Thursday, May 10, 2012


its so hard - sacrificing individual children for the good of the hospital

in fact, i don't really do it that often, being a firm believer in the individual over the collective

but.....the hospital does have to be self-supporting - if we give everything for free.....what about those thousands of babies 2 years down the road, what will they do if there IS no hospital......

i want to give everything for free. 

I want to assess a patient - make a list of their s/s - and give them everything they need

I want to give them fluid - even just maintenance fluid
I want to give them nutritious food, 3 times a day
I want to give them a bath
I want them to be laying on clean sheets, instead of puddles of urine and sweat
I want them to get a full course of antibiotics
I want them to get as many days of IV quinine it takes for them to get better
I want to test their Hemoglobin, if they look pale
I want to kick their families out and strictly enforce visiting hours
I want to give juice - when they refuse to drink
I want to give all their medicines IV - when they are throwing up
I want to give Tylenol every 4 hours, instead of every 8
I want to call a code, when their heart stops
I want to breathe for them, when they stop breathing
I want to give them epi, atropine, etc
I want to shock their heart
I want to give them oxygen
I want to hook them up to a ventilator
I want to call respiratory
I want to make them sleep under mosquito nets
I want to adjust their air conditioning
I want to get a nutrition consult
I want to give them multivitamins
I want to call hospice
I want to consult wound care
I want to draw a rainbow - and analyze the bloodwork
i want to give them dextrose - when they are hypoglycemic
I want to check their blood sugar
I want to get an EKG
I want to get an CXR

I want to give them the same thing a patient in a fully equipped hospital would have -

 a chance

a chance to live
a chance for their heart to stop beating again
a chance to come out of their coma
a chance to die peacefully
a chance to be cared for at home
a chance to battle cancer
a chance to know all their options
a chance to recover

just give me some oxygen
give me a well-stocked pixus
give me regular vital signs
give me a crash cart

tube the medicines I want up from the pharmacy
give me a stat on that order

give me a society that lets their patients pay later
give me a society where you will get the best care possible - regardless of your bank account

give us a chance
to give them a chance

it is just so unfair

another kid died tonight - i knew he didn't look good, kept assessing him, re-assessing him - they had no money  - but he went faster than i thought he would - there isn't anything we have here that could have helped.....

and then you take the IV out of a limp grey hand - and they cover the face - and walk away

and then everyone else wants to leave -

and you tell them to stay - you point out, if they go home, their kid will probably die

threaten and bribe them to stay the night -

buy the medicine they have no money for - the IV quinine the kid desperately needs

and then the others see it

they expect you to buy their medicine too.

they didn't buy the medicine today - now they really won't buy it

so by buying that kid his quinine - am I helping, or hurting

They won't go look for money

they may have it, they may not

but they will look you in the eye, and tell you they have nothing

there is no way of knowing

I made someone cry tonight - insisting she buy an IV - telling her she had too

But I made another man buy quinine - a man who had been refusing to buy all day, insisting he had no money - and then i talk to him one more time - and there he is pulling out his wallet -

its so brutal to demand someones money - to argue with them, to insist that they pay - to tell them to trade in their phone, their bike, to call their relative - to basically hassle them until they pay.  but when every single person looks at you, sees that you are white, and tells you: i have no money.  What are you supposed to do??  how are you supposed to separate the liars from the destitute - 

and when i saw that man, the man who insisted he had no money, when i watched him pull out his wallet that was falling apart - and carefully pull out his 2,000 CFA ($4.00) and buy the quinine, and the Glucose, and then walk back slowly with his shoulders hunched - my heart broke.

because why did he lie?  because I'm white??  probably not just that - he could have spent his last money - he may go hungry tomorrow - his other kids may go hungry tomorrow - he may not be able to pay his bus fair, he may not be able to take the next sick child to the hospital - and for what.....a quinine perfusion.  but whats the alternative?  letting the kid die??

but is someone else going to die so this kid can live?? 

is the whole family going to go hungry?? 

we think they don't care enough about their kids - but we may have no idea what they sacrifice

we may have no idea what its like to decide what to do with your last dollar 

knowing that either way, someone you love will suffer

the cycle of poverty generates an environment in which impossible choices must be made every day, choices that leave you sick to your stomach, choices you may never forget, choices you should never have to make

and the mother - the one who really didn't have any money, the one who looks 14..... she had walked miles today, shown up at the hospital with nothing, has not eaten all day, will probably not eat tomorrow, is sitting there with her head in her hands because she is just so exhausted. 

her baby is tiny - stick thin arms and legs covered with wrinkled skin - a smooth old face - he hadn't eaten or drank all day, I put an NGT in and now he's at least keeping something down

so should i feed her?? and if i do, will I have to feed everyone?

should i buy her the IV?  and if I do, will I have to buy for everyone??

I had IV fluid - and I didn't give it to a kid that needed it tonight, a kid who when you pinch his belly it stays in the shape of a tent, and I didn't give it because if I did, they would no longer buy any of his other medicines......

i hate the brutality of this kind of nursing

I hate utilitarianism

it works in theory not in practice

it only works when you can't see their faces

the individual that didn't get what they needed so the nameless thousands in the distant future would be okay

what am I supposed to do? 

half the patients hadn't bought their next dose of IV quinine tonight - I get report - oh, they didn't buy it. 

but I'm still an American nurse, I still take personal responsibility for the scheduled medicines on my watch - If they don't get it, if there is a full 24 hours between doses, if they miss a day - the quinine levels are not staying therapeutic in their blood, the parasites are not dying, your body is developing resistance, its just bad care on so many levels

so what am I supposed to do?? pay for everyone?  I can't.  I shouldn't.  we are not here to give handouts.  In the broader sense, where your not looking at a shrunken feverish kid, handouts are crippling - they are whats WRONG with least a piece of the puzzle

and so we trade this for that, and barter and plead and threaten, and translate, and shove the carne under their face, and gesture emphatically toward the pharmacy, remind them funerals cost much more than prevention, glare and insist, and slip off to buy it for them and try to give it unseen by the others, and somehow it comes together every night.......

what am I supposed to do?? 

I hate this part of it - of stripping the poorest of the poor of their last penny -

walking around with my nice phone and nice stethoscope - there is judgement in their eyes

but their is no alternative

if it was America, would we look for the money?? would we call all our friends and relatives and surrender our car for collateral???  would we fight for life the way we are famous for, would we never give up if we payed for EVERY SINGLE THING upfront???  EVERY siringue to flush the IV.  Every single medicine - EVERY IV???? 

and if we saw someone getting something for free, would we hold out, to the detriment of the child, hoping we could get it too??

or would we, as some people do, spend our income for a year - get deeper and deeper into debt....saving a child when several others had already died????

if we were living on less than a dollar a day....what would WE do???

somehow....i don't think it would be much different -

but no matter who is in what situation.....

the hardest thing about working here is that it is grossly unfair - all of it. 

that someone has to die because they were born into the wrong country.......

because some environmentalist somewhere that never saw a malaria patient taking their dying breaths - decided to wage war on DDT

that a child has to die because the parents don't know any better

that the parents didn't know any better because their parents didn't know any better

its terribly, terribly unfair

and we shouldn't be content to let it stay this way. 

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