Thursday, March 22, 2007

The frightened, frowning child - A patient encounter

A frowning Swazi child (not the one in the story below, mind you).

“She is scared.” Pretty said.

I had never met a Pretty before. Fear, on the other hand, is routine around here.

Pretty is a gogo. For you newer readers, “gogo” is the word for grandmothers around here.

Pretty was accompanied in the exam room by a miniature one year-old, the daughter of one of her daughters.

Pretty used to have another daughter, but she died.

“This one won’t grow,” Pretty said, nodding toward her grandchild, who wore the clothes of a 6 month old.

For you newer readers, there are a lot of undersized kids around here.

“Her mother is afraid that the baby might have HIV.” Pretty shifted her weight slightly. “She will not test her.”

“She recently had thrush too,” Pretty continued, again nodding toward the child.

Thrush is not normal in a healthy one year-old.

The kid was starting to figure out that she was the topic of conversation, and the corners of her mouth sank symmetrically toward her chin, indicating that she would cry in approximately ten seconds.

She looked up at me.

Nine seconds.

Her big brown eyes became accusatory and frightened. (“What the heck did I do?” I wondered.)

Eight seconds.

I grabbed a cute little book with a doggy on it, a book in which the doggy actually has fur you can touch, and within its pages there are several other textures for the illiterate but tactile child.
Seven seconds.

She glanced at the book.

Six seconds.

She pushed it away.


With my other hand, I grabbed a bright orange, oversized leggo, and offered it.


She glanced at it.

Three seconds.

She pushed it away.


She inhaled deeply and looked fearfully at me, as if I were evil incarnate. (She had apparently forgotten about my heartfelt peace offerings, or perhaps she did not like furry puppies and the color orange.)


She exhaled, and with it came the screech that I no longer really hear because, in my line of work, I hear it so doggone much.

Her large, dry, suspicious eyes were now puffy, wet and pitiful.

I was reminded why I even bother trying to [futilely] prevent a frowning one year-old from crying ten second later: they just look so darn pathetic when they weep.

Cute, but pathetic.

Pretty and I began to discuss her reasons for coming into the clinic. (It was the 64 year-old who was the actual patient, not the screeching, frightened, pitiful yearling.)

With the doctor’s spotlight pointed safely elsewhere, the baby eventually calmed down and started fiddling with the fake fur on the cover of the book. She even reached for a leggo (a big, bright pink one) and alternated between sucking on it and banging it on the wall. Each collision left a few small specks of saliva behind.

Apparently she preferred pink to orange.

Pretty has been on ARVs since 2003. When she started, her CD4 count was in the sixties. The ARVs had quintupled that number.

“I am very well on these medicines,” she said when I asked her how she was doing.

I gave her a prescription for more of the medicines that were keeping her very well and stood up to escort her to the pharmacy.

“Does your daughter know her status?” I asked.

“She is scared.”

“Can you talk to her?”

“I can.”

“If she is positive, we can offer her very good medicine.”

“I know.”

“If the baby is positive, the medicines will help the baby grow and help her body fight off the thrush.”

“I know.”

“Will you invite her to come with you next time?”

“I will.”

As they walked down the hall, the baby watched me—the scary physician—move farther and farther away.

I was no longer a threat.

She was no longer frowning, no longer afraid.

I am afraid that she will not be back.



At 3:10 PM, Anonymous Anonymous said...

you know they say children are very perceptive...

At 3:14 PM, Anonymous Anonymous said...

... just kidding. And I do hope you get to see her (and her mother) again, however unlikely.


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