A lesson: On Meningitis and Compassion

Life out here  is hard.

Today I went into clinic, and we had a patient with really advanced AIDS. He has progressed into the “wasting syndrome” and additionally is suffering from other symptoms from an additional opportunistic infection, seemingly, meningitis which seems to have localized in his nervous system, and it is affecting his ability to walk and it is causing him intense pain. This patient was carried in this morning by two members of his family.

He was too weak to eat, so Sunita puréed him some rice, which his wife spooned to him. I just kind of watched this couple from afar, and thought about how difficult their lives must be.  Rubina, always the oracle who answers all of the questions I can never really articulate, broke my contemplation: “he has been out of work for 8 months, they have no food for the children.”  She is working to connect them with a program that provides food and clothing to destitute HIV patients.

I thought about this all afternoon. About hunger. I imagined this couple’s children, and superimposed the faces of the children I see each day on the street into my vision of their family and their struggle.  I suddenly felt more grateful for the sticky rice I eat day in and day out, and the vegetable curries Sunita piles on my little tin dish.

As the day was winding down, Dr. Suggunama (we call her “madam”) informed me that this patient needed to have a lumbar puncture (a spinal tap)  in order to collect some cerebrospinal fluid for lab analysis. She invited me to observe.

Uncle helped position the man into the fetal position, his back facing us. He was so gaunt his skin stretched over his vertebrae like tight leather, and I could clearly see the demarcation from where madam would pull the fluid.

Now, I’ve never had a spinal tap, but I can’t imagine its entirely comfortable.  On top of that, this poor man was already in so much pain he couldn’t walk—much less have a needle stuck into his spine.  Uncle held him, so he could stay steady. As madam started the puncture, this man began to whimper and eventually he cried in discomfort. The whole time, this man’s poor wife was standing next to me. She began to wail so loudly and so severely, I thought she might hyperventilate. Uncle shot me a sharp look, so I took this lady by the arm and led her outside.

Once in the sunshine, I sat her down under the tamarind tree where she continued to wail. This woman’s voice was full of agony and pain. I went to the kitchen and found a small bottle of cold water and brought it out to her. I sat with her as she sipped it slowly, and then she slowly slumped into my lap. Quietly, she shook as she wept into my Punjabi.  Immediately, I began to cry as well. Then how strange, I thought. This woman and I don’t speak a word of one another’s language. We’ve never met. I don’t even know her name. And yet, I can feel her sorrow  and here I am, sharing in her pain. Is this what doctors do?

The spinal tap revealed that the patient does, in fact, have cryptococcal meningitis. I turned the sharp focus knob on Mary’s microscope and got a clear look at the tiny blue circles on the slide that was the cause of all our tears this afternoon.

Cryptococcus spores in spinal fluid

Madam had to send him away to a bigger clinic since he needs some very advanced treatment outside of our scope, but truly, he won’t live much longer even if he survives this (which is unlikely). I thought about my time at NIMS and imagined this man and his wife navigating through the giant crowded hospital, weak and brokenhearted.

As they carried him out into a waiting vehicle, his wife followed behind with her head bowed. I whispered a prayer for them both, and then they were gone.

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