A Part of the Team

Last night, I ended what has been a very intense and difficult week playing soccer with the intramural women’s soccer team. Despite the fact that running is a big coping mechanism of mine, I am not a very sporty person. I do not follow any sports teams, I do not watch any form of sportsball, and my general understanding of how to play soccer does not extend beyond kicking the ball with your feet into the goal without using your hands. Yet, as I squinted at the blurry people passing the ball, having removed my glasses lest something happened to them, and joined in the joyful fray, I could not help but be caught up in the similarities between playing on the team and taking part in the week’s intensity as a member of the interdisciplinary medical team.

Life here in Laos is difficult at any time of the year, but rainy season tends to magnify the difficulty a thousandfold. Access to care, which at the easiest can be up to 24 hours of travel for some families, becomes nearly impossible when the rain drives rivers up onto banks, swamps roads in mud, and makes bridges disappear. The effects of the rain have been apparent throughout the season, with families unable to make follow up appointments or arriving with nightmarish tales of spending days with compound fractures, seizures, or meningitis before being able to travel to care, but the results of the rainy season really peaked this past week. Over the course of four days, we had approximately 9 or 10 patients arrive and then pass away in the ED from illnesses which had progressed to the point that there was little the medical team could do to save the child. At some point, I stopped counting. In order to preserve our sanity and continue to be present with each and every grieving family, it was essential for every member of the interdisciplinary medical team to function exactly within their role, moving from bed to bed and code to code, acknowledging and making space for one another between compressions and handprints.

A statement I heard often throughout the intense week from many different members of the medical team was, “At this point, [the patient] would have died in any hospital in any part of the world.” It was an interesting variation on the typical, “there’s nothing more we can do”, but it sounded wrong to me for reasons I couldn’t pinpoint at the time. As I embraced weeping mothers, fathers, and grandmothers who clung to me so tightly that I could smell the lingering scent of the morning’s cooking fire in their hair, waved away eager flies who weren’t fooled by the oxygen masks we placed over the faces of newly dead children to sneak them back into their villages for burial, offered shrouds and hats and burial clothes, and made careful handprints and footprints of so many sizes and colors, I was continually struck by how horrible and unique it all was. Yes, the patients all arrived in a state where there was little if anything anyone could do with any amount of resources in any hospital setting, but in other parts of the world, they would not have progressed that far before finding care. Most of the time in places like America, diarrhea is not a death sentence.

This week was unspeakably tragic and as much as it drove home the privilege of growing up in a country where I could consistently access care no matter the weather, the repetition of resuscitation attempt after resuscitation attempt on patient after patient after patient drilled into each and every one of us the impact of our roles. As I stood in a quiet moment with the body of a dead 8-year-old boy, waving away the flies and rubbing my thumb over his stiffening shoulder to give the fleeting impression of life to patient and family passersby through the ED and lend some measure of comfort through vigil while his family went to arrange transportation home, I was taken by how important each member of the interdisciplinary medical team was in such moments of extreme, repetitious tragedy. Just like the blurry, joyful women sprinting and kicking after a ball on a dusky Friday night, changing direction back and forth or waiting for their moment in the goal to dive, block, and save, the frenzy of the resuscitations, the sober calm of conversations about withdrawing support, the heartbreaking spreading of paint over palms and soles, and the gutwrenching wailing of the families of the newly deceased paints a similar, though unspeakably more tragic picture. In any environment, be it a field or a death, each of us has a part to play. While this week has been so very difficult, I am honored to have been a part of the interdisciplinary medical team and to have been able to lend some small comfort during the hardest of hard times.