Shock

January 22^nd 2013 9:50pm Dili, Timor Leste.

Shock

I am in a state of shock.  Much like the child’s side whom I just left 10 minutes prior to beginning to write this.  That is, he was in shock.  Severe hypovolemic shock induced from one and half weeks of profuse diarrhea.  I say was, because when I got there, it was too late.

9:20pm my phone rings in Stephanie and my small Dili apartment, jarring me from a relaxing evening.  I somehow knew…  I wasn’t expecting any calls, it had to be Dr. Dan Murphy – the head physician at the Bairo Pite Clinic where I am working - and it had to be something at the clinic.  Just the night prior he had joined us for dinner and I had told him as we reside about 50 yards from the clinic he should call me if ever an urgent matter arose.

“Just got a call in from the clinic, young boy, dehydrated, I want you to go in and evaluate him: mucous membranes, pulses, sunken eyes, etc. and give me a call,” his voice came through metallic, distorted by the poor telecommunications of Timor-Leste.

I donned my clinic attire, grabbed my tools and headed out the door, promising Stephanie to be back as soon as I could.  The busy streets had quieted and you could almost call it a comfortable temperature.  The clinic gate was open slightly and I walked in, calling good night to the entry guard.  No one was on the small ER but as I turned away the night nurse called to me and I hurried over to the room he mentioned.

The sudden bright lights inside the room cast their fluorescent glow over two nurses, a crowd of people at the door, a woman seated at the end of a bed and small boy, maybe 4-year-old, supine on the bed, an oxygen mask covering half his face.  The steady whir of the O2 machine was the only noise.  The woman, I presumed the mother, looked apprehensive.  The nurse, in broken English gave a quick run down – “ they are from far away, Liquica, the child had over a week of diarrhea, it was long ambulance ride in, kid was shaking when he got here – we gave Tylenol and ceftriaxone.” 

A phone was handed to me before I could examine the kid – it was Dr. Dan.  “So, what is going on?” 

“I am not sure yet, I haven’t had a chance to do anything,” I replied as I started to assess the child.  No evidence of breathing… no radial pulse… no carotid pulse… no heartbeat detected by stethoscope… I relayed each finding to Dr. Dan.

“Look at his pupils,” he instructed me.  “If they don’t react it’s too late, and would indicate irreversible brain damage secondary to cardiopulmonary arrest.”

I shined my high power flashlight directly into the child’s large dark left pupil.

It did not move.

Each year around the world thousands of children die from easily preventable and treatable diarrheal diseases.  I know this.  Tonight though, I looked into the face of just one boy, one person, affected by this tragedy.  His only crime was to be born to a poor family far from medical care.  I will never forget him.  Nor his mother’s hidden sobs of grief.  And I hope one day stories like his will no longer have to be told.