Thursday, April 19, 2007

Fever and affection - A patient encounter

I reached out my hand to and told Njabulo to please feel better.

His small fingers were hot to the touch, well above the expected 37 degrees Celsius.

His face glistened as perspiration found its way to the surface.

I hoped that the sweat and ibuprofen he had just received would cool him down, for fevers are unpleasant, especially high ones.

Personally, I really don’t like having ‘em.

Njabulo did not seem to mind.

He reached out his clammy hand, squeezed my scaly-dry-from-too-much-between-patient-hand-washing hand, and held it for a few seconds.

He then took a step forward and casually rested both of his elbows on my lap.

He looked up at me intently, comfortably.

Everything about his demeanor suggested that he was actually my patient and friend of many years and I had somehow mistaken this for our first meeting.

Njabulo had been vomiting everything he put in his mouth for 24 hours, with the exception of some liquids and his ARVs.

I did not know for sure what was causing the ten-year old’s vomiting (a virus, bacteria, food poisoning of some kind, etc.) but as I watched him play with my stethoscope, listening into the left earpiece while tapping on the other end, I knew that he would probably recover quickly.

He was a resilient child. His CD4 had jumped from 394 to 1242 since starting ARVs and TB treatment mid-2006. There was light and energy in his eyes.

He smiled frequently.

I gave him some ORS packets and told his mom what to look out for, in case he got worse.

Njabulo seemed content to perch beside my chair indefinitely, but his mother grabbed one of his hands and pulled him toward the door. His other hand grabbed mine until both arms were taut, then he let my hand slip from his, and pulled the door closed behind him as he left.

I typed his clinic note into the computer and called the next patient.



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