"No child should die in the dawn of life."

As most of you have probably gathered by now, my friend Angie is visiting me from the United States. She and I completed our ophthalmology residency together in June. She is a dear friend and is also interested in international ophthalmology. She decided to come visit Swaziland for awhile to help out in the clinics. Dr. Pons is very grateful for her help!

Today we had another busy clinic. Angie was also impressed by the pathology here, and we were diagnosing things we have only encountered before in textbooks. As she said, it is very humbling to work here and you realize that, despite an amazing education in ophthalmology at the University of Iowa, there are still many things we haven't seen/don't know.

We diagnosed:

- CMV retinitis

- Ophthalmia neonatorum (gonococcal conjunctivitis in a 3 week old baby)

- Many squamous cell carcinomas

- Molluscum contagiosum in an older male (usually seen in children, but in setting of an adult, may indicate immunocompromise, so we ordered an HIV test)

- Removal of two corneal foreign bodies

- An open globe (stellate corneal laceration and traumatic cataract) in a 2 year old boy who had trauma to the eye yesterday

- Posterior scleritis


And, the worst news of the day...my retinoblastoma child came to the clinic. I posted about her last week. I didn't even recognize her at first.

As we last left it, I was able to obtain the globe (eyeball), and we mailed it to the UK for pathology read. I was successful in this endeavor, with Jono's help. Unfortunately, the pathology will take a week or two to come back, given the logistics. Well, today the family showed up (mother and father) with their child. The father was holding her and she was listless. The tumor was even larger, and I honestly could not believe how much it had grown in just 8 days time. I asked the father how she was doing and he said, "She stopped eating four days ago and she is in so much pain she cannot sleep at night. I came here, doctor, because she is in so much pain, I thought you could help us."

I felt nauseous and sick and angry and a million other emotions. I discussed with Jono, and we think it is likely palliative care at this point. I admitted her to the peds ward (under the eye service), and we are giving her fluids and morphine for the pain. I ordered a CBC, a chest X-ray, and an ultrasound of the abdomen (liver) to check for any sign of metastases, which may help us figure out how advanced the disease is. MRI is not available and South Africa cannot help her until they have a formal tissue diagnosis. Plus, I think she is too sick to travel at this point in time.

I explained to the father that I wasn't sure how this was going to turn out, but that I fear she is dying. He had a quick look of shock and fear on his face, and then he said, "I understand, doctor." 

I have brought a "polaroid" camera with me (the 21st century version...the Instax Mini), and I have been using it to take photos of kids in clinic, which I then give to them to keep. They LOVE watching the photos appear, and the parents love having a photo of themselves with their child. At any rate, I didn't want to stick a camera in this man's face, especially with his child looking so ill, but he must have heard I had a camera because he asked for a photo. So, I took a photo of the little girl with her parents.

When Angie and I went by to see her on the peds ward this evening before leaving clinic, she looked peaceful and did not appear to be in pain. The mother was sitting at her bedside. My heart breaks. This is life, but it is devastating and never gets easier. Especially when it seems that more could have been done earlier.

When I was in high school, I loved the story of Danny Thomas and how he came to start St. Jude Children's Research Hospital in Memphis, Tennessee. He decided to build a pediatric hospital for catastrophic illnesses because he said, "No child should die in the dawn of life." I love that quote, and that is exactly how I feel in this case.