She was brought in earlier but you could hear her crying throughout the ward. Her cry was upsetting the other patients. It’s a paediatrics ward after all and everyone there is small and afraid and sick.
I was with a patient who had cerebral palsy. A product of poverty, one of a set of twins born to an underage and underweight mother who didn’t receive state supplementation.
And I could hear the fear and worry. I cannot leave my patient, there are other staff there. A worker stumbles in green and sits on a chair while I keep playing with the 6 year old whose life was stolen by malnourishment and a culture of child marriage and poverty. I advise the mother to not have more children as two is enough and a child with cerebral palsy is a difficult thing to care for. She wants me to talk to her husband about it. This is important but not as important as what is going on in the other room. The nurse is from Nigeria and has seen burns like this before. She preps a sterile field on one table and another on another while I finish without looking like I am in a hurry.
I walk in and see the extent of the damage. Clothes are charred beyond recognition and a child howls in agony. Parents fret and worry and are told to not touch her. I quickly shoo them out as I pull on gloves and pull out a pair of scissors while the nurse hurries for a venflon catheter and a BP cuff. A lack of education helped caused this. The patient’s burns were not treated with water allowing for deep tissue damage. Her caretakers didn’t know how to deal with burning clothes so they simply pulled them off rather than make her roll on the floor and smother the flames. The damage is extensive. A rough estimate of 40% burns. Her entire arm is blanched and blood seeps through. The smell is that of cooked red meat, seared through for a few seconds of intense heat. I balk at the weird feeling of hunger and a rumble of my stomach at the smell despite the visual. What does it know? I only ate last night and overslept and missed breakfast in my rush. A couple of slices of apple a breakfast do not make.
The nurses bathe her in sterile saline, to clean the burns while removing any charred lose skin. I take her BP, it’s low, she will go into shock if we don’t fix that. tissue fluid leaks from her burns so we need to remedy it. So I insert the venflon catheter. I get it on the first try and we start the line. She needs Pethidine (Demerol) as the pain is so severe and the IV line is how we give it.
She is slathered in an antibiotic cream and wrapped in foil covered bandages. We used tubes of it and has lost some blood. So we make a whip round. B+ve it is and I give my share. She has already slipped into an opiate haze and the parents never see this. They are already in the room holding her one good hand wearing masks.
I am starving and lost half a litre of blood, but still standing. And I stop to ask the most important question.
She reached over a burning lamp for something and a trailing piece of cloth caught fire and spread before anyone could help her. And a lack of education on first aid meant that the help may have exacerbated the problem. Or she was just another girl to be killed for being a girl. That’s not for me to decide, the police are there to do that.
My job is to smile and bring smiles to those who don’t have any.
I left a waiting room of people and went back to my patient and played with him. As much to see if he was okay as it is to see someone smile.