Volume 2, Issue 25
December 20, 2007
…when you are 911…
This past week has been overflowing with critically ill pediatric patients, incredibly low hemoglobins, and lots of “what am I doing” moments. Of the 12 patients I saw today, seven had hemoglobins less than 5.0 (normal for adults is 12-16) and three of those children were on at least their second or more transfusion for the week. Today was one of those days, the type of day in which I am reminded that there is no 911 in Bundibugyo, Uganda. I am 911.
I had three critically ill, severely anemic patients on the ward today. Two brothers with known sickle cell disease had hemoglobins of 2.5 and 2.7, and a third child that looked worse than the first two, who was almost white as snow and barely responsive secondary to anemia, probably had a hemoglobin no higher than 3.0. Over 20 attempts were made to obtain IV access on the third child, but to no avail, so for the second time in three days I had to use an intraosseous needle. Once again I used the large bore needle to go directly through the 9 month old child’s outer leg bone into his bone marrow. I was able to push blood through the canula, and when I last checked on the child he looked much better, though far from complete recovery. In fact, this was the 11th blood transfusion for this small sickle cell child who is only 9 months old!
I often feel very inadequate in my medical knowledge and ability as clinician, but my mantra still remains “I am better than no one” in reference to the fact that if I were not here these very sick children may have no one caring for them. Somehow that comforts me. Even if I can’t safe a child’s life at least I can do all I know how to and comfort the family in the process.
Tomorrow I am planning a mini-Christmas party for the pediatric inpatients, including chapattis, hard boiled eggs, candy, and Christmas music. Even if I can’t completely heal these kids I can at least give them some food and love them.