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When your best is not enough

Year: 1994
Setting: Chevron Hospital in Papua New Guinea
Position: Chief medical officer

There are a few villagers living near the hospital, and often kids play on the dirt track leading to the main gate of the prefab compound. After a few trips out of the camp, I notice one boy in particular who is often near that gate. He cannot run, and walks only short distances. His chest is protruding and he pants a lot. I ask a nurse to talk to his parents to see if we could help him. First, she reports that the parents have taken the boy to a witchdoctor who has given them some local medication and assured them that their son would get better. I send her back with the following message: “If his condition does not improve, please come to the hospital.”

Weeks go by, and one day I see them in the waiting room. The child is now constantly short of breath when he moves around. I examine him and the diagnosis is a defect in the wall between the two ventricles in his heart. The bad news is that there is no pediatric cardiac surgeon in Papua New Guinea. The somewhat good news is that in two weeks one is coming from Australia and will be in Medang, which is a 20-hour car trip from the village. I make an appointment with him and arrange for transportation for the boy and his parents.

I see the boy each day in the hospital until his departure. As it is often the case with the sickest children, he is the sweetest patient. These are stressful consultations because, despite my best efforts, his condition is gradually deteriorating. On the day he leaves, he is breathing heavily even at rest. I wonder if he will make it through the 20 hours of travel in the back of a truck on bumpy tracks in a rugged, mountainous terrain. We say a poignant good-bye. To this day, his penetrating, grateful, anxious and pleading look is printed in my brain. A few weeks later, I learn that he had made it across the ridges to the seashore (what a fighter!) only to hear the surgeon say that the boy’s status was so severe that surgery was impossible. He died just a few days later.

Lesson for the doctor: In undeveloped countries, doctors must face the fact that their efforts won’t enable them to save all of their patients. It is useful to learn how to cope with frustration and guilt beforehand.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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