Khartoum, Sudan
July 18, 2009.
I am, as you know is a lazy person. But this morning it was a pleasure
quarter of an hour before getting up at 6 and a half to present a
breakfast half an hour. It was just me and Edgar, the German heart surgeon
: there was no way to get a coffee because I have not learned yet
where they keep the dust in the enormous new kitchen,
but even a tank would have broken this morning .
I prepared a cup of strong tea, I took the two-day old bread
and hard as marble, I put the jam on pretending it was
biscuit and I went to eat
peace in contemplating the holy river. I took my time then, satisfied,
are gone from the driver: I was in the eighth precise Mayo. What a godsend.
I wonder how will I get used to the trill of the phone, to make breakfast
race, I have to drive to go to work. Thank goodness there is in the middle
few days of leave.
Few people today, an effect clear water these days.
I was in surgery and visited only 18 children, however, cases
not very serious, except in two children ... I made a diagnosis of sickle cell anemia
. The first I was not even too upset: a child of
a year, with fever, I had the blood test looking for white
before I wanted to control severe anemia: bingo, damn it.
As I have said, is in a beautiful cross, chronic disease, incurable
in itself, it also allows for a decent life if you do everything to avoid crises
, impossible thing here (at Mayo then!). I tried to explain to
mother (a woman at least six feet high
fully veiled, was only out of the eyes)
through an interpreter what had happened, but she did not seem too upset:
who has not understood? I asked myself the question, but she was one of those classic
women exorcise the tension by attacking. He kept talking,
without actually asking questions, and without waiting for the answers.
This attitude fails to irritate me greatly, and the matter so I slipped
, emotionally, on him. The second was tougher: two parents
careful, aware of Darfur. Their child is three years:
had a fever, and I brought the resignation of the sheet
Bashir a year ago and that two months ago (they were always in
visiting relatives). The first time they have done a blood transfusion, the second
antibiotics were written tests, the test for sickle cell
not have done it. I did it because I saw white as a sheet
pray that God will be wrong, but I have not asked well, why
was positive after a few seconds (sometimes it takes 24 hours to be sure
). By Jon to be my interposed i got them and I
calmly explained everything that I had bad news, that it is not in itself
curable, that it takes full attention, which should be given folic acid, which in
a crisis with certain symptoms hasten to the hospital saying
what has the child, other children that if they have 1 in 4 chance that
happen to them, in short, everything. I concluded by saying that I was sorry
have to give them bad news. I have thanked
because at least now understand what creature had at least one.
I looked into his eyes, and I was sure they understood that
would do the right things for the baby, but an infinite punishment,
for this, I have fallen on me and left me no more.
To make matters worse, over all, get safe,
the health promoters, to bring a case. I spoke Fatma, who advocated a
my yes. A two year old child, already admitted to Khartoum, and from there discharged
with the request to do an MRI. As you know
up to 14 years do not pay the hospital, but only supplies generic
: the resonance pay, costs 250 pounds and they do not have
. So we pay Safe asks us to do?
I look at the folder: have done it all, missing only one. The'd
in Italy? Yes, certainly. Safe ask to see the child again after ten minutes
, live around the corner. A child with severe mental insufficiency
, as well as motor, you can not stand to sit, not speak.
According to the mother, it all started a year ago, with a convulsive crisis
, but this does not mean, may have been a meningitis
which has survived as it may be a degenerative disease, or it may be that it
be realized only then.
What should I do?
I think about it. And I decide not. Or at least that will give a negative opinion Gina,
that is the one to decide really. First, do not change either
prognosis or therapy. The therapy is impossible, it takes physical therapy, psychomotor
, social service ... at Mayo. The prognosis is terrible
in Italy, let alone in these conditions.
would understand the diagnosis: how to respond to parents, to give satisfaction to us
doctors, not to him.
Second, if we take care of children chronically
if we begin to give everything to everyone, we will soon not even giving the antibiotic to those who have the
fever. You must choose, as triage in the morning, as the triage of
Gino Strada speaks five wounded when they come blasting and you only
an operating table: do not choose the worst, he can choose
do it with your help.
Safe to say I tell my mother that I will speak with Gina, who will send
home to tell her the answer. So the final decision will not be mine. I feel really
a coward.
spend the rest of the morning to read the PC (which I brought back
) dozens of messages from colleagues that the debate on pediatric topics
Italian, and I look very far. I decided to launch
a message with the picture of a boy who showed me Safe,
a mysterious and terrible situation in which I can not really make my holy
that: a sort of monster with a thickening of the hands and feet from
gallery of horrors. The hope is that some of the fellow members
I prepared a cup of strong tea, I took the two-day old bread
and hard as marble, I put the jam on pretending it was
biscuit and I went to eat
peace in contemplating the holy river. I took my time then, satisfied,
are gone from the driver: I was in the eighth precise Mayo. What a godsend.
