrum. Two grandmothers appeared in the kitubbi just as I was heading off. Sigh. What now? I read the referral: the child they were holding had been send to the operating theatre in Bundibugyo . . . For a foreign body in the nose. I could have given them transport money, probably what they were hoping for. Instead I went inside for a flash light and my handy little ear-wax remover, part of the essential pediatrician package, a sturdy pen-like instrument with a small wire loop at the end. A few seconds later I had determined which nostril held the object, and reached past it with the loop and pulled it out. A bright orange plastic bead, just like the dozens that were braided into this toddler’s hair. The old women jumped to their feet and began a spontaneous song and dance, they were so happy. Me too. This is my kind of problem: concrete, limited, solvable, with clear evidence and end points. I laughed with them. They must have been very worried, and must have been so attached to this little girl, their rejoicing was refreshing.
I have to admit that I prefer beads over blood. Something I have the tools to handle, something where I can see the problem and make a difference, in a very short time. No patience required, and little faith. No broken hearts, no tears, and quick glory. Why can’t more of my life be like that, instead of convulsions and tears and blood and feces? Why can’t my problems be as shiny, compact and tangible as a bright orange bead?