Not fast enough

Warning – this post talks about a child dying.

Yesterday was a really tough day for me. V, the other pediatrician, didn’t show up until 4pm. He had texted me in the morning to say he would be preparing for a presentation and should be in by 1 or 2. So, I was on my own seeing the roughly 50 inpatients in the hospital, as well as any outpatients.

We relied on our security guard, who controls who enters the unit, to triage any outpatients that arrived to be seen. Usually there are 30 or so who show up to be seen for colds, tummy trouble, etc. (There is another place at the hospital where outpatients are seen, but many prefer to be seen by V, who is one of the only pediatricians in Saint Marc, so they just show up on the wards and he sees them there.) He only let in those who he thought might be gravely ill. Not a perfect system, but we did still see some sick outpatients without the usual large crowd of not-urgent outpatients.

My first patient of the day was one who had been admitted with dehydration from vomiting and diarrhea early the previous morning. She had been severely dehydrated, so V very appropriately ordered IV fluids to rehydrate her. She then sat waiting for a nurse all morning without receiving fluids or any other hydration, until the mother carried the now-limp child back into the evaluation room in the afternoon. She had gotten much worse, and required CPR to resuscitate her. She finally got fluids, but it was too little too late. I found her near-dead yesterday morning and my best efforts at resuscitation (best under the circumstances) were not enough to save her. She died after about an hour of our efforts.

Any child’s death is tragic, but this one stung extra due to the factors contributing to her passing. In the 21st century there is no reason a child should die from gastroenteritis, particularly not one who has presented to the hospital in time. She didn’t receive fluid in a timely fashion because our two nurses were so busy seeing the 50+ patients already in their care that they simply couldn’t spare a moment to start IV fluids for this new child. That is partly due to understaffing and partly due to the extreme chaos of the workflow. We also lacked the equipment we needed to resuscitate her optimally. For instance, I don’t think having a suction catheter would have changed her outcome, but it would have been good to be able to do things the best, not just the best we could manage.

I am hoping today will be better, but there will have to be some real changes for things to actually improve. Some days piti piti just doesn’t feel fast enough.

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5 Comments

  1. Karen Stockmal

     /  January 27, 2012

    Sara,
    I am so, so sorry about your patient’s death. There really are no words to make sense of such a tragic loss. As I read your post, I was reminded of the Serenity Prayer. In letting that child’s death inspire you to continue your work, you give meaning to something that seems so meaningless.
    Hang in there. If you need anything that we can provide, please let us know.
    We love you.
    Karen

    Reply
  2. Cynthia Halligan

     /  January 27, 2012

    Hi Sara,

    I know its been sometime since we’ve seen each other and spoken – June/July in Boston during the Creole course. I’ve been following your postings and your process to working in Haiti here and on facebook. I think what you are doing is beyond great. The easy route would have been to work as a peds doc in a comfortable setting somewhere in the West but instead you chose the difficult road. I do not understand what you are experiencing there in Haiti but I try to as I read your postings and as I read and write about social justice and healthcare as an academic. More importantly, what is “beyond great” about what you are doing is that you are writing about your experiences. You are making the invisible visible by working there and writing about it. You are making what Farmer calls “stupid deaths” visible. Also, it helps me with my work to know that there are wonderful people like yourself working in resource-poor settings doing their part. Thank you for continuing to write about your experiences. Don’t forget to take care of yourself so you can continue to do this work for years if you desire to do so. Cynthia

    Reply
  3. Dear Sara,
    I just read about the tragic loss of your little patient. Karen talked about it tonight while we were at her house but I had not seen it until now. I have real tears for that family and for you. What your doing to try and help these people is wonderful and at the same time unbelievable. I truly believe your a Saint for putting yourself into this type of situation. If we can do anything to help your cause please let me know.

    Love,
    Uncle Dick

    Reply
  4. Thank you for the comments!
    Karen, it will definitely shape my thinking about my work in quality improvement here.
    Cynthia, zanmi mwen! Mesi pou w comment la. You’re too kind. It’s great to hear from you. I am taking kreyòl lessons (okay, tutoring) again, but it’s not quite as much fun as our classes were! Paul Farmer is right, they are stupid deaths. Such a lot to process. The blogging helps.
    Uncle Dick, thanks for your support.

    Reply
  5. Jaime

     /  February 3, 2012

    Proud of you Sara! This should make anyone receiving treatment in the US really appreciate the care they are given despite human errors. The nurses and fellow physicians you are working with where you are, are never going to forget your passion to save a human life. I appreciate hearing that you go the length may e if you know there is a slim chance. That’s the kind of Ped I want for my kids, someone with hope, someone with faith when noone else has it. Don’t lose it.

    Reply

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