I Sometimes (recently, more often) lie awake at night wondering why I chose to work In Paediatrics.
It brings back memories of working in the surgical theater’s making small talk with the medical officers and surgeons. As they lay crossed armed in the corner awaiting the spinal to go “In” or the patient to be anesthetized, they would be awkwardly made to stare at my face as I waited along side them. And there begins the awkward small talk.
Funny enough, no one asked me about my personal life outside of medicine because ofcourse, at this point, none of us had a personal life. Judging by the number of over time hours and the-4-weekend-calls a month arrangement, we really did have no lives outside the hospital.
As prof would say, “If you have time for more than a shit and a shave, you must be blerry houdini”. Followed by his sarcastic giggle. I never knew whether to laugh or cry at this statement.
I remember being in theatre, waiting to scrub up for a thyroidectomy, which would usually drag on for hours. I distinctly remember the face of the anaesthetist when she realised how big the thyroid mass was, encroaching on her precious airway.
She looked up at us, patiently waiting in the corner and decided to get working on intubating her difficult airway. It was going to be a long wait.
We shuffled in the corner, trying to keep out of everyone’s way. I was perfectly fine standing in silence but I knew prof was not.
“Moosa, what do you want to specialise in?”. I kept silent.
I was caught between being political and taking on the assumption that every doctor must specialise or just answering honestly and conserving my energy for the hours I was about to spend retracting neck fat and mass. I chose the latter.
“Prof I’d like to do Paediatrics, but I’m not entirely sure yet”.
“Paediatrics! Why!? That’s a Terrible field. Dont ever do it, Moosa. It’s absolutely horrible. It’s totally abnormal Moosa, don’t ever….”
The anaesthetist signalled and gave us the go ahead, the endotracheal Tube was neatly tucked deep inside the trachea and she was overjoyed. Prof stopped mid-sentence as the Patients neck was extended and glistening under the theatre lights, ready to be incised, cut open and dissected. I found the irony of him calling any other speciality “abnormal” totally hilarious.
A few weeks back I was stuck with a difficult case, to put things mildly. A toddler who presented with a fever that just would not subside. We feigned bacterial infection and covered her with appropriate antibiotics, waiting for the fever to break or something else to show itself. Nothing did.
A week passed. In my books, if a patient isnt improving in 1 week, there will be more problems. Infact the fever got worse and the child had a seizure. We searched high and low for infection but nothing turned up. Where the hell was this fever coming from?
Blood, sputums, cerebrospinal fluid, urine, stool, blood cultures, viral studies, xrays, ultrasounds, CT scans, autoimmune studies, malignancy screening all showed us absolutely nothing.
Approaching this patients bed made me cringe. It was frustrating, annoying, irritating, grating all my nerves all day long. What the heck could be wrong with this child? How can the whole of modern medicine be failing us on a simple damn fever.
The incident that broke me came weeks later. It was a tuesday afternoon and yet again we were stuck. We decided to repeat the septic work-up and our straw-pulling continued. We prepared to do a lumbar puncture first.
The intern I was working with at the time, happened to be a white male. Now, I dont usually focus on the racial profile of people I work with because frankly, it doesn’t matter to me but this stood out and you will see why.
The intern offered to do the procedure while I held the child, because he wanted to perfect his technique. I didnt mind, so I gloved up and tried to talk to the little girl.
We didnt think much of this lumbar puncture, as its pretty routine. I’d say we do a few per day, after all meningitis is not something you can miss In Paediatrics.
The child layed absolutely still and I thought It was going to be a piece of cake holding her. She stared at me wideyed, while the intern scrubbed up and cleaned her back in slow circular motions. She was so compliant. I should have known something was wrong.
The moment the needle penetrated the skin in her back, she jolted so violently, it shocked us both. She screamed as I tightened my grip around her, struggling to maintain her position. The needle was in the spinal space and she dug her nails into my arms, nothing I’m unfamiliar with.
She flung her body from side to side as she screamed and cried in agony. My zulu usually fails me and I really wish I’d had failed me in that moment.
“Ndiya, umuntu omhlophe uyangibulala. Ngisize. Ngisize. Ngiyacela. ”
“Indian lady, this white man is trying to kill me. Help me please”
I shut my eyes and I tried to remain focused on restraining this little beautiful girl while I could feel my chest fill up as my heart broke. Her head pressed against my ear as her words ringed inside my head. I felt her tears against my cheek and something inside me tore.
My heart sunk as I realised that from her perspective, the white man is trying to harm her and I am an accomplice. She doesn’t see the logic behind our actions or the fact that we’re trying so hard to help her, to recover and go home.
The ugliness of the past reared its head once again even in the face of noble actions and intentions.
Will there ever be a time that this little girl didnt feel threatened by “the white man”? I didnt know.
I left the room after the procedure feeling disoriented and confused. How can I convince a 3 year old that I am trying to help her when a white man is sticking a needle in her back?
I removed my gloves and sunk to the floor. I couldn’t believe I was an accomplice to a crime in an innocent 3 year olds mind. I felt guilty and convicted. I couldn’t help her. I didnt help her.
I thought back on that day in theatre and Profs words were stuck in my head.
I finally understood what he meant by he hated Paediatrics. It doesn’t mean he hated children, in fact it is the opposite. Seeing innocent children being poked and prodded, stabbed and pricked, injected and incised is so painful. Children are meant to be enjoying the fruits of their innocence, running and roaming carefree.
Not pinned down by the indian woman while the white man sticks a needle in her back.
I wanted to quit Paediatrics and run far away from medicine on that day, and I did.