The long rains had just begun and
the weather was rather chilly. He wore a home-knit green marvin, wore green
sweater to match and an oversize pair of black pants. He sat on the bed with
his mother besides him. He stared apprehensively at me with his big black eyes,
balancing a few drops of tears. When I inched closer, he responded by cuddling
his mother. I stretched out my hand a flashed a smile in response.
“Simo, salimia daktari.” (Simon,
say hi to the doctor) his mother said in a slow but reassuring voice. He then
smiled back. “ Anaogopa sindano.” (He is afraid you will inject him).
“Usiogope, sina sindano.” (Fear
not I am not going to give you an injection) I said taking a seat on the bed.
He reluctantly offered his hand and I clasped it in mine: he was running a
fever. He then broke into a session of repeated coughing lasting about a minute
or two: his chest was very congested. “Pneumonia,” I thought. Could it be that
he had fallen victim to the weather? I continued to take a focused yet
extensive history.
Mama Simon informed me that her three year old boy had been unwell for about a month. It had started with him
not playing as much as his other six siblings. He was always fatigued and had
developed the cough and a fever over the past seven days. They lived in Lodwar,
but during the cold nights he had drenching night sweats for the past month.
However, it was not until his cough got worse that she visited the local
hospital in Lodwar, where they were referred to Moi Teaching and Referral
Hospital.
This had me thinking, pneumonia
was a possible diagnosis but it left a lot to be desired. The history was one
month old, he had easy fatigability and night sweats. Being constitutional
symptoms, they were not specific for any illness but they meant I had to rule
out any malignancies or TB. Malaria was highly unlikely to be the primary
diagnosis given the duration of illness, but I had to send a blood smear to
rule out its presence at the time of presentation. Moreover malaria and
pneumonia were treatable at Lodwar, and Simo had no obvious signs in history to
warrant referral.
It was during examination that I
noticed that Simo was very pale i.e the amount of hemoglobin in his blood was
low and there were tiny bleeds in his gums. He also had a mildly enlarged
spleen. “Oh my!” I thought. Blood cancer was now at the top of my list. I
needed a complete blood count. I looked back at Mama Simon and forced a smile,
“Ameongezewa damu?” (Has he had a transfusion?).
“Ndio, moja.” (Yes, one pint)
This was not enough, so I also
planned to order a more few pints. I explained to mum that we had to work him
up and promised to be back feedback. In the meantime I instructed a course of
antibiotics for the pneumonia and some paracetamol for the fever.
It was not long before the
results were back. The nurse handed this to me and I took a seat at the nursing
station. Simon, out of the hospital corridor had seen me and came running. “
Jomba, jomba, jomba, mum jomba amekuja.” (Uncle, uncle, uncle, mum, uncle has
come.) His mother waved him off and waved at me. His pants fell to his knees
and he stopped to pull them up. I stood up, smiled and went to pick him. We
exchanged greeting and he asked for the sweet I had promised him earlier. I
reached into my pocket and pulled out the lollipop I had bought on the way to
the ward.
He sat on my lap as I reviewed
the results. My spirits were dampened when the complete blood count confirmed
my suspicions. All the cell lines were abnormal. His chest X-ray pointed to a bronchopneumonic
process, inferring that he had pneumonia. His malaria test was however
negative. The next step was examining his blood and bone marrow under a
microscope. I looked at Simon and told him we go say hi to his mother.
I took time briefing the mother
about my suspicions and what we needed to confirm and the consequence of either
diagnosis. She had never heard of leukemia. She had left her children alone in
Lodwar and was very concerned as to their well-being: she was the only
breadwinner. I promised to do my best to get them home soon and contacted the
social worker to take over the case. I knew if I did not address this she would
eventually default treatment.
The tests took about a week to be
processed, by that time, Simon’s pneumonia was cured and he spent most of his
time playing at the Sally Test playground. By this time we had bonded. When I
was writing down notes he would sit beside me, ask for a paper and a pen and
doodle. The result read Acute Lymphocytic Leukemia. As was usual I sat with
Mama Simon for counseling. This was the last session, since I would have to
work them up for transfer to the oncology wing.
Her first question was when she
could go home. She understood the treatment as I had earlier explained is a 2
year course. I took time to explain about the breaks available in between the
courses of treatment but made sure to note that that decision however would be
made by the cancer doctors in consultation with her.
When Simon was off my service, I
missed his presence; it was never the same without the young boy who sat next
to me doodling. I made a point to visit him. He had just received his dose of
chemo and appeared sicker than I had ever seen him. I had expected this though.
Over time his condition improved
as the tumor burden fell. It was approximately a month and a half when he
received his first two week break. His mother informed me on phone.
She called me a few days ago: it
had been a year since admission. Simon was well; however, she had not been back
to hospital since. I asked her why and she said God had healed him. I pleaded
for her to visit the local hospital for a complete blood count. She promised to
do so, but I am still not convinced she will.
