Marion

I've been thinking a lot about Marion lately, but I don't think I've yet blogged about her. She's a little 5 year old girl who was admitted on my very first day in the wards, about 4 weeks ago. She presented with bone pains, fatigue, and weight loss. From her lab work, she had terrible anemia and low platelet counts, and during her stay on Upendo ward we had a horrible time controlling spontaneous bleeding from her gums, nose, etc.

This poor little girl went through hell. Suspecting some sort of leukemia, we attempted 3 bone marrow biopsies on her that were "dry" (no marrow). Not knowing what else to do, we did an excisional biopsy of a huge lymph node she had under her chin. The next day, the pathologist was finally able to get a succesful bone marrow biopsy. Waiting around for the results, she just kept getting worse and worse. Eventually she needed oxygen support, and we were continuously trasfusing either blood or platelets. Her lymph node biopsy came back as lymphoma, but her bone marrow showed no malignant cells -- really it didn't show any cells, so the pathologist called it aplastic anemia. Our consultant suspected that she had a leukemic lymphoma, that is a lymphoma that had infiltrated the bone marrow and caused a leukemia-type picture. Even though we weren't sure of the diagnosis, the team decided it would be best to start on cytotoxics (chemo) anyway, as she was so sick. The last time I saw her was yesterday. Her mother, crying, was holding her, as Marion looked like she was literally on the brink of death. Well, she was. We got to the wards today, and the intern said that she coded right after rounds got over.

I really liked this little girl (who was my patient), and her mom, who was SO nice. So, it is sad. But at the same time, I don't think prolonging her life with chemo and its horrible side effects would have been that great for Marion either. It's always sad when a child dies. But, when a child is no longer suffering, I think that's a blessing. And this little girl suffered more than any other child on the ward, with countless sticks for biopsies, blood draws, and transfusions. It got to the point that she screamed whenever anyone besides her mother touched her. I'm less grieved and more retrospective about this death, due in part to a very encouraging email I got from Emily today, and also due in part to the fact that our team worked very, very hard to figure out what was wrong with Marion. In the end, I really think we did all that we could have. Even in the United States would likely have been a little girl that didn't survive.