four days old

You always hear the children crying first and we usually start rounds in the
pediatric ward. Frankly we triage with a bias towards the children, because
it is often they who will succumb to malaria or other infections in this
place, in these times. 'Succumb' of course is a picturesque way of saying
"die". As we discuss events at the end of the day at the base I will sometimes
launch into my latest humor offensive, directed against these 'spoilt
children' who tend to demand all the attention. They get carried around on
people's backs all day long. They get fed a lot on demand. They occasionally
appear cute and playful(probably a ploy to trap us into liking them). They
inspire stupid smiling faces and gurgles from adults who should know
better(that's me). They often sneakily pretend to be helpless!
Beneath my dubious sense of humor lie other, quieter realities.
These are the beautiful old people who also arrive at our hospital
regularly. They are often stooped and crooked, sometimes dying, their
complaints as such perhaps not given the weight they might deserve. They
don't merit quite the same attention, they don't often squeal or cry. These
men and women arrive quietly and look at you with a calmness or a
resignation or a detachedness that seems to ask; "do I also matter, to you?"
Do they?
These are the survivors of a harsh life, walking or being carried in for
help. They have clouded eyes, pain, urinary retention, cancerous growths and
thin wrinkled skin. I sometimes ponder are they victims or victors?
Emergency medical organizations like ours are not ideally set up to handle
these old souls, in this place in these times.
The things these survivors could probably share with me. Those 'spoilt'
babies have no idea. I, have no idea.

An old man comes in with a distended abdomen; it looks like a small cantaloupe down there. It is his bladder, swollen and painful from urinary retention. We ask how long has this problem been going on? "about four days" he says. Maybe, but probably not I think. Swollen joints, end-stage
tuberculosis, HIV wasting, tumors, gangrene and festering wounds; when
asked, the patient will often tell you he or she has suffered from it for
"about four days".
And really, why think back any further?
I smile softly as these thoughts flow through my mind.
Everybody somebody's baby.
Four days old.
More later
John B Fiddler ANP