Patience

The following was submitted by Ben Trappey, a fourth-year medicine-pediatrics resident:

Urgence is an amazing medical hybrid: part Emergency Room, part Urgent Care. Part short stay, part inpatient unit, part NICU. It consists of one long room with a smaller area sectioned off in the back and a hallway running the length of it where another 5 to 12 patients are housed. The main room holds 15 or so stretchers, where the sickest kids, ranging in age from a few months to 13 years old, are housed. Along one wall are another 15 or so newborn babies, many of them premature. (St. Damien's has a separate NICU, but it is open only to babies born at the hospital. Those born elsewhere are initially managed in Urgence.)

Outside the Urgence department at St. Damien's Pediatric Hospital

Each patient is accompanied by a family member who sits patiently beside him/her and provides much of the nursing care. The back room is home to 8 of the more stable children. The hallway holds the overflow of children for whom there is not room in the main or back rooms.

The other American doctors (if there are any) and I start our day in the back room, and when we finish rounding there, we move on to the hallway. The hallway is full of kids who had been seen overnight and are either waiting to be sent home or to get a bed in one of the main rooms. Some, however, end up staying in the corridor for several days. Their maladies range from pneumonia to seizures to severe malnutrition, and some of them would probably qualify for ICU care in the U.S. The hallway ward is furnished with a long row of connected metal chairs, a few moveable chairs, and one padded table. The sick children sit or, if there is enough room, lie on blankets or towels in the chair next to or in the laps of their family members. The table is usually occupied by the child whom the mothers somehow seem to decide needs it the most.

Inside the Urgence department at St. Damien's Pediatric Hospital

The patience of these families is, perhaps, the thing that I've seen here that astounds me the most. Many of them sit in this hallway for days, waiting for a bed to open up, for the doctors to round on them, for the one nurse who covers both the back room and the hallway to carry out our orders, for lab results that usually do not return for at least 24 hours.

And so they sit and fan themselves and talk to each other and lean upon each other for a nap, and watch each other's children while one of them takes a bathroom break.

What they do not do, apparently, is complain. In the four days I've worked so far, I've not had one parent express concern about the wait or about being tired or hot. Two have let me know that the antibiotics have not yet been given or the fluids have not yet been hung for their child, but these were the mothers of two of the sicker children, to whom I had expressed concern and stated that we needed to move quickly to get treatment started. Neither of these mothers seemed angry or put out.

Nor did the grandmother of the very small 11 year old girl who presented three days before I got here with low-grade fever and yellow eyes. Her fevers resolved quickly, but when her blood counts returned the next day (day 2 in the hallway), she was severely anemic. Her other blood counts were normal, as were the remainder of her labs. Her grandmother had been told in the past that the child was anemic as well. The most likely cause of her anemia was sickle cell disease, which runs in their family. She received a blood transfusion the day before I arrived (day 3 in the hallway), but when I saw her the next day, her follow-up hemoglobin had actually dropped. So we ordered another transfusion and waited for the results of her sickle cell labs.

Unfortunately, St. Damien's did not have any more of her blood type in stock, and the family had to find a family member to come in to give blood for her. On the evening of the fifth day she had spent in the hallway, she finally got the blood transfusion. We repeated her hemoglobin the following day. The result, along with that of the sickle cell test, finally returned yesterday.

She'd responded well to the second transfusion, and we were able to confirm that she has sickle cell anemia and to arrange follow-up in the sickle cell clinic here. She had spent an entire week of her life in that hallway.

When I was 11 years old, a few hours of not being engaged or entertained seemed an eternity. This child sat patiently on those metal chairs for seven days, while younger children beside her cried and coughed and vomited and had diarrhea and seizures. Every day when I would see her, she would grin broadly and tell me that she felt well. I would tell her and her grandmother that we were still waiting.

And they would smile and say "dakò" and "mèsi", which means "agreed" and "thanks".