The cottage where I stayed in Maseru, as a visiting physician for a month, is immediately adjacent to the clinic building. As I mentioned before, many patients arrive fairly early in the morning, and the clinic doors open at 7am, though the doctors, the rest of whom live at least a 10 minute drive away, aren't usually there until 7:30am at the earliest.
The last day I worked at the clinic, I woke up at 7am and got into the shower after brushing my teeth and shaving. Shortly after, I heard someone banging frantically on the bathroom window from outside, and I knew immediately what it meant. I jumped out of the shower, put on a pair of jeans and a t-shirt after quickly drying off, grabbed my stethoscope and ran outside, where one of the clinic nurses was still banging on the window. She saw me, ran over, and breathlessly confirmed what I had suspected -- a very sick patient had just arrived at the clinic.
We ran over and I got to the treatment room just in time to see a pale, cyanotic, three month old infant gasp his last breath. Although my first instinct upon walking in the room was to think (and almost say aloud), 'we need to intubate this kid,' it was not an option. We simply don't have the equipment to do it. There are no ventilators in Lesotho, so as a consequence, nor are there any laryngoscopes or endotracheal tubes. I helped the nurses already there with positive pressure ventilation and chest compressions, but looking at the child I knew from the outset that it would be futile. He had stopped breathing, was pulseless, and we couldn't intubate him. There was neither IV access nor epinephrine to push. After about another minute, I did the only thing I could at that point: I called the code. Time of death: 7:24am.
The infant's mother crumbled to the ground sobbing; one nurse looked sullenly away as another quietly covered the child's face with a white sheet; I stood staring down at the lifeless body, stethoscope dangling over my left shoulder, interlocked hands resting on top of my wet head, and took a deep breath. No one said a word; there were no words to say.
We break the silence by uttering soft reassurances to fill the uncomfortable void, but they are ineffectual, inconsequential. An infant has died, one of several this month. And though we may become desensitized to many things we see with regularity, this cannot be one of them. I stand over the tiny corpse and consider this indisputable demonstration of our limitations, this unmistakable demand for humility, and bow my head.
We break the silence by uttering soft reassurances to fill the uncomfortable void, but they are ineffectual, inconsequential. An infant has died, one of several this month. And though we may become desensitized to many things we see with regularity, this cannot be one of them. I stand over the tiny corpse and consider this indisputable demonstration of our limitations, this unmistakable demand for humility, and bow my head.
