Death

Today I saw my first dead child here. Just now. Some kids have died while I’ve been here, but I hadn’t seen them after. Only before, even if I knew they were going to die. But this is different. I walked into the urgent care centre here to talk about something with a nurse, and see a child on a table, motionless. He looked 5 or 6 years old. The nurse was listening to the heart, and then stepped away. There were no chest movements. I put on my stethoscope to listen, and heard nothing. Just in case, I also felt for a pulse. Nothing.
I asked another nurse what had happened – he had come in earlier that morning with convulsions, and they had attempted to resuscitate him, but clearly with no success. He had been pulseless for quite some time. Thinking about it, a child coming in, likely in status epilepticus for who knows how long, and now pulseless for an equally poorly defined period.
They have no ventilators, no ability to do any diagnostics in a case like this. I decided not to resuscitate him. It would take too long to figure out what had already been attempted, I had no idea why he might have seizures, and there was likely little left to salvage. I walked away, letting the caregivers here do their work.
Lisa, a former UCSF peds resident, had talked to us at UCSF about how she generally does not code kids in Kenya, mostly because there are no post-resuscitative options. Without any labs, really without many meds, and with no ventilators, there is no possibility to manage this kind of patient.
Saddened, and humbled by my inability to help and my lack of knowledge about how to deal with this in this foreign setting, I went back to the coordinator’s office, where I work.