The one that breaks the lungs

I don’t think I’ll ever forget baby May*, or the time we spent with her parents as she lay on the hospital bed in her bright green dress – her nostrils flaring as she fought for every breath…

A father lost in thought

We arrive at the hospital and see May’s father, David*, sitting on the edge of the bed where his daughter lies unmoving. His wife Imani* stands nearby.

The oxygen mask and May’s heaving chest suggests something serious. Then David starts to explain that the diarrhoea started two days ago, and she stopped eating, taking only breastmilk before going off that too.

Misdiagnosis and panic

Worried and unsure what to do, they phoned a nurse friend. She works at a private clinic and suggested taking May in. There, no-one mentioned pneumonia. May was just given medication for teething and sent home. But in the early hours of the morning, her mother Imani woke to find May unconscious. They panicked.

Talking quietly next to May’s bed, David and Imani tell us they have faith that she will be okay – but were still scared she wouldn’t make it to help in time.

Leaving their other child with a neighbour, they rushed May to the area’s biggest hospital, arriving at 6am.

*Names have been changed and faces hidden, to protect identities.

A hurry to diagnose and start treatment

The emergency doctor assessed her quickly: May was barely responsive – weak, wheezy and breathing very fast. She had eyes sunken from dehydration. The doctor heard bronchial sounds on her chest – suggesting it was wet – and noted diarrhoea and a cough. Everything pointed to severe pneumonia.

May was moved to the acute room on the paediatric ward, where children in the most critical condition are treated under the watchful eye of Disney characters painted on the wall.

You hear people talking about it

As doctors and nurses come and go, David continues his story. He says the guttural noise coming from May’s chest sounds like each breath is a struggle. And he clocks the doctors’ worry – commenting on their unease and the attentive way staff are moving around their daughter.

He tells us he’s heard people talking about pneumonia – saying it’s the one that breaks the lungs.

Struggling to stabilise her

Tired and anxious, David looks at his daughter whose breathing is speeding up.

May wakes up and her parents lean in closely – adjusting her oxygen mask, touching her skin. The doctor comes in and puts her head to May’s chest: “Her chest is wet.” She puts a tube into May’s mouth making her gag, and sucks out the mucus.

Lying there on her back, arms and legs splayed, wriggling now she’s awake, May makes a wheezing sound that’s loud even from the edge of the room.

And all the while, her chest rises and falls rapidly, her belly pulling up and under her ribs as her whole body gasps for breath.

Peculiar rhythms of a children’s ward

As time ticks by, May’s parents face a cruel waiting game. David steps out to speak to the clinicians and then comes back in, becoming animated at times, talking about May. Then as exhaustion seems to take over, he sits back on the bed, resting his head in his hands, silent again.

He leans right over his daughter, gently holding her chest and squeezing her arms, whispering to her, swatting away occasional flies and sighing heavily.

Imani walks out of the room then straight back in again, stooping to lean against the bed, head down. Then she paces around, unable to keep still or take her eyes off her daughter. It sometimes feels like she’s forgotten we’re there.

“Could go either way”

Some of Imani and David’s friends arrive and we step out.

May has been moved onto second line antibiotics already, but isn’t responding to them. The doctor worries aloud: “There’s not much improvement… it’s touch and go until she’s stabilised. If in 12 hours she’s still critical, we will give her third line antibiotics.”

“She requires around-the-clock care. We should have one nurse specifically for her but we can’t. And I’m the only doctor on the ward at the moment. It’s very demoralising when you don’t have what you need to care for a child, but we try our best with what we have.”

Awareness is everything

Looking weary, the doctor continues: “May was sick for three days before coming here. Maybe the parents didn’t know what the signs of pneumonia are – it’s a common problem.”

Imoni had said she’d feel more prepared if it happened again. It makes me feel so sad – many parents appreciate the urgency if they’ve seen the symptoms before. But when their children don’t survive that first encounter with the disease, the lesson is learned in the cruellest possible way.

Tiny signs of improvement

After two days on the ward, May was still in a critical condition. But she stabilises ever so slightly and on the second day, we watch her feed through a nasal tube. Still though, her fever spikes and she’s not responding to the stronger antibiotics.

Nurses do more tests to check for complications and everyone is still concerned: “Once in a while we get the most challenging cases like this one,” says the doctor: “We will see…”

Clinging to hope

David and Imani are helpless, and all too aware that they have to put their faith in the doctors. Nonetheless they clutch at anything – like May’s hands moving – that could be a positive sign.

Their faith feels reassuring at times, but I go to sleep that night still worried about May’s chances.

An empty bed

On the third morning, we arrive on the ward and walk towards the room where May’s being treated. The bed is empty.

We quietly split up and start looking for her in the other wardrooms, scanning each bed in case she’d been moved overnight, not quite ready to accept the most likely explanation.

Eventually we find a doctor who confirms our fears. May died in the early hours of the morning. Her condition had worsened and the on-call doctor wasn’t phoned in time to save her.

Those hours are the coldest and most risky for pneumonia patients, especially on an understaffed nightshift. We knew that, but it still came as a shock.

A tragedy repeated over and over

In our two weeks on the ward, even though pneumonia is preventable and treatable, May wasn’t the only child who died from the disease because parents were unaware of the signs or the healthcare was overstretched. I wanted to scream in frustration, thinking of the pain David and Imani must be going through as they prepared to bury their daughter.

We must prevent any more parents experiencing such needless anguish.

 

*All names have been changed to protect identities.

Leave a Reply