A sombre moment

Death can be sad, it can be funny; sometimes it feels right, sometimes it feels stolen. This morning as I skipped merrily into the paediatric ward I learnt that a five year old boy I had seen the day before was dead. Death is quite a common theme around here, especially with the amount of young children and infants I see with HIV related illnesses. However, this one was quite unexpected, if I can refer to it in that way. Yesterday the boy was all gay and happy; twelve hours later his heart stopped.

He was admitted the previous night, accompanied by his family, after a horse had kicked him. This is not an infrequent presentation here. Often the kids bounce home after a brief admission for observations, with only a few cuts and grazes to show. He was no different from any of the other children I have seen; in fact I would have said he looked far better. He had a niggling tummy pain, like many of the children do, but no other signs or symptoms of impending doom. He was very much “stable”. I kept him in for observations. During the night he started vomiting and became very agitated, according to the staff on shift. He was probably bleeding internally. No doctor was called and he gradually deteriorated. Why observe someone if you’re not going to act on the results?

I saw the mother this evening. She presented to casualty in a state of hysteria. It all felt so unjust. He was so well. Learning from your mistakes is one thing, but when it takes the life of a child it is a very different matter indeed. I am not trying to say that a child’s life is worth more than anyone else’s, but for whatever reason, it can sometimes feel more significant. What could I have done differently? Or, more to the point, what could we have done differently? Could we have prevented this untimely death? A question I’m sure his family are pondering, as well as myself.

I keep asking the nurses to call a doctor if a patient’s observations jump the wrong way, but the message doesn’t seem to have quite got through yet. Instead, I often get told the next morning that a child’s condition has changed and that they have “rested” (i.e. died). Hence, I try to get all my unstable children transferred to a better staffed unit. Often there isn’t a lot we can do, but in a case like the above, we could have definitely tried. I don’t blame the nurses though. I can see their point of view. They are very short staffed too, frequently have inadequate training and often have difficulty, to the extent where it is almost impossible, to get hold of a doctor. This is especially true at night when there is only one clinician on call. Hence, I visit my ward at least once a day and liberally dish out my speed dial so that I can be called.

There is so much to address, but we will get there one little bit at a time.