Wednesday, June 25, 2008

pointless

i've put off posting about a patient i once had in paediatric surgery because my writing could never justify how i really felt about him, but i suppose i should at least try.

when i rotated through paediatric surgery, there was a memorable patient. let's call him k. when i knew him he was 2, but his story started long before that.

k was one of a set of twins. for whatever reason his mother favoured the other one. this means she lavished what she could on his brother. what she could lavish was nothing more than food. k became very malnourished. around roughly their first birthday the mother decided she was tired of k, but how do you get rid of a baby? she decided to poison him. she gave this poor malnourished child something to eat that was supposed to kill him.

i still don't know for sure what she gave him, but it was amazingly corrosive because it burned his epiglottis almost completely away, it destroyed the opening to his trachea and it essentially destroyed his esophagus. he had a tracheostomy through which he breathed, a gastrostomy through which he was given food and because he couldn't swallow, there was a constant stream of drool running over his lower lip. he also could only mannage a strange low pitched moan if he tried to make a noise.

when i worked there, he had been in hospitals for a full year. he was a delightful child. i started work every day by giving him a hug. i figured love was something he hadn't seen too much of in his short life and it was something i could do for him. he seemed to enjoy it.

then one day, while we were in the morning meeting, we got a call that little k was dying. we rushed down. in the ward we found that he was blue and had stopped breathing. my senior colleague ran up to him, ripped out his tracheostomy tube that was blocked and quickly inserted a new one. he quickly recovered. i did not.

such a simple problem like a blocked trache tube had almost meant his death and that in an academic hospital. what chance did he have for the future? i considered adopting him then, but after much thought decided that if i wanted to adopt every child that i met in my profession that had a raw deal in life i'd have to start an orphanage and drop aspirations of becoming a surgeon.

time went by as it tends to do and my time in paediatric surgery came to an end. i saw k a number of times because i often went to his ward to give him a hug if i had a moment. then one day when i got there i heard he had been sent back to his referring hospital. he was supposed to follow up again in one year for a more definitive surgical repair.

about a year later i asked the senior colleague who had saved his life when i was working there what happened to little k. without batting an eye he calmly told me he was dead. his trache tube had blocked in his referral hospital. there was no one there who knew what to do and he suffocated. that was the end of k. the colleague went on to say that it was probably better because his life was doomed to be miserable etcetcetc. i just felt sick.

to this day i can't forget little k. i still wonder about the permutations if i had adopted him.

33 comments:

Cathy said...

That is the saddest thing I have ever read. Thank goodness you were there and that you gave this little guys many hugs. What a horrible person his mother was. i hope she rots in hell. I also hope someone saw fit to remove the other child from her care. Who knows maybe one day she would get tired of him as well.

I could never do this job, I am far to emotional.

Roer said...

I don't understand how a mother can do that to her child. How anyone can do that to any child. It's unthinkable.

rlbates said...

How very sad.

Anonymous said...

"A man never stands as tall as when he kneels to help a child" ... nor does a remarkable surgeon.
take care Bongi

Corey said...

I'm so sorry.

ditzydoctor said...

that's horrendously sad. i have no words for you, but i am thankful you gave him hugs while you could

Karen Little said...

I'll just never understand some people... I hope the mom went to jail, but she probably didn't.

Bongi said...

little karen, yes she actually went to prison. in prison she fell pregnant (i suppose by one of the guards) and was therefore released to look after her baby. this is a crazy world.

Dr. Emer said...

Similar incidents happen in the Philippines, Bongi. It is negligence which kills the poor little fellows. And like you, I have colleagues who have grown cynical about the whole thing.

It's a cruel world. Life is so unfair. It is so easy to make conclusions to appease our own sadness. But nothing justifies early and unwanted deaths.

Thanks for sharing your experience.

amanzimtoti said...

This truly is one of the saddest, most horrible stories I have ever heard. Sometimes the cruelty that exists in this world is too much to conceptualise.

crazyrn2be said...

what a sad story

Enrico said...

"and was therefore released to look after her baby."

What?! The baby should be a ward of the state until/if she's ever deemed competent to mother again. It shouldn't change her sentence one whit. Unless the time sentenced was so woefully inadequate that the judge said "screw it, she only has x months left anyway." Either way, that's seriously f*cked up.

The fact that she bred again is just a whole 'nother level of sadness, particularly for the innocent child not having the faintest clue what its in for.

Dragonfly said...

That is so sad. It is such a terrible world we live in sometimes.

Anonymous said...

You were the light of his short life.
That is big, bongi!

Øystein said...

This makes me to sad and angry to comment really.

I just wanna say I think you certainly managed to convey your feelings for k.

Devorrah said...

I once had a very sad child named Kyrie in my kindergarten class, big eyes, dirty clothes. Mom had dirty bare feet and scabs from meth scratching. As happens so often, Kyrie disappeared, yanked by the state. I had a very dedicated aide who happened to be a registered foster parent, and she tracked down Kyrie and her sister in a hellish foster home and managed to get both girls removed to her own home. Kyrie spent several happy years there, and the aide eventually found her extended family that had lost track of her and her crackhead Mom.
We celebrated my foster son's 19th birthday yesterday, and I would encourage everybody to consider taking in a needy child--they enrich our lives. And Dr. Bongi, pleasd don't torture yourself, you helped k greatly.

Dr. Val said...

Wow. Such powerful tragedy. Hard to find words, isn't it. :(

Greg P said...

I think about all the k's in the world when I see people fervently focusing on saving whales or preventing abortions in developed countries.

