I am the reporter

Today was like the start of any other day.  But this is not Lake Wobegon.  We had morning report and chart rounds and a nice discussion of a difficult medical case in this resource-poor setting that is Ilula.

A twenty year-old man was seen for the third time over several months, condition gradually worsening.  He had severe hypertension and increasing dyspnea with the diagnosis of pulmonary hypertension.  There were several odd items in the history.  First, this is rare in a man although it does happen in women his age more often.  He also had severe hypertension and dyspnea.  When it does occur, it is often associated with HIV.  He was negative.

At home, we would have used sophisticated echocardiography, EKG and CXR to make the diagnosis and then would have wanted him to be in a center where experts could take care of him. We do not have those diagnostic tools at Ilula.  Chandra, our third year FP resident did a brilliant job discussing other likely possibilities.

The young man died.  If the diagnosis was incorrect, in the US several other possibilities could have been managed well.  We are blessed at home to have well-trained and brilliant doctors like Chandra (and no doubt our other students will be equally trained and talented).

Life goes on.  For some.

As I walked toward the ward, I heard the mama’s wails and saw Astrid and Shana standing outside the ward.  The others were still inside.  Astrid told me the story, which I report, not as a witness.  A fifteen month-old infant with a known cardiac problem of some kind had been admitted over night and put on oxygen due to respiratory distress.  Rather suddenly, the infant quit breathing.  Only a moment before Jill had examined the baby who had no obvious chest findings.  The staff began CPR, but ineffective, so our team took over, to no avail.

The baby died.  I do not know what might have happened at home.  Our pharmacy team felt deskilled in this predicament.  Their armor had been stripped away.  They had no crash cart full of life-saving drugs.  They had no team familiar with the protocols of a well-oiled crash team.  The doctors and med students were no better served.  Cole put something hard under the child to augment Shana’s efforts.  There was no bag or mask handy.  It was locked in the surgery theater.

Thus the team’s efforts proved frustratingly futile and the baby died.

Theoretically, each of these humans would have had a better chance if born in the USA.  There are many “ifs” however.  If we had better diagnostic tools (a year or more ago); if they had better training; (if I had better training, etc.); if, if, if.  It will be years before the technology reaches Ilula Lutheran District Hospital.  For now we can only keep on coming, bringing students and residents and faculty dedicated to doing the little things we can, teaching and questioning in a learning, not critical fashion.  Ilula’s staff is just as brilliant as any of us and without the tremendous advantages we have had in our training and careers.  I never forget this, no matter how frustrated I may be.

The whole team was devastated by the infant’s death.  We returned to the faculty house to commiserate and vent.  When we got around to naming the emotions we were feeling, I heard anger, frustration, helplessness, sadness, inadequacy – all our humanness came to the fore.  There were tears and pain.

Friends from Como Park Lutheran came to tour the hospital.  We entreated Pastor Marty Erickson to pray with us about our experience with this small child.  I felt some personal healing in his prayer.

Despite our tragedies today, we had a rewarding and pleasurable visit with The Como Folk.  Truly, a help after trouble.

One life leaves and another arrives.  This afternoon Dr. Leslie and Laura delivered a breach presentation baby by C-section.  It went well.  A fitting end to a trying day.