4 - Alpha Omega Alpha

ng to forget
cry. I listen to his heart but it doesn’t make any more sense
to me than his occasional verbal sputters. I’ve only seen him
open his eyes once in the week since his birth. He has thick
and dark hair for his size, and it mats in tangled patches when
he’s sweating. He sweats all the time. I sweat all the time.
Zambia feels so hot lately. The baby smells like milk and baby
powder and he attracts flies. I’m watching him die, so I try to
pay attention to everything, I try to remember everything. I
also try to forget everything.
Sarah says he should have a name. I don’t want to give him
a name.
The baby sleeps with us some nights. He doesn’t move
much at night, and his breathing is so quiet it sounds like
two pieces of paper rubbing together. It is almost completely
lost in the awful whine of the mosquitoes, so if he is sleeping
we have to listen closely to be sure he is breathing. When he
doesn’t sleep I sing to him. Sometimes I ask him not to die.
Sometimes I ask him to stop suffering and die. We didn’t really
adopt him, but his mother died at the clinic. She was the
outside party in an extramarital affair. The teenage children
of that family beat her to death when she showed up seven
months pregnant. She lived long enough only to deliver her
premature son. It probably doesn’t even make things any
Illustration by Erica Aitken. Photo credit: Left, Flying Colours Ltd. Center, Roadsworth. Right, AFP/Getty Images.
worse that he was born with her HIV infection, but I think
about it because of the father, and the rest of his family.
In the last week, when I see pregnant women or babies, I
want to cry. Sometimes I do. I’m sad, of course, and also I feel
very angry. I feel angry because I feel very helpless. I don’t
know what I’m doing with these patients. I don’t know what
I’m doing with this baby. I don’t know how to make a difference.
I especially don’t know how to make a difference when
the world around me looks so hopeless. And I don’t know
how, once I leave here, I will ever close my eyes and not see
the images of this world around me.
Lesson for a student: There is healing
strength in understanding death
We left the clinic a little earlier than usual and drove together
to the hospital where we would meet one of my mentor’s
oldest patients, moving from hospital care to hospice
care. Although my preceptor worked with pregnant mothers
and pediatrics, the bulk of his practice was in the wider world
of family medicine. He took great pride in treating as many
as four generations of a family. He had pictures in his office
of patients he has delivered and is now still treating in their
twenties. With a patient population spanning such a spectrum
of age, he was in a position to witness those great beginnings
as well as to counsel those coming towards the great
endings of their lives.
The patient we were going to see had had a lifetime of reasonably
good health and activity, now culminating in a week
of shallow breaths and the feeling of pressure on her heart.
To me this was one of the great hallmarks of the medical profession:
the role of the physician at the end of life. What can
you do to ease the frightening transition into noncorporeal
existence? What tools of sympathy and empathy can you conjure
up to achieve an effect of soothing compassion? What do
you say to the family? What do you say to yourself about your
abilities to preserve life?
I wanted to save most of my questions until after our
meeting with this patient and her family, but I talked a little
The Pharos/Spring 2009 13