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Remembering Kevin

Published: 
Tuesday, July 28, 2015
DAVID E BRATT, MD

Kevin died more than 30 years ago. I have not forgotten the night he died nor the manner of his death. He was not my patient but everyone in Peds knew him. A little seven-year-old boy with leukaemia. Diagnosed at age six. He had been in and out of the ward many times and many times we had thought it would be his last admission. Somehow each time he pulled through. This night would be different. 

In those years our management of children’s cancer was not very good. We had few drugs and an unreliable supply at that. The politicians were still to decide what to do with the influx of oil money. It was not until a group of young doctors went on strike that the government flew in a BWIA planeload of supplies. Discardable syringes! Disposable gauze. Throw-away needles! Whoopee! You ever gave an injection with a blunt, reused needle? You have to force it hard, deep into the flesh. Painful, really. 

Dr Waveny Charles had not yet arrived in Trinidad so the Blood Lab was quite primitive. You were lucky to get a bag of whole blood. Separated blood components, white blood cells, red blood cells, platelets, were a distant dream. Blood was kept for adults, especially the ones belonging to the political party in power, a fact which made at least one haematologist emigrate after his patient died whilst a “big boy” got the 15 units available that evening. He still died, but pink. 

Children were not important. Not like now when the Children’s Life Fund is the topic of gossip. Children died like peas from gastro; pneumonia; whooping cough; tetanus; jaundice; prematurity; marasmie and liver disease from bush teas. 

Leukaemia was not a priority. There were two drugs that we had to treat it. If you did not respond, your a-- was grass and the lawnmower was coming. Yes, quite cynical. That’s what corrupt politicians and ignorant administrators do to doctors. 

Kevin initially had an excellent response and went into remission (no sign of the leukaemia in his blood, bone marrow or spinal fluid). Oh yes, we tested for that in those days. It wasn’t that we did not know what to do. The drug treatment of the common type of leukaemia that Kevin had was standard all over the world and some of us at least had been properly trained in faren. We also knew what tests had to be done and we knew who the reliable, hard-working technicians in the hospital lab were. So you would do your test and take it down yourself, hand it over to Irma or Shalini or Rodrick (names changed to protect the guilty) and a couple hours later, have your results phoned back to the ward to you or if the news was bad, brought up to you, with an anxious face and an apology. Yes, we had lab technicians with heart and soul at Port-of-Spain General (PoSGH). 

The problem was blood products and antibiotics to manage the complications of the leukaemic process. The problem was the lack of isolation on the children’s wards. The problem was lack of nurses to give a very ill child the care needed (there was no intensive care unit at PoSGH until the mid-80s). 

After some months Kevin’s leukaemia came back. He was admitted to the open ward on the fourth floor, put next to a child with an infection, became febrile, septic and slowly died over the next three days.

The night in question, he was moaning in pain and bothering the other children on the ward. So nursey moved him from in front of the nursing station where the most seriously ill children would be placed, into the farthest corner. I can point out to you the place where he died. It’s the north-west corner of the ward. She placed a screen around his bed, sort of ostrich-like, checked that his intravenous drip was running and basically abandoned him. So did I. No excuses. We were very busy. She was alone that night, the only nurse on a ward of 40 sick children with one nurse’s aide to assist with the checking, feeding (lots of babies to bottle feed, no mothers allowed on the wards) and giving medications. 

I was covering four full wards (two general, 40 beds each; gastro, 65 beds and prem, 30 beds) and receiving new patients every hour on the hour. As usual I had one intern, three months graduated, to help me. A hundred and seventy-five sick children for one paediatrician and one junior doctor who knew very little.

Pressure!

So we left him alone, in a corner of the ward, by himself, lonely, in pain, confused and sick, to make the journey we all must make but which hopefully will be easier than his. Because he suffered all night. It wasn’t until about 4 am that I could get back to him and give him something to relieve his pain. To tell the truth, he was so weak and malnourished, I had been afraid to give him anything earlier. By then it was too late. He was rapidly sinking. I sat down at his bedside and held his hand for a couple minutes. I am still sorry that I did not take him from the bed and hold him for the last moments. 

Nurse called. There was another emergency. I left. When I returned an hour later, he was gone. Poor overworked nurse had not noticed. I hope my medication helped.

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