So you we think we have it bad.

hi pretty girl. its5pm

here - sitting at the computer lab in the mulago hospital library.

feedback was good on the first update, so i added some more people to

the shout out list.

feeling pretty broken down...

yesterday

on rounds, we met lilian, a 10 year old girl whose dad brought her in

the day before w/ severe belly pain, fever and an inability to pass

urine. at that time, a short discussion was had about renal failure,

blood pressure control and how she needed dialysis but wouldn't get it.

her father helped her to the floor and placed her over a plastic tub. i

heard a whimper and a small splash - dad turns to us and reveals what

looks like milk inside. i realize that she is peeing frank pus and ask

whats being done to control her infection. after a bit about the

utility of urine studies, i was reassured that she was receiving the

proper antibiotic therapy.

as

per routine, the attending dictates her 'findings' and 'impression' to

the resident, and we move on. the 'plan' is also transcribed but

remains nebulous "continue antihypertensives, monitor urine output". i

remain stunned and fall behind in rounds.

this

morning she looked awful. her face was swollen such that her eyes were

2 black creases. she was foaming at the mouth; unresponsive. apparently

her potassium was in the 6's and the serum urea was through the roof.

Dad was instructed to go to the pharmacy and buy lactulose (to induce

diarrhea so she stools out some of the potassium she is unable to

excrete by urinating). Dad says in a soft voice that he is afraid he

will get lost. He is reassured that he will not, and rounds continue on.

i'm

figiting with my camera when i notice the nurse pushing a clear liquid

through a syringe into the IV in lilian's hand. i ask what it is and

she replies 'adrenaline'. i grab lilian's wrist and feel for a

pulse...none. i grab the medical student who had been examining lilian

- "what the hell is going on?" He looks at me wide-eyed and stutters:

"we were listening to her chest and she just stopped breathing. I asked

for help and they brought this adrenaline."

The

group, which had moved on to the next patient, was slowly and without

any hesitancy making its way back to lilian's bed. i raise and place my

hands on lilian's chest (as in "news flash people i think we need to DO

SOMETHING" here) but before i even apply pressure, i realize that i'm

the only one moving. the attending reassures me, "there's no point in

resuscitating her. even if we did, we have no ventilator". she then

chastised the resident for ordering the adrenaline and moved on with

rounds.

i

believe doctors care for patients to the best of their ability given

the availablity of resources. but i'm like "F you lady, you could have

at least tried!"

i

know i don't know jack about their world. i'm a american white guy,

raised in the suburbs who has no concept of the reality of life for

doctors and patients inuganda. and who am i supposed to hate for the fact that they have no ventillator?

lilian's

father never left for the pharmacy and saw the whole thing go down. i

tried putting my hand over his shoulder and muttering "i'm so sorry",

but i never saw one break in his face. the man just lost his daughter

and he was completely flat. not shocked, just flat. he told me in a

quiet voice that he was going out to make a call. two sisters

(nurse-nun types) dressed all in white came and wrapped lilian up in

her bed sheet. i remember them tying a piece of gauze around her head

and chin to keep her mouth closed. they folded the mattress and carried

her out of the ward, the other parents following with their gazes.

life

is so different for different people. you can never, ever judge or even

claim to really understand. the only truth i consistently come back to

is this: life is fucked up sometimes. it is not our fault - situations

may be made worse by generations of damage and corruption, but to

expend energy on assigning blame is wasteful and non-constructive. and

it is most certainly not God's will, for the sun shines on both the

righteous and the wicked.

but

i have faith in the perseverance of the human spirit. we should strive

for a world where basic needs are met and where people can share their

thoughts and feelings freely. i'm probably just on someafrica shit right now, but i believe that we can achieve this goal in our lifetime.

its

weird but even though the context has changed, it hurts the same way -

i feel awful for lilian's father. no parent should ever have to bury

their child. not innew york city, not in uganda.

if

you've made it this far, thanks for sticking with. i miss you tons and

will be in touch. as emily would put it, expect more politicking. hit

me back w/ thoughts (like dude you talk to much..!)

-clem