Two weeks into my time here, a 15 year old girl
checked into the Kopp. She was a very young 15, with a thin frame and the face
of a 10 year-old. When my attending saw her chest x-ray, he was so discouraged
and angry that he tossed it onto the table before I could see it. I was too
distracted by the patient herself to look at the x-ray. She had her hands on her
knees, and was leaning forward taking quick and labored breaths. Someone had brought the ancient oxygen
machine into her room and put her on a nasal cannula, which she clutched tightly
behind her ears. She held that cannula in place, I think because she was too
scared to miss one second of the air it delivered.
When my
attending had composed himself, he zeroed in on her mother. Although he already
had read the story in her transfer
documents, he asked her anyway.
Her
transfer letter from the hospital in Port-Gentil told an unforgivable tale, one
that started with her diagnosis of tuberculosis in 2010 in Libreville. The
letter than said that her treatment was “interrupted” by her parents inability
to pay for the complete treatment. In 2011, she started to feel ill again,
unable to sleep due to coughing fits and a fever that wouldn’t abate. Her
parents took her to Port-Gentil, where she restarted anti-tuberculosis
treatment. Again her six month treatment was again “interrupted” by her parents
inability to pay for the trip to and from Port-Gentil for her appointments.
Now in
February of 2012, almost 2 years after she was first diagnosed, she arrived at
the Kopp, with a chest-ray that revealed a fatal mix of atelectasis, fibrosis
and several cavitations. Her lungs were a mess, and my attending told her
mother as much: “Your daughter has NO lungs. She has no lungs. How are we
supposed to help you?”
In the
afternoon, when I returned to enter lab results, she was doing worse. The
oxygen settings were maxed out and she still couldn’t seem to catch her
breath. Her mother was frantic at this
point, coming into the nurses station every five minutes exclaiming: “She can’t
breathe. She can’t breathe.” The nurses were empathetic, but weren’t as
affected by her sense of urgency.
I saw her myself. She was scared and tired.
Her eyes frantically scanned the room, looking from face to face, from mine to
her mother’s to the nurses’, as if searching for oxygen in our expressions. I
called my attending on the phone and told him what I saw: She was tiring and
seemed like she wouldn’t be able to keep up this marathon breathing for much
longer. He listened to me and said only “OK.” I wanted him to tell me to hang
something, to change oxygen settings, to arrange a transfer; I wanted him to
tell me to DO something. But he didn’t. It is the most frustrated I have ever
been with an attending.
What I
didn’t know was that my attending had been in and out of the service all
afternoon and had seen her worsen. The nurses knew, the doctors knew and I
think even she knew, but when I saw her at 5 o’clock I had no idea. Everyone
knew she was going to die, except for me and her mother.
She died
overnight. Too tired to breathe, she died of a curable disease. A professor of
mine once siad that it is stupid to die of tuberculosis today. The combo
medication of RHZE works and works well. All that is needed to secure a
complete recovery is strict compliance with the regimen for 6 months.
My last
memory of her was seeing the fear in her eyes and kneeling in front of her. Her
mother, had grabbed my arm and pulled me into the room. As a medical student, with really no idea what to
do in the situation, I did the only thing I knew how to do. I knelt in front of her, put my hands on her
knees and said “Its ok. Its going to be ok.” I smiled at her, in an attempt to
reassure her. Because she looked like a child, I remembered that in Pediatrics
I learned that children with trouble breathing should be kept calm. Her breathing
slowed a bit and my last thought before I left was that if she could keep calm,
she wouldn’t tire so quickly and would make it through the night.
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