Complacency

It doesn't matter how long I am in Africa, I just can't get used to the blase attitude toward death. Last week, we had a 9 year old girl admitted with epistaxis. She was found to have pancytopenia. No blasts were seen on the peripheral smear and she had a normal LDH. She was put on high dose steroids, but her counts never improved. I kept pressing for a bone marrow. I thought the girl either had ALL or aplastic anemia (the latter being more likely due to the normal LDH.) The last time I saw her, she looked sick but wasn't acutely ill. This morning, I asked Gigi (one of the interns) if they ever got a bone marrow on the girl. She said "Oh, she died." She said it with absolutly no emotion. I tried to ask questions about the death, but she kept saying "She just died." I could tell she was getting frustrated with my questioning, so I stopped. Later I found out that they think she died from sepsis. She was put on some big gun antibiotics (pip-tazo and amikacin) but it was too late. I found this whole thing frustrating. Had this girl been in the US, she would have had a bone marrow within 24 hours of admission followed by prompt treatment of the underlying cause of the pancytopenia. Plus she would have been covered with antibiotics from the beginning. But, she wasn't born in Pennsylvania with all of our state-of-the-art medical care. She was born and died in Africa.