Evans

I went to work this morning only to discover that one of our patients had died overnight last night. This was the very sick little boy who I mentioned in yesterday's post. I'm not completely sure of his whole story, as he has been in the hospital for several weeks, but Evans was a 9 y/o boy initially admitted at a rural hospital for fevers, was being treated for malaria and not getting better, so was transferred to MTRH for further evaluation. The concern (and most likely diagnosis) was that he had leukemia, as he had had a longer history of fatigue & weight loss to go along with his fevers. His initial bone marrow aspiration was indeterminant, and these results took several weeks to come back, so we repeated another one yesterday. Yesterday when I left in the afternoon, he was not looking very well, was having a very difficult time breathing & looked very uncomfortable. His platelet count that morning was 13 (very low... with a normal count being at least 150) and he was having persistent nose bleeds, so we wrote to transfuse him with some platelets. The system being... the way that it is, as of 4PM yesterday his platelets had not arrived yet. Apparently shortly after that he started coughing up large amounts of blood and went into respiratory arrest. With his low platelet count & persistent bleeding, it seems he probably died from a pulmonary hemorrhage, though we will probably never know from exactly what.

In the end, Evans was a very sick little boy who would have required ICU-level care in the US. The frustrating thing in this case is that even though his particular chances of survival were not good from the beginning, I still don't feel like we did absolutely everything that we could have for him. It's mostly systems issues in this case; the delay in getting a read on the first bone marrow biopsy (about 7 days) before we knew we needed a repeat, the delay in getting platelets, and ultimately the delay in starting (chemo)therapy because we didn't have a diagnosis. His clinical picture & severity of illness was consistent with leukemia; however, childhood ALL (the most common type of childhood leukemia) actually has a good 5 year survival if treated (somehwere in the 80% range, but my heme/onc colleages would need to help me out with that one). I just feel like this is case where, if we were in America, the diagnosis would have been made much sooner and the treatment would have begun immediately. Who knows if the outcome would have been different, but it's just universally unfair for Evans to have started at such a disadvantage simply because he was born in Kenya.

Of course the real kicker is that he had (has)an amazingly nice family, including an older brother who was with him night & day, and who, yesterday afternoon I could tell was preparing himself for the worst. The rule of nice family equals poor outcome for child apparently applies in Kenya too. I saw his brother this afternoon on the wards (families have to pay the hospital bill before the body can be released), and all I could say to him was "pole sana" (I'm very sorry). What else can you do?

On a happier note, when we went to work this morning, Ryan was still there, and actually went to the theater early this morning during rounds. I think he'll probably stay on the surgical ward now, but I will try to check up on him at some point.

And, just so this isn't all depressing subject matter: through a long, random process of hyper-linking, I managed to stumble upon my old blog. Not Kenya v.1, which is at this address, but my OLD blog... the one I started as a first year med student and actually kept up with regularly until this one was created. Now, I'm not usually one to toot my own horn... but I was funny. Instead of doing all of the things on my to do/wish list tonight, I spent the entire evening reading through blog archives, and I laughed aloud on multiple occasions. Self-congratulating aside, it was actually nice to remember how I used to look at the world (very idealistic) as a young twenty-something, as well as read the comments from my friends... back in the day when we were all young twenty-somethings without real jobs and actually kept up with our blogging (I'm looking at you: Jaybeus & IRMcK). I'll probably link to specific posts as the time goes on, but for now, read at your own peril: http://parasolmd.blogspot.com/. Remember, I was 22 when this blog started. The post about the mysterious red box from April 2005 is a must read for any former or current IUSOM student (I'm looking at you, E. Pearce).

Tomorrow will be another day on the wards. Until next time.