.puff

today is May 6. 

We have had 6 days in May.  We have had 5 children die in 6 days.

4 of them we were treating for malnutrition

Bed 7 alone is left - Out of the 5 kids we have been cooking up bouille for the last week - of the ones we have been fighting for, trying to rehydrate, trying to save. 

Bed 5 died - he was covered with sores, he never stopped crying

Bed 6 died - malaria, dehydration, malnutrition - dyspnea getting worse and worse

Bed 9 died - malaria, dehydration, underlying malnutrition

Bed 10 died - the one I just wrote about - the one i wanted to live - the one that was 4 kilos and 3 years old - now i want to delete all the pictures because the blog seems like its mocking me

the mother of bed 7 has sat there, her child in her arms, or propping him up on fluffy arabic pillows - feeding him eggs and growing gradually more and more distrustful of the bouille we brought - the child won't stop vomiting, won't stop having diarrhea - but she saw us give the bouille to everyone else - and she saw them all die.  She saw me put down the NGT the night before bed 10 died - and so she refused that too. 

all her neighbors have died - she has sat there - holding her child, closer and closer, watching literally every child in every bed surrounding hers take their last breath.  Now, it is just her on that side of the ward - an oasis of fabric and color and pillows surrounded by empty black mats.  an island. 

The other week I had broke down sobbing hysterically - there was a child that I didn't assess properly - didn't follow my gut, let an argument with the next shift frustrate me to the point i left the free form and all the medications she needed in their hands - and left.   after i left i thought about it all night and all morning - and i knew i should have stayed - should have argued and pushed and followed the paperwork all the way through until the medicine was actually in her veins...... 

and so when i came in to work and saw that she had just died - i lost it.  because there was a clear chain of events in which i was implicated -  Olen was there and pointed out that he hadn't expected her to make it as far as she did and that she had been breathing poorly for days. 

"you will kill a patient,"  he said.  "you will.  eventually, you will make a mistake that kills a patient.  We all will.  But it was not today, it was not this patient."

and now, its ringing in my ears

you will kill a patient

even worse

you will kill a child

and all histrionic nonsense aside, this time it is true. 

I have killed a child

I was fighting a war, a jihad, a crusade.  I was calling Bronwyn to bring bouille and mixing up ORS and collecting empty bottles to put it in.  I was writing it as medicine on the dossier and instructing the parents to give it every hour. 

I knowingly mixed up the ORS sachet's wrong, made them too strong.  because i thought, they won't give it anyway.  the other nurses won't give it.  The family will ignore us.  I am always infuriated to find the bottles at the same level as I left them when i come in the next night. 

and so i thought, mix it strong.  more bang for your buck.  more rehydration in every drop. 

and I told them to give bouille every hour - thinking, they won't give it anyway - no one else will give it except me and Bronwyn, the nures won't give it.  the family will ignore us.  night after night the bottle would be at the same level as when i left, the families would refuse to give it - woman after woman would refuse - stating all sorts of wild claims as to why it would not work - its making his stomach hurt, he doesn't want it, the sugar is giving diarrhea. etc.  etc. 

and then me and Bronwyn would plead and fight and force and translate and argue and just try to get SOME nutrition and hydration into these kids

i barged into pediatrics, knowing very little about malnutrition, having researched and read very little, somehow convinced myself i was an expert on the subject, never once bothered to break down calories or calculate protein and sugar content, never once trying to get an exact textbook formula about how much should be given, never once differentiating between the different levels of severity of malnutition, never once realizing that different kids needed to be started out differently. 

I never once thought about any of those things. 

a person that knows very little but thinks they have all the answers is far more dangerous than a person that knows they don't know

i was dangerous. 

I am dangerous.

and i had NO idea.  it didn't once cross my mind. 

but every one of these 4 babies died within almost 24 hours of starting to feed and hydrate them. 

would they have died eventually??? yes.  probably.

did I kill them?  not technically.

did I speed up the death?  absolutely

we were flooding these kids with protein - giving feedings that were too large and too concentrated

I was creating dehydration and lethal electrolyte imbalances by giving severely malnourished children concentrated ORS -

i found out today it should be into 2 liters instead of the standard 1 when you are working with malnutrition.  I was putting it in 1/2 a liter. 

i was cutting the fragile, fine line that separated from life and death

and i didn't even know it. 

these kids, they are on death's door.  they are already trying to fight malaria, support IV quinine, and IV metro, and get rid of parasites, and then I go and flood them with protein, potentially give them re-feeding syndrome, screw up their electrolytes beyond repair - and bam another one bites the dust

....."and another one's gone, and another one's gone, another one bites the dust.....""

it is chilling

but isn't this what we so often do?  we that think we have all the answers, that are so convinced we are doing right and doing good, we that have no idea we are actually killing what we are fighting to save?  isn't this a horrific real life metaphor for what the West has done in so many African and other 3rd World countries - well meaning individuals, churches, organizations charging in with the magic fix and trampling the delicate balance of life and death and culture and survival. 

i'm playing with life and death like i'm blowing bubbles or taking an evening stroll

yeah

puff

your dead

puff

your gone

remember.  i wrote that last night.

i just failed to say it was I who blew out the candle.

and I'm not interested in hearing that it wasn't me.  I full well know that there were other co-morbidities, that they had been sick for years, that they waited until the VERY last minute to seek care - that if I never touched them they still might have died

I am not interested in being absolved, nor am I interested in taking all the responsibility. 

I am interested in saying that I was wrong.  so. very. wrong.  and it caused small tiny wrinkled up humans with wise shy eyes to die a little sooner than they might have. 

I am interested in admitting that I was treating a disease i did not have a full understanding of with a treatment I had never researched and knew very little about and despite those glaring facts I would have argued you into the grave and out of my life that I was right, i was doing right, i was saving lives, I was right. 

do you get it?  how chilling that is?

but i also have realized that i have been playing with a very fragile disease, with very fragile lives, with LIVES with LIVES with life and breathe and little fingers closing around mine that will be dead tomorrow - i have been playing with the lives of people's brothers, sisters, daughters, sons, grandchildren, children, only children. 

and i never paused to consider that I didn't understand what i was doing
I never paused to consider that i didn't have all the facts. 
I never paused to even consider if I should consider. 

and that is the problem. 

puff

your dead

puff

your gone

puff

i blew you over

puff

I'm sorry

it is chilling. 

i was so caught up in the rightness of my cause that I didn't even pause to consider if I was going about it the right way - and that is a horrific lesson that I need to learn, that anyone, anywhere, especially those who play with life and death MUST consider

but its not like I'm beating myself up very much.

i feel more of a clear headed horror mixed with grim determination to learn from this and NEVER ever play with a life without knowing all the facts. 

do no harm

thats what we are supposed to do, as medical professionals.  people have their lives in our hands.  and we owe it to them, i owe it to them, at the very least to be as smart and intelligent and and well-read and as well-informed as possible - its the least i can do, its the least i didn't do, but it is a moral imperative. 

puff

your dead

puff

your gone

puff

i blew you over

puff

i'm sorry