Follow-up on the patient with heart failure

My patient with congestive heart failure that I wrote about on January 23rd continued to worsen. His work of breathing significantly increased and he appeared more tired. I decided to transfer him to Dili, the hospital with the greatest resources in the country.

Yesterday, I traveled the 3.5 hours to the capital to secure an extention on my visa. Just after a brief stop at the office of immigration, I visited the hospital to check in on him. There were no physicians available and finding him was not an easy task. Finally, I located him in one of the pediatric intensive care units, in the fetal position in a crib much too small for him. Yes, an 11 year-old was is a crib.

He was breathing extremely hard and seemed very pale. I tried to wake him and say hi, but he looked up for a brief moment, had a look of confusion, and fell quickly back to sleep. He was much worse. I fear he will not survive.

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