The problem is it's all so overwhelming, the numbers out there. To simply give food, save a life temporarily, doesn't really assess the magnitude of the problem, but somehow we have to find those moments when we can actually do something constructive, maybe at least temporarily relieve someone's suffering.

Bongi said...

greg, you know the story of the starfish? i like to believe it.

Kathy G said...

It is a sad story, but it is also unfortunate that the government cannot take steps to prevent this from happening in the first place...I suppose this was an act of desperation as the mother could not take care of both children.

Bongi said...

kathy g, to be honest i find you excusing the mother in any way quite disturbing. there are a few things i know. firstly, k is dead and his mother remains alive. then there is the matter of k not being able to swallow even his saliva for the last about two years of his life. his mother could swallow at this time and still can as far as i know. then there is the matter of breathing through his neck, which, once again his mother doesn't do. then there are questions of being able to defend yourself at the age of one against someone that is supposed to protect you but is trying to kill you. the mother had a greater chance of surviving the encounter.

sorry, but my sympathies do not lie with the "poor mother who in an act of selfless desperation" decided to simply kill her child.

ok, blame the government if you must, but she could have dumped him at numerous places where he would have found his way into a state sponsored system. she did not do this. she mutilated her child in a botched murder attempt. sounds like a fine upstanding misunderstood law abiding citizen to me....not!

beachbirdie said...

The woman should have been sterilized. Anyone who could do this to a tiny, defenseless child should be rendered incapable of ever producing another.

Buckeye Surgeon said...

Tragic and awful.

Anonymous said...

If you have not adopted, or been interested in adopting and suddenly have an opportunity thrust upon you it is very hard to make a decision; particularly if you are not already set up to care for a child. If you ever are in the situation again, with a very hurt orphaned child, here are some options to consider.

You know since international adoption opened up (for USA anyway) in places like Ethiopia and Liberia many children, victims of caustic ingestion, have been adopted and are apparently, with a lot of surgery and therapy, living happily ever after- several families have blogs.

It is a shame they can't arrange for these children to be adopted because there are families who would be glad to take them and work with their conditions.

I don't know if international adoption is available from South Africa but if it can be done these places are very successful in placements of hurt children, HIV, TB, Downs Syndrome, Caustic Ingestion and other difficult medical conditions http://www.acresofhope.org/ or http://www.reecesrainbow.com/

here are some of the blogs
http://www.helpmercyandjoy.blogspot.com/
http://libertytograce.blogspot.com/
http://chickensndiapers.blogspot.com
http://libertytograce.blogspot.com/
http://cornishadoptionjourney.blogspot.com/2008/03/denis-has-family.html
http://specialneedsbaby.blogspot.com/
http://www.cornishadoptionjourney.blogspot.com/
http://urbansworld.blogspot.com/
http://ukieadoptmom.blogspot.com/
http://spahrfamilybigtop.blogspot.com/
http://andrewscrew.blogspot.com/
http://fromthetrenchesofadoption.blogspot.com/

Jamie said...

the thought of the substance (could it be concentrated bleach?) burning down K's throat is already so painful for us to bear.. i wonder how was his 'not rightful' mother's reaction to the sight of her own son going through that episode.. its crazy!

anyway, at least u did give him hope although it was not too long a period of time.
i stumbled upon ur blog sometime back and have been a silent reader. i have to say that reading ur posts like this have kept me on track and even more motivated to be a doctor. someday, i wanna be like you. ;)

Bongi said...

jamie, that is quite a compliment. thank you. go for it.

pkayski said...

This was, like your many other blog posts just incredible/amazing/etc. I enjoyed staying up late and going through your entire blog and reading some incredible revealing stories. Really big eye opener and it thought me a lot about the life that an individual such as yourself has to go through in a country so far away fro me. All the best with the work in the hospitals and I hope things turn for the better.

As for this blog post specifically: Yes, it might sometime seem futile when there is a sea of starfishes washed up on the shore.... But never give up and for every starfish you throw back in the water, it will make a difference to a life.

Kind regards.

DrB said...

I am so glad you found me, as now I have found you. :) I have done a number of medical missions, and have been trying to figure out how to do more. I just got back from the Dominican Republic, where the health care system is terrible, and there is so much to do.
There are so many patients that one has like little k. And you always wonder "what if?..." The only consolation that I can offer is that 1. for the time that he knew you, his life was infinitely better than it was without you, and 2. no, you cannot save everyone.

To him, it was not pointless.

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Please go and read new blog about sa doctors..
if you want to, we can exchange links..

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Dena said...

I am at a loss to understand why we have not come to peace with death ... and why we think that "saving" this lovely child was the best medicine. Sometimes death .. with dignity and in someones loving arms, is the best option, and sometimes ... the best medicine of choice.

You dear man have my heart as you are doing the work of the gods. ~Dena

xmariachi said...

sad story... much respect for your work and feelings.

Anonymous said...

Maybe he was a stepping stone in your life to teach you to look into what you can give at that time and look beyond the now to what is practical and/or possible.

With injuries like that what sort of life would he have lead without being a creature of internal pain and external stares.

Was his mother to blame yes but it sounds like she was mentally unstable herself and abused by life.
Where was anyone to reach out to sort the problem they must have seen was happening if they did not or did not care that also speaks volumes.

What shocked me was that basic trachi care is not taught in the human hospitals.
That should be one of the lessons it is not the big things in life that kills like loosing so much of your body but the simple things like a gob of dried spit and gunk.

Jabulani said...

Speechless. And my heart is sore.