i have, for the past few months, been lamenting about the sorry state of affairs that has been my life thus far. i tried to compartmentalize my feelings, lose myself in work and hide behind the millions of mindless little errands i had to run in order to stop feeling sorry for myself and for all the things i felt that i was missing out on. after all, i'm 24 years old, without a job, still financially-dependent, still single since birth and probably will still be for the next ten years, chronically sleep deprived and emotionally dead inside.
how shameless i have been with my selfishness. it took the strength and courage of one little boy to wake me up to life's little wonders.
i had always dreaded rotating in pediatrics for the simple fact that children petrified me.i don't mind them when they're cute and smiling, but i absolutely dreaded having to examine them, and worst of all, see them ill. i had somehow mastered the art of clinical detachment when it came to my patients in medicine, surgery and neurology. they were all adults, and in my mind, they could take care of themselves. in those times when we lost adult patients in the ward, i could deal with it, chalking it up to being part of the cycle that is life.
but the death of a child is a violation of the natural order of things
i met him when i was a rotator in our neonatal icu (NICU). i had chosen him as my patient since at the time, he seemed to have the most interesting and difficult case. the case in itself was pretty straightforward: born to a 26 year-old, unmarried female with a 29 year-old live in partner with a previous history of a stillborn and one living child, denied intake of drugs, alcohol or exposure to viral illnesses or radiation. on ultrasound during the 6th month of fetal life he was found to have hydrocephalus. he was born via caesarean section and was immediately admitted to the NICU because of his enlarged head circumference. he was also found to have multiple congenital defects: cleft palate, facial palsy, inability to suck, cry or close his eyes fully and micrognathia (very small jaw). perhaps his problem was part of a yet to be determined genetic syndrome. he was also having episodes of apnea (cessation of breathing) due to the increased pressure within his skull. from a clinical standpoint, it was a dream to work this patient up. he needed a cranial MRI, serum bilirubin determination, chromosomal analysis, arterial blood gases, CBC...you get the picture. he was kept in an isolette under close watch by the NICU staff.
i studied my patient's case with enormous interest. rounds with our consultant was coming up in two days, and i had to step up since i had the NICU's "star" patient. i then successfully presented the patient during rounds and was riding high over the next few days.
unfortunately, my patient wasn't. his MRI showed a large amount of fluid within his brain, with thinning out of much of the brain substance and underdevelopment of some parts. the neurosurgeons wanted to operate asap.
he would have been operated on of his parents had money, or if he had any decent parents at all. turns out his parents had never visited him since he was admitted. they never sent him diapers, breast milk, even clothes. the only article of clothing he had on was a knitted green cap that the nurses put on him. he was a cute little boy, he had tiny hands with long fingers and cheeks that puffed out like a chipmunk's. he liked being stroked on his tummy and he hated when i would wet his eyes with drops. he was as active as any infant could be in his condition.
until that day when he stopped breathing. it was inevitable that the increased pressure in his head would affect his respirations. we called for the boy's parents but they never came. not for their dying son. i spent the rest of the day and night beside him, giving him oxygen through different routes: ambu bag, NCPAP, free flow. the resident, intern and my fellow clerk and i decked in shifts in order to help him breathe. we tried as hard as we could. the father finally arrived to sign a Do Not Resuscitate order. then he went home. the coward.
by dawn we knew there was no other hope. his brain was already long gone. but his heart kept on beating, even when his respirations were failing, it kept on beating. it held on until we had an emergency baptism for him at dawn, and for another hour after that. he arrested twice only to come back without any intervention. those two times he amazed us. this child was a fighter. he had more courage and strength than his parents. but the time had come, and his heart had to give out.
at 6: 03 am in the 20th of January 2008, heaven received its newest little angel. a 9 day-old baby boy. this is in memory of one of the bravest and strongest human beings i have ever met: my teacher, inspiration, hero, and savior.
i have learned much more from this patient than from any book, lecture or discussion i had ever come across in my medical education. all the things i had thought was lacking in my life, i now realize how silly and trivial they were. i was loved, cared for, living, breathing, healthy and doing what i had always wanted to do with my life. that little boy died without even so much as a shirt on. his parents never visited him, they never held his hand, they didn't keep vigil at his bedside, they didn't cry during his emergency baptism, they didn't look for a decent spare shirt among the mothers in the OB ward for him. his parents may have given birth to him, but they never gave him a life.
strength is possessed not always by the mighty
