significant moments

i hate paediatrics. people who don't understand the life of surgery may think this means i don't like children, but in fact the contrast is true. surgery is suffering and heartache. surgery is pain and misery. it is stuff children are not supposed to experience. children are supposed to be caught up in the joys of life. they are supposed to play and smell the roses along life's paths. pain will come later, but childhood is supposed to be a sanctuary, albeit temporary from the harsh realities of life. and when life really gets harsh, you may need to come to me.

i once spoke about a very special boy who crossed my path. his death still haunts me but there was another incident which drove the wedge between myself and paediatric surgery forever.

it was during my thoracic rotation. to be honest it was one of the more enjoyable rotations. they actually occasionally allowed me to do a thoracotomy or two. most of the other disciplines used us as their underlings to get the ward work done. of course in thoracics we were also used for this but at least there was a payoff.

one day myself and a rotating registrar from another university were sent to draw the preoperative bloods on all the theater cases for the next day. i was fine with this. i secretly hoped i'd find a case i could do myself if the powers that be smiled upon me the next day.

we soon found ourselves in the paediatric ward. there was a girl of about eight years old that was going to be operated the next day. she was apparently born with a severe heart abnormality and had undergone some sort of procedure at birth that had enabled her to survive these last eight or so years. however she was now due to undergo a slightly more permanent operation that would hopefully get her through the next thirty or so years. thereafter she would apparently most likely die. the tragedy of it was already something that weighed heavily on me. it seemed so unfair. but when i saw her i was shaken.

she was blue, a colour i've never thought looks good in someone's face. she also passively sat there trying not to expend any unnecessary energy. i could see she was puffing to try to get enough oxygen. an eight year old is supposed to enjoy life, not struggle for every breath. my normal heart went out to her.

the sister called her to go with us to the procedure room, a room in most paediatric wards that the children fear because they know it is associated with pain. she, however just looked at us with a tired forlorn expression on her face. it seemed too much effort for her to be scared.

in those days we used to draw blood from children from the internal jugular vein (in the neck). i'm sure there are readers that will feel this is cruel but drawing blood from a child is cruel to start with. we were good at the jugular approach and at least we knew we would get it right with the first attempt which is a darn sight less cruel than multiple prolonged attempts from another site. we got to work. the other registrar was going to hold her in position and i was going top draw the blood.

he placed her on the bed and got her position right. she didn't resist at all. if anything, her body lay limply waiting for the inevitable. the registrar tilted her head to expose the neck and i readied the syringe. then i went for it. she went berserk. she started screaming and kicking like mad. the registrar held her down and the needle advanced. i concentrated on getting it right and that meant i had to get my mind off her experience of emotional trauma. when the blood started flowing freely into the syringe i relaxed a bit and listened to what she was screaming between her tears.

my tswana is not very good but it was good enough to understand what she was saying. the registrar holding her was also a tswana and she was speaking to him, not me.

"uncle, uncle, save me from the white man!" she cried over and over again. he quietly whispered in her ear that it was going to be alright, but she would not be consoled. i would not either. like all children she couldn't reason that, although what she was experiencing was unpleasant, we were doing it in her best interests. all she knew was that the white man was stabbing her in the neck with a needle and it traumatised her. it was the sort of thing that you don't easily forget. it was a significant moment for her.

the next day i was tasked with assisting with a few smaller cases while the prof, another consultant and the senior registrar attempted the fancy operation on the eight year old girl's heart. i wouldn't get to see how it went, which, to tell the truth at that time, suited me fine. however, as it turned out, the prof ended up walking up and down between the two theaters and giving us a sort of running commentary.

"how's it going?" asked the registrar operating with me.

"not great." replied the prof. and then he dropped one of his typical gems.

"eintlik is ons besig met een moerse fokken palliatiewe pooging langsaan" (we're actually busy with one massive f#cken palliative operation next door). he then gave his usual inappropriate giggle. i couldn't even manage a grimace.

that night i was on call. part of my job being on call in thoracics was to look after the thoracic icu patients. the girl was one of them and would be my responsibility. from the first moment things went badly. then they quickly got worse. i did all i could think to do, but as i looked at her small body lying there in the big icu bed with tubes sticking out of her all over i realised the odds were stacked against us. i phoned the prof to ask what else i needed to do and followed his advice. however just before he hung up he said that thereafter there was nothing more we could do. when he omitted his usual giggle i knew she would die.

a few hours later it was my duty to give the prof a courtesy call to tell him the girl had passed away. he simply said thanks that i had informed him. then i was left alone with my thoughts.

i thought of her looking at me the previous day with no more fight left in her tired body. i thought of the years she had had a semi-existence and had missed out on all the things that make life magical for children. i thought of whether she had had any significant moments that had put a smile on her face despite her circumstances. and then i thought about her last significant moment, the one that had traumatised her for the rest of her life, the one where the white man had driven a needle into her neck despite her vociferous supplications for him not to do it. we are supposed to make life better. we are supposed to enable people to go back into the world to enjoy the beauty and wonder of life. what we do is not an end in itself but a means to an end. the point is to have a better life and that i did not give her by any stretch of the imagination. i felt devastated, but i was alive to feel devastated. she would never feel again. i no longer wanted to go on with this painful profession. i could no longer hold back the tears. it was a significant moment in my life.