Uncertainty - A patient encounter

I picked up my first file of the day around 8am this morning.

The facesheet read, “URGENT. Child in ER.”

Our clinic “emergency room” is set up to stabilize the very sick before sending them to the hospital.

The hospital was exactly what the patient in the ER needed. She had lost 1.2 kg over the previous month, which unfortunately was nearly one fifth of her total weight. She was lying on her back on a stretcher in the middle of the room. She had scabs lining her lips.

Her father told us that, though eating was painful, she had been eating. This was certainly good news.

“But…,” the father continued, “She vomits everything.”

He pronounced the word everything slowly, emphasizing the word’s totality.

“Eev-err-eee-thing.”

This explained the weight loss.

I looked at the child, and the child looked at me. Her crusted lips tensed and her eyebrows wrinkled a bit, then she began to make a soft, humming noise each time she exhaled. It resembled the monotonic whir of a laptop’s cooling fan, or the maybe the sound of a carpenter’s rotary power-saw a few houses down.

The girl was crying. Rather, she was trying to cry, but was too weak to do so convincingly. I do not know if she was asking for help or telling me to buzz off.

I knew that I could not do both.

We were unable to send the child to the hospital. The father refused. The reason for this was simple: there was nobody to stay with the child on the ward. (Because of staff shortages, admitted children without caregivers often receive inadequate inpatient care.)

We gave the child a shot of broad-spectrum antibiotics, some milk-based formula designed for severely malnourished children, and sent the child home. She is scheduled to return first thing in the morning.

I tell myself that we did not send the child home to die but, to be honest, I am not sure that the child will be back tomorrow.