patient snapshots

I wanted to share a couple of patient stories that have particularly struck/moved me in my time here so far.

The first patient made me cry.  A mother and her parents had brought in an 8-month-old baby girl with jaundice.  Through the grandfather's explanation and a few questions to my resident, I figured out that she had been brought in six or seven months earlier for jaundice, found to have biliary atresia, and undergone a Kasai procedure to allow the bile to drain from her liver.  This had since failed and since liver transplantation was not an option, the goals of care at this point were palliative at best.

The grandfather told me that the itching (from hyperbilirubinemia - high bilirubin levels in the blood) was keeping her up at night crying.  Her bilirubin had gone from 17 at the last visit to 19 and her alk phos from already elevated in the 100s to high 200s (a sign of obstruction).  Upon reiteration of the no-more-options place we had reached in treatment, tears welled up in the mother's eyes.  The grandmother took the crying, fitful baby and walked away, wiping her own eyes.  I patted the mother's shoulder helplessly and found a tissue in my purse to offer.  Eventually we led the patient's family to an empty room to allow them to talk and cry, and I left the room crying myself.

A second patient that moved me was a child I saw during my time on pediatrics when I went to ID clinic where they see HIV-positive patients.  I am sure I will see many more HIV-positive patients and AIDS patients in zambia, but I haven't seen any others here.  It was my first time seeing pediatric HIV patients, many of whom were infected in utero by moms who found out they were positive when tested during pregnancy.  Seeing one family come in - mother, father, and five-year-old daughter - all HIV-positive felt like such a death sentence.  There are not many antiretroviral regimens available here, and compliance is often a problem due to finance, leading to the possibility of resistance.

Yet at the same time I was moved with a small portion of God's love for them in the midst of their difficult life circumstances.  Jesus loves you, little one, was all I could think with regards to the little girl.  Jesus loves you, I thought to the parents who didn't have any easy answers.  

And neither do I.  But I do have a deep conviction that God walks with them - and with the family of the baby with jaundice - in their situation in love as much as he moves in my privileged life with the same love.  Left speechless to communicate any of this by my lack of Tamil, I simply prayed that they would come to know the love of the Father who one day will heal all our diseases and wipe away every tear.