Saturday, January 3, 2015

Death of a Child

"Ibu, jangan tinggalkan kakak"
Mother, please don't leave me.
Words like this coming from the lips of a 4 year old girl a few hours before she died made me believe that sometimes children just have the ability to know that they will go soon. Adults have their own ways of dealing with impending death, but since being in Paediatrics, I cannot help to wonder how children deal with it.
It was a Tuesday morning, and I saw a small boy being pushed into the isolation room, a room reserved for children suspected to have a contagious disease. I was in charge of the cubicle opposite the isolation room, and saw that my colleague in charge of the isolation cubicle was quite busy attending another patient. I offered to help take blood investigations for the newly admitted patient and set a line through the veins to hyrate the child.
When I asked permission from the mother to bring the child into the procedure room, I saw her eyes was swollen, fresh tears. It is common for a mother to shed tears when seeing her child in pain. But I failed to recognize that the emotional suffering she endured was far deeper than I thought.
Blood taking in Paediatrics remain a challenging procedure for young doctors, not only because the veins are small, but also because children tend to resist aggressively. Restraining a child to take blood is not an easy task. With a bit of a struggle, luck, and the mother holding tight to the child, I managed to gain access of the veins through the small needle. I withdrew just enough blood be sent to the laboratory. However, to my disappointment the needle that I used to squeeze the blood out almost fell off, and as expected, a small bulge formed under the skin as I tried to push fluids in. It meant that I had to insert a new needle. I asked the mother is it okay to insert a new one. I was worried because she obviously seemed sad. But that was when she bursted into tears and said:
"Buatlah apa-apa saja untuk selamatkan anak saya ni doktor, kakak dia dah meninggal pagi tadi"
Do whatever you can to save him, Doctor. His sister just died this morning.
For a moment, my mind went into a halt. She started to burst into tears and hugged her son tightly and went on to say
"Kakak dah tak ada"
Sister is no more with us.
I did not know what to say except to whisper 'Inna lillahi wa inna ilayhi raji'un' (surely we belong to Allah and to Him shall we return). I focused on gaining access to another vein. To my relief, I managed to secure a line, and after cleaning up after the procedure, only then I managed to gather my thoughts and asked the mother what really happened. In a breaking voice, the mother told me that her 4 year old girl died this morning on the way to the hospital. She has been having fever for the past few days, but just when her fever started to settle down, that is when rashes appear on her palms and soles of her feet, with multiple ulcers breaking out in her mouth. She went to another hospital and the doctor diagnosed her as having the 'Hand, foot and mouth disease", by itself is self-limiting and rarely life threatening, and told the mother to rest assured as it will go away on its own.
However, that night she deteriorated quickly and started vomiting out blood. At the same time, the mother realizes that the younger brother had also started developing rashes on his hands, and to her suspicion, he has ulcers in his mouth too. That was when the little girl said to her mother "please don't leave me". The mother quickly called the ambulance to bring both children to the hospital.
On the way to the hospital, she died.
The mother went on to tell me that her neighbour's daughter had came to her house to play a few days before. She also had the same symptoms as her children. A few of my colleagues were aware of the case. We knew that Hand, Foot and Mouth disease (HFMD) rarely cause deaths. Judging from the bloody vomit which might indicate bleeding in her digestive tract, and also the high number of children around the area admitted to our wards with dengue, our best guess was that it was HFMD superimposed on dengue fever. In other words, it was dengue that caused her death, and already having her immune system weakened by dengue, she also contracted HFMD from the neighbour's daughter at the same time, so when she presented to the hospital with typical signs and symptoms of HFMD, the doctor was easily misled to NOT think of dengue and sent her home with the reassurance that it was HFMD.
The mother had stopped weeping by the time she finished telling me what happened. I accompanied her back to the isolation room. What she had told me shook me to the core. A lost of a child is tragic, but a soul of a sinless child is promised heaven, a soul that He calls al-nafs al mutmaina: the reassured soul, which is mentioned in the Quran:
"O reassured soul, return to your Lord, well-pleased and pleasing. And enter among My [righteous] servants. And enter My Paradise" - Quran, 89:27-30

Nobody can promise you that they can still be here tomorrow. Nobody knows what tomorrow will bring. We keep on thinking that everything will be the same tomorrow as it is today. But the fact of life is that life can arbitrarily cut you off your air. When you have a few hours to live, what would you do? For an adult, mostly would choose to spend their time with their loved ones. The last phone call, the last dinner, the last "I love you mak, I love you ayah". But for a child...maybe all they can say is
"Ibu, jangan tinggalkan kakak"

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