DCMO

When I was 9 years old, I really wanted to be a teacher but then humans did what they do best, human, and made me feel otherwise.

I believe there are some memories in life that define you as a person for the rest of your days. Memories that are immortal and govern your entire life’s course. No matter who you become someday, you’re still the little 8 year old child trying to heal what others have done to you. Its the first time you’re injured in some way as a child. The first time you know what pain, heartbreak or human evils are. The first time your spirit is destroyed or you’re hated just for being alive.

I was in standard something in a primary school in Harding. Teachers were the ultimate authority in life who had agency and ability to affect those around them. They were highly respected, knowledgeable and very influential. To a young 8 year old, your life revolves around school and by default, teachers and friends. And they knew that. And they abused it. They woke up every single day, put on their clothes and came to school to hate children.

I was mentally tortured and tormented by primary school teachers to the point of core trauma so I decided against that because in my small mind, teachers eventually were not my saviors or protectors. They were abusers and bullies. They did not just mentally torment me, they did it to all children. It felt like thats what we deserved because that was so normal.

It was only much later in high school that I encountered kind, thoughtful teachers who wanted to teach and did not have some deep twisted hatred toward children.

Children believe what you show them and then spend the rest of their lives justifying what was shown to them and making sense of it. That is a theory that has stood the test of time. Every human being spends their life making sense of their childhood in some way or another. All other experiences in life are shaped by the lens of childhood and thats the biggest problem. Because that lens is uglied by broken people with power over you.

As a child, if no one shows you love and protection, you really don’t know it. You expect what you get. Back then, abuse didn’t even have a name in my mind. “Its just the way they are” “they’re trying to teach you” , “its tough love”, accepting and packaging bad adult behavior so neatly.

Some parents welcomed “stricter” teachers in the hope it made more for more disciplined children. How wrong they were. I’m not saying dont discipline your children, but mental torture is not the way. Just in case you had any doubts.

In many ways for myself choosing paediatrics was a way protecting children-born out of childhood trauma. Teachers were bullies. Engineers and lawyers were far removed. So being a doctor who could protect children was a path to healing for me. Taking all the behavior I had seen in adults that was ugly and negative and channeling it into something safe and protective healed me in ways I still don’t understand and may never.

Anyhowza, In paediatrics, there is a hierarchy to doing 24-36 hour calls (crazy that there is a promotion in this sleep deprived world, i know) But I guess its a necessary step to making sure the experienced registrars do the most difficult calls. Being “promoted” to Paediatric ICU or neonatal ICU calls mean you’re dealing with children on ventilators, life support machines, inotropes. Most are touch and go situations and some children die. It is a significant milestone in your specialist training as youre now deemed a senior with a new skillet able to cope with stressful situations and apply your mind and skill.

I was both very afraid and very excited. I decided that no one would die on this call (as if I could decide such things).

My first ICU call started with 3:45pm handover rounds. I was nervous and my feet were already sweaty in my white crocs. I had spent the day doing ward rounds and seeing new admissions to the wards. Between pre call anxiety and a days work, i was tired. The night was not young, it was in infancy. Mental note to wash my feet later because athletes foot is not the one.

The intensivist came flying in with a double door opening action and stated very loudly “I do not want a patient with DCMO in this ICU”.

I didnt blink. “Why”

(DCMO=Dilated cardiomyopathy)

“Because they’re extremely difficult to manage and that heart can die at any time”. The over simplification seemed logical to me.

The point of that statement was mute because pretty soon we were adjusting high flow oxygen settings and getting the 8 year old girl comfortable in the ICU. A few minutes earlier, intensivist and I went to the emergency unit to assess her. And its very difficult to decide which children get admitted to the paediatric ICU because we want to save everyone. We want everyone to “get a chance” and “the benefit of the doubt” and “let’s not prematurely prognosticate”. Its a child for goodness sake.

She looked at me sternly every time I moved. I greeted her, smiled, tried to make small talk. She was not convinced and made me feel like I was trying too hard, which I was. She was playing hardball and did not give me a dot of a smile. I was disappointed.

Adults think that the bigger children get, the easier it gets to manage and do procedures on them when in fact, its the opposite. Once you know how to move with the flails of a neonate, you get used to adjusting the angle of the wrist, or pulling the skin taught enough to expose the veins. Bigger children are complicated and they judge you and are sometimes, quite mean.

I was told by a teenager to “wipe that stupid smile off my face” Because “I’m a needler” when trying to draw bloods. Eish. “Your hairstyle is ugly and you need to wax your arms” haibo. “You kak dom cos you didnt know the answer on the ward round” after I answered the genetic mutation wrong for Noonan syndrome. A sick hormonal teenager is someone you don’t want to prick twice.

Toddlers are by far the worse because they are extremely strong and have this inner primitive rage that gives them an extra dimension of strength. I’ve had multiple situations where toddlers took on 4 grown security guards for a drip or blood draw. I have been kicked in the abdomen by a barefooted toddler (after ketamine sedation) so severely, Im convinced I had a bruised spleen. I’ve also lost quite a few chunks of hair on many occasions.

The little girl was not intrinsically mean but her eyes sized me up immediately. She did not trust me and was appropriately skeptical. I needed frequent blood gases to check her lactate, electrolytes on lasix and respiratory parameters. I knew it would be difficult because she was awake, alert and conscious of my every move. I put on some EMLA on her wrists and explained what I would do in my kind voice. She said nothing. Just more staring eyes.

I did the PM rounds, blood gases for 11 patients on ventilators and waited for the emla to kick in and numb her skin. I was being constantly watched and i could feel it. Still, she said nothing.

As I placed an A-line, the EMLA was working because I did not hear a squeak but felt more eyes. I never felt that pressure in a while. She was not afraid of the prospect of being poked or proded. There was no fighting or bargaining. And that scared me because that meant she knew pain. Stillness and wall gazing.
She said nothing to no one, all night. When the night shift sisters came on, i watched  to see if she would bond with them. PICU sisters care deeply and are strong and take zero nonsense. She started at them too which gave me some consolation.

Why was she so detached? I considered a low GCS due to lack of brain perfusion due to altered cardiac output but all parameters were normalizing. She also kept drawing slowly and neatly in a coloring book which meant a normal brain.

I wondered the entire night, what is this little girls story. Why is she so quiet and withdrawn and doesn’t flinch at pokes.

My thoughts were interrupted with an admission that needed oscillation due to viral pneumonia and PPHN and the night became morning and it was handover in no time, so I was distracted and did not say bye to her, not that she would have responded.

As i left the ICU, I saw a lady at her side. The little girls entire demeanor changed. I cleaned my glasses lenses twice and looked again. She was smiling, laughing, chuckling, giggling, showing off her coloring books and holding her hand. I wondered if that was her relative or mother or aunt but there was no resemblance at all.

I asked the day sisters who that was, and they told me it was her teacher who drove 2 hours to see her as soon as she heard she was admitted into hospital. That gave me such hope, faith and some belief of goodness in this world.

A few weeks later, a colleague posted a message on our registrar WhatsApp group that her heart eventually gave in and she passed away. On the funeral flier, there was a picture of the little girl hugging her teacher. Her smile was so deep, pure and wide, her eyes were shut closed by her cheeks, in the arms of her teacher.