This week I started work in the pediatric outpatient clinic just down a short incline from the hospital; 45 kids yesterday, another 25 today. In my entire seven years of medicine, I don’t think I have treated that many kids at once.
A little boy was brought in today. He was maybe four or five. The wiry older lady who brought him said that she thinks his parents might be dead but can’t be sure. I thought she was his grandmother, but apparently she is the caretaker of a run down ad-hoc orphanage somewhere on the outskirts of Port-au-Prince. The boy is rail-thin, but has a really big belly, not fat more like bloated. He has reddish, mottled, brittle hair. His eyes are sunken and tired; no childish spark, no curiosity. He exists – nothing more, no smile, not even scared.
Dr. Sophie, a traveling pediatrician from the UK, seems to think that the boy may have AIDS. We have no way of really knowing, but we get a sense that he is far sicker than one might think at first glance. Medicine is as much art as science, but unfortunately without the necessary resources we really have no way of coming to a complex diagnosis like AIDS. We turn back to the long line outside the little exam room. Some of the kids are really sick, but some are fine and just have parents with overactive imaginations. There is a saying in pediatrics that half the time you spend treating the parents instead of the kids. Parents often worry far too much, and generally want a much more complex explanation than we are capable of giving. “Madame, se pa grav” chased with a smile.
I finish at the clinic and retreat to our kitchen, which is really just an unused patient room with a table, chairs, hot plate and a dish rack. I settle to eat lunch with some of my coworkers, now friends. It’s the same staple of rice and beans with some sort of vegetable side; a meal with little variation that shows up everyday around 1:00pm. I’m about to start when I am called to help run a code downstairs on a 28-year-old woman. Her family noticed she stopped breathing and went down the hall in search of the nurse who then called the code.
Even in the best hospitals nearly everyone who stops breathing dies, so in a way her dying was not unexpected. But the whole event was just chaos – nothing about the situation was conducive to effectively managing a coding patient. We did not have the necessary medications in the crash cart – I had to run to the operating room and grab a small vial of epinephrine. Valuable seconds wasted. We arrived late; I have no idea how much time passed from when she stopped breathing to when anyone noticed and called the nurse. We didn’t have anything to put under her back to provide a stable surface from which to treat her. There were too many people in the room; we all pressed into the general ward which has 5-6 patients there at any given time, plus 1-3 family members per patient. And, of course our scrambling about caused a commotion and everyone within earshot moved closer to catch a glimpse. The hospital staff aren’t to blame for the chaos; many haven’t received any formal training for this type of situation.
But, was it our fault? Hard to tell. Maybe. Yes. No. Probably not? Regardless, the whole event remains unsettling. So, I found a sink, washed my hands as procedure, mopped up some sweat with the back of my hand and walked back upstairs and back to lunch.
It’s curt and far too contrite a statement to say “life goes on”; as though death merits little more than a sigh and a crisp Hallmark card. Yet, the reality is that as death passes through, life does go on. There is nothing deeper to say. Someone I don’t know died. I did my best to save her life. I failed. We failed. Sometimes we don’t. But, some people just can’t be brought back from the precipice.
There have been more deaths here at Haiti Adventist Hospital in the last six weeks than the entire twelve months of my internship at Hospital La Carlota in Montemorelos, Mexico. The deaths I see are mostly premature babies and the elderly. Babies too young to breathe on their own and grandparents too tired to keep on.
My mind goes back to that little boy again. Even if he didn’t have AIDS – what are his chances in this life? Where will he go? He is obviously malnourished. Six hours without food and I’m starving. How often does this kid even eat? I complain about the monotony of the hospital food, but I can wager this kid wouldn’t share my sentiment. I guess I have become a little complacent about my time in Haiti and the work I am part of.
Haiti is a beautiful country. I found that out when I first got here. Haiti is not at all like all the news reports you see of quarter after quarter of slums and torn buildings. I wanted to focus on Haiti’s beauty, but in thinking about how beautiful it is I must have forgotten a bit of how filthy, sick and wretched life in Haiti can really be. Haiti’s claim as one of the poorest countries in the world is not for nothing. When I see her people dying, and watch the kids with little hope for the future, it makes me take a step back to critically survey my own life.
What am I really doing for these people?
Am I really helping?
What is it, exactly, that I offer?
I wanted to come to a place where I could be sure that my actions really meant something to someone else, anyone else. But on days like today I begin to wonder how much what I do really matters.