A Strange Feeling

Over the past two weeks, I have occasionally encountered on the wards a strange feeling, something primitive, like an anxious stomach or restless feet. During rounds at the nutrition center in Lacor, my team (an attending, intern, and myself) came across a 9 month old boy with sunken eyes and twig-like arms, lying in bed under a tattered piece of clothe. When the attending physician removed the piece of fabric away from the baby, I felt a kind of displacement under my chest, and a need to shift my eyes around and take a deep breath. I had seen dozens of emaciated or swollen-limbed kids with their skin peeling off for the past couple of days, but this boy’s situation seemed so far from natural that it couldn’t register. There was hardly more than skin and bone on the bed. He needed a transfusion, and so we needed to type and cross his blood. The intern failed to draw any from his femoral vein, so the attending was asked to help. The boy didn’t even twitch, as the attending took 4 sticks to finally get the sample we needed. I came home to the guest house that afternoon and told Dewan how I thought it was strange that seeing this boy made me feel light headed when I had seen all these other really sick kids and didn’t flinch. The next morning, we arrived at the boy’s bed and I noticed a different mother at the head of it. I asked how the boy tolerated the transfusion, and my intern told me he never got the chance to give it to him. The boy had passed away shortly after we sent off our samples.

This feeling came again the following week, while our team was doing its routine visit to a community hospital in one of the suburbs of Kampala. Though classified as a hospital, the facility could be easily mistaken for a clinic based on the limited resources there. It’s a collection of 3 small buildings with space for about 30 patients, run by a single newly ordained physician, and has a solitary ultra-sound machine as its only diagnostic imaging tool. Despite the lack of resources, however, the staff is able to offer some of the most essential medical care possible, like treating an emergent ectopic pregnancy.

While on rounds there, our team entered a patient’s room tucked away in a dark corner off from the hospital’s inner courtyard. Inside the room, there was a healthy young Bugandan man in his 20s seated on a bench next to the door, and across from him, was a wiry hospital bed where a head of sparse gray hair protruded from a mound of army-green wool blankets. The young man was completely silent, staring at the heap of fabric which roared a waxing and waning gurgle that could be heard from the hallway. The staff physician pulled away the blankets from the head, and underneath was an unconscious, frail 70 year old man who had a stroke a couple of months ago and been hospitalized for the past several weeks with an aspiration pneumonia. I again felt a need to rock on my feet, and began shifting my eyes around the room. But this time it wasn’t what I saw that made me restless, rather it was recognizing the source of the inhuman gurgle, so far from right, that made it so hard to hear. One of our team members asked about suction for the patient, to help remove some of the mucus plugs in his lungs. The staff physician kicked around under the bed, and finally pushed out a little foot-pump vacuum. She demonstrated how it worked before noting it hasn’t made much of a difference. We left the room with the understanding that there wasn’t much that could be done, at least nothing curative. An hour later, while examining a young girl for a skin rash in the outpatient room, a male nurse came knocking on the door. The gurgling had stopped, and he couldn’t feel a pulse. We all hurried across the courtyard and into the dark hallway where we found a gaunt elderly woman, dressed in a bright traditional gown with tented shoulders, wailing outside the patient’s room. We stepped past her, and went to the bedside to do our exam. His heart had stopped, and with it, the breathing. As we left the room, I told Michael that I had that strange feeling again when we saw the patient earlier that morning. He told me the first time he heard the patient two weeks ago, he got the feeling too, and was surprised he lasted this long.