I wonder how will I get used to the trill of the phone, to make breakfast
race, I have to drive to go to work. Thank goodness there is in the middle
few days of leave.
Few people today, an effect clear water these days.
I was in surgery and visited only 18 children, however, cases
not very serious, except in two children ... I made a diagnosis of sickle cell anemia
. The first I was not even too upset: a child of
a year, with fever, I had the blood test looking for white
before I wanted to control severe anemia: bingo, damn it.
As I have said, is in a beautiful cross, chronic disease, incurable
in itself, it also allows for a decent life if you do everything to avoid crises
, impossible thing here (at Mayo then!). I tried to explain to
mother (a woman at least six feet high
fully veiled, was only out of the eyes)
through an interpreter what had happened, but she did not seem too upset:
who has not understood? I asked myself the question, but she was one of those classic
women exorcise the tension by attacking. He kept talking,
without actually asking questions, and without waiting for the answers.
This attitude fails to irritate me greatly, and the matter so I slipped
, emotionally, on him. The second was tougher: two parents
careful, aware of Darfur. Their child is three years:
had a fever, and I brought the resignation of the sheet
Bashir a year ago and that two months ago (they were always in
visiting relatives). The first time they have done a blood transfusion, the second
antibiotics were written tests, the test for sickle cell
not have done it. I did it because I saw white as a sheet
pray that God will be wrong, but I have not asked well, why
was positive after a few seconds (sometimes it takes 24 hours to be sure
). By Jon to be my interposed i got them and I
calmly explained everything that I had bad news, that it is not in itself
curable, that it takes full attention, which should be given folic acid, which in
a crisis with certain symptoms hasten to the hospital saying
what has the child, other children that if they have 1 in 4 chance that
happen to them, in short, everything. I concluded by saying that I was sorry
have to give them bad news. I have thanked
because at least now understand what creature had at least one.
I looked into his eyes, and I was sure they understood that
would do the right things for the baby, but an infinite punishment,
for this, I have fallen on me and left me no more.
To make matters worse, over all, get safe,
the health promoters, to bring a case. I spoke Fatma, who advocated a
my yes. A two year old child, already admitted to Khartoum, and from there discharged
with the request to do an MRI. As you know
up to 14 years do not pay the hospital, but only supplies generic
: the resonance pay, costs 250 pounds and they do not have
. So we pay Safe asks us to do?
I look at the folder: have done it all, missing only one. The'd
in Italy? Yes, certainly. Safe ask to see the child again after ten minutes
, live around the corner. A child with severe mental insufficiency
, as well as motor, you can not stand to sit, not speak.
According to the mother, it all started a year ago, with a convulsive crisis
, but this does not mean, may have been a meningitis
which has survived as it may be a degenerative disease, or it may be that it
be realized only then.
What should I do?
I think about it. And I decide not. Or at least that will give a negative opinion Gina,
that is the one to decide really. First, do not change either
prognosis or therapy. The therapy is impossible, it takes physical therapy, psychomotor
, social service ... at Mayo. The prognosis is terrible
in Italy, let alone in these conditions.
would understand the diagnosis: how to respond to parents, to give satisfaction to us
doctors, not to him.
Second, if we take care of children chronically
if we begin to give everything to everyone, we will soon not even giving the antibiotic to those who have the
fever. You must choose, as triage in the morning, as the triage of
Gino Strada speaks five wounded when they come blasting and you only
an operating table: do not choose the worst, he can choose
do it with your help.
Safe to say I tell my mother that I will speak with Gina, who will send
home to tell her the answer. So the final decision will not be mine. I feel really
a coward.
spend the rest of the morning to read the PC (which I brought back
) dozens of messages from colleagues that the debate on pediatric topics
Italian, and I look very far. I decided to launch
a message with the picture of a boy who showed me Safe,
a mysterious and terrible situation in which I can not really make my holy
that: a sort of monster with a thickening of the hands and feet from
gallery of horrors. The hope is that some of the fellow members
mailng list can give me some help.
I feel a little better, but always take taste with a bitter taste in my mouth.
I've got 250 pounds, and maybe buy gifts for the kids. But because
gifts to this and not another?
What a fucking world? Emergency
We give free health care to all, as it should be
but we also know we succeed only in part. We do our
patients who are few in the midst of all the others: we do what we can
, which is little. And when one tries the same feel helpless.
bad I'll sleep tonight.
gifts to this and not another?
What a fucking world? Emergency
We give free health care to all, as it should be
but we also know we succeed only in part. We do our
patients who are few in the midst of all the others: we do what we can
, which is little. And when one tries the same feel helpless.
bad I'll sleep tonight.
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