Wednesday, October 8, 2008

Last Patient of the Day

About 30 minutes before we closed, I grabbed what I hoped would be the last patient for the day. I groaned when I realized it was a family of three, and they were all new to the clinic.

At best a visit like this takes an entire hour. But if any of the children are sick, it takes much longer. Reality check: everyone who is new to the clinic is sick; otherwise they would be at home or at school or playing soccer.

The family consisted of four children and a mother; I was only seeing three. The three-year-old won the lottery today. He was the only one of his brothers and sisters who tested negative for HIV.

It's easy to assume that this family would collapse with the news. But I've now seen their stoic response many times. Parents accept the diagnosis of HIV like any other--an ear infection, pneumonia, appendicitis. This mother can't collapse because she still needs to figure out how to feed her children tonight.

And what about the staff? They can't collapse either despite doling out tragedy on repeat. So of course, they'll rush me to finish. Tomorrow we'll do the same thing again and again. The bus leaves at 4:30.

I've found myself moving on as well. My baseline is slowly shifting to a new reality.

5 comments:

Geo said...

Andy, this makes me all sorts of thoughtful. I started typing what this first made me think of, but I deleted it—I think it would come across strangely, but boy, it's got me thinking. Maybe via email.

Love you guys.

Cally Carlson said...

Thank you for sharing your experiences. I am in Pocatello and got your blog address out of the Sunday paper. I hadn't realized that HIV can be passed through breast milk. Is there any formula at all available there? Are there any programs in place to get it there? As a breastfeeding Mom myself, I can't imagine the conflict that would be felt feeding your baby, knowing that they could get the virus, but also knowing that without it, they would die of malnutrition. Again, thank you for sharing.

Melissa said...

Hey Dr. Smith and family! It's so awesome to be able to check in and see how things are going there. I'm still insanely jealous... does that sound twisted? I just want to go SO bad! I admire you both so much for going. Johanna, you are an incredible woman! Please let me know if there's anything you need that I could send to you or anything I could do for you. Finn looks so healthy! Carter is starting to get a bit chubby now too. It's so amazing to watch them grow. I was just reading about a doctor that did a lot of work in Africa before and after WWII, and it made me think of you guys. I hope the best for you and look forward to updates. (And seriously, if there's anything you need, please let me know.)
Melissa (from the lab at work)

Johanna Buchert Smith said...

You can get formula in Malawi, but it is beyond most people's pocket book. The problem with giving formula and breastmilk is that mixed feeding makes transmission of the virus much more likely than breastmilk alone.

Johanna Buchert Smith said...

great to get a message from you melissa. Glead to hear that you guys are doing well. We miss Pocatello!