Monday, August 17, 2009
Medecins Sans Frontieres by James Maskalyk
I sat down with the mother.
"Your baby's not breathing well. See? He's only breathing small. Not good. We need to help him breathe. Put this tube down his throat to push in air. I think if we do not do it, he will die. Even if we do, he might die. I don't know. It's the only thing I can do."
The nurse translated and the mother agreed.
I put the flat blade of the laryngoscope past his tiny white teeth and pushed his tongue to the side. I lifted the blade until I could see his vocal cords. They flickered with each breath. I pushed the tube past them, into his trachea, then attached the bag to it.
His oxygen saturation improved to 100%. His chest rose and fell with each small squeeze of the bag.
Muriel arrived from compound 2. She's young, was trained in Khartoum, and worked for years with MSF in Darfur. She was interested and competant, the best we have.
"Okay. Like this. Just a gentle push. Watch his chest. In...and out...in and out. This is the suction machine. You work it with your foot, like this. You'll need to suction him every hour or so"
I adressed the other nurses. "This is a hard job. You will have to help her. You too, Mom. She can't stop. If she does, the baby won't be abe to breathe and he will die. Okay?
We left them, Muriel pushig on the bag, twelve times per minute, 720 times per hour.
I wonder in cases like this, if the battle is worth fighting. The war is a long one and the odds are stacked so heavily that perhaps energy is best conserved. Maybe it's best to use likely defeats to increase our resolve to work towards a day when it will be easier to win. But then there is the other tack. Battle every time, with everything you have. Do the best you can for the person in front of you. Persuade the family of every malnourished kid to get into the truck, to come to the hospital to be fed until they are better. Track down each TB patient who left, frustrated, halfway through his long treatment and try to get him to come back even though the countryside is littered with tuberculosis patients we will never see and one case will not tip the balance sheet noticeably towards a TB-free future. To the world it doesn't matter that much. Until you remember that it means the world to the patient. One exact world, bright and full of sounds, per person. That's what is lost...
The next morning when I got to the hospital, Muriel was still pushing the bag. She had not taken a break all night. The mother was lying down on the bed, her hand resting on her child's chest, feeling its rise and fall.
I relieve Muriel, and she stumbled towards the waiting Land Cruiser. I explained to the mother that we had needed to take the tube out, to see if the child would breathe on his own. I suctioned his small mouth, removed the tape from around it and from the tube. I stopped bagging.
He was breathing. A little. More than a flicker, more than last night. I pulled the tube.
On my way home for lunch, I got a call from the hospital. His breathing was getting worse.
"Put him on oxygen," I said. We couldn't intubate him again. We didn't have the resources or the trained staff. Fifteen munutes later they called again. He was dead.