“Well, I hope its TB and not leukemia.” He said.
There was silence.
I thought about that for a second. A consultant I really respect and admire said
“Atleast TB is treatable over a few months. But Leukemia, well… that is harsh and unforgiving. I mean, whats worse than a child with blood cancer?”
That night, the thought rang in my mind. Life felt so weird in paediatrics lately. It felt heavy and always severe in all its forms. We were always looking for the better of a bad situation.
A small infant who weighs 5kgs, with ever multiplying tuberculosis bacteria. The thought of his liver, spleen, lungs, blood stream and hopefully not brain, crawling with bacteria made me cringe.
A familiar taste from another life time surfaced, Rifafour. I brushed my tongue against my hard palate like it was yesterday. I rememeberd my orange urine and tingling fingers and toes like it was yesterday. Community service. A year that proved to be a turning point in my life. It physically broke me but also made me, in ways I still don’t fully understand. It was the year my migraines became chronic. It was the year I saw 2 of my colleagues get assaulted and robbed in broad daylight. It was the year I burned out so hard, I don’t think I have fully recovered from it nor will I ever. It was also the year I got pulmonary tuberculosis.
In hindsight, I’m not suprised I got TB. It’s surprising I didn’t get it on day 1 of the job. After all, the clinic in which I worked was so poorly aerated, the windows opened into the face of a brick wall. There was never any cross ventilation or free flowing air. We had 3 consulting rooms in one cramped up area which was permanently congested.
I was always intentional about wearing an N95 but after 3 hours in durban humidity, it often hung around my neck like a glorified garland. I downgraded to a surgical mask, but that too often hung off my ear lobe so I could speak to patients in a loud voice, hoping they would hear me over the constant noise.
On the bright side, Its also the year I figured I wanted to work with children. Many people ask me “Why paediatrics?”
And honestly, I haven’t found the right thing to say yet. I know how my heart feels about it but I don’t know how to translate that into words. All I know is, I was nudged into the paediatric direction during comm serve and that’s when something in me shifted toward children.
People think working with children Is a medly of giggles and rainbows but to be honest, it’s brutal and often unforgiving. Newborns have a completely different physiology and therefore pathology to infants. Older children’s bodies don’t fully behave or get sick in the same way as adults but also not as newborns. It’s sort of an in-between that isn’t fully understood all the time.
Children don’t smile or play when they are sick, they die. And they die quickly. Their reserves are low, their weight is lower, they’re brain and carrying capacity is smaller. Everything affects them more severely and rapidly. But on the contrary, interventions also help them faster too.
Paediatrics is difficult in every way possible in comparison to other specialities and I don’t say this out of bias. For instance, you always have to be on-site unlike other speciaities. Calling from home as a medical officer or registrar is not possible. Children are so resilient but also, so demanding in their pathology.
A newborn needing immediate airway attention can’t wait for your 5 minute drive from home. His brain will be dead. A shocked gastro needing immediate fluid boluses can’t wait for you to put on your shoes and navigate to work. And after a while, alot of tasks feel urgent. Mainly because you know and have seen just how quickly a 3kg baby’s saturation can plummet, never to return.
Everything in paediatrics is laborious. Your patient doesn’t talk or complain but scream in your face. They cant talk or complain, which we love, but also becomes problematic. It takes minimum 2 people to do a simple procedure like a drip. A simple examination becomes a fight and wrestle between you and a cutie. The cutie is always right. You have a grumpy, screaming patient who refuses to be touched and now you must poke them for blood work and drips. Much of medicine is based on trust but how can a child trust a person who is hurting them?
Enemy lines are drawn almost immediately and although most parents understand that you’re trying to help the child, their primitive protective instinct is also at play. No one wants their flesh and blood being poked and prodded at all.
Drips are the worst. A universal agreement between all doctors in all specialities is that paediatric drips can turn into a nightmare quick and fast. It’s the only thing an orthopod and paeditrician would agree on. Sitting next to a Day 67 ex premature neonate who needs a drip for IVI Meropenem can END you.
But It’s incredibly rewarding too. Seeing a shocked gastro recover in 12 hours, happy and smiling is unexplainable. Seeing a ventilated child wake up and cry and scream in your face is gold. I both love and hate the extremes of the speciality but its very taxing.
Living in South Africa makes everything more extreme. Children who are starved of food become malnourished is beyond understanding. In this day and age, when there is so much food available freely and so much wastage, innocent children still become malnourished. People just cannot afford food anymore. The cost of living with unemployment becomes disastrous.
I mean imagine your cells starving for food to the point where all your organs completely shut down and you are at risk of dying. An innocent, completely dependable child is now suffering for months or years. Seeing this every day, affects your psyche.
Back to my story. I had developed flu like symptoms over a week. That was normal, I was working like dog and eating junk to survive. I waited it out, did vicks rubs, took cold meds and hoped it would eventually go away. On day 8, I was still ill but feeling much better. I persevered through all my calls because I didn’t want to inconvenience other people (not that there were many anyway).
I was in the middle of seeing a gogo with a stroke when I felt an urge to cough that was so deep, I grabbed my knees and bent over. I felt like I was Drowning while breathing room air. I couldn’t move or speak. The more I inhaled, the less I could breathe. My chest throbbed with a piercing pain. I stumbled to the bathroom and gagged. 5 seconds felt like forever. I did my best to cough whatever was obstructing my breathing, no success. I fell to my knees, trying to call for help.
Sweat poured from my earlobes and forehead. I managed to take 2 small breaths and was feeling less hypoxic.
I felt it before I saw it, wet and runny. Blood.
I coughed and stared. More blood. I looked in the small broken piece of mirror stuck to the wall, hoping my teeth were the source.
My teeth were stained red, all of them. It was not my gum or teeth. My lungs were bleeding.
Hemoptysis is usually and always TB unless excluded. My mind raced to the past few days. The sweaty nights were not durban humidity indiced, but night sweats. My scrub top didn’t feel baggy because the washing machine had stretched it, I was losing weight. I wasn’t coughing because of the flu. I had TB.
I was shocked but I’m not sure why. It was very possible to get TB in these working conditions, I just didn’t think it would happen to me. Why? I don’t know. I just did not have time to have TB.
I couldn’t believe how much work had consumed me, I didn’t realise how sick I was. The system had swallowed me whole to the point where I felt like taking a sick day was too inconvenient. The age old south African system issue- you work until you are dead. And the only person I could blame was myself. I was complicit in making myself suffer and I realised that many Years later.
Well I guess I need an xray at some point, but the que is long right now. I put on my N95 and walked to my managers office, he wasn’t there.i saw a reflection of myself in his glass door. I didnt look like the same person i knew all my life, things changed.
I sent a quick email to my manager and stared into the distance for a few minutes.
With my side eye, I saw the gogo I was consulting peep out the door wondering what was going on. I whipped my pen out, walked down the passage and entered the room.
“Sorry gogo, how can I help you today?”