Since arriving in Goma, I have stressed that we should never give up on a patient. I have encouraged resident doctors and students to vigorously fight for every life and told them on multiple occasions that sometimes “miracles” happen. A child may survive under the most unfavorable circumstances if we just give them a chance.

Last week I had a change in philosophy. One of the neonates became ill and stopped breathing. We gave him breaths with a mask for a few minutes but, after no improvement, I inserted a breathing tube. We continued to keep him alive for 4 hours but he did not show signs of breathing on his own.

Around 6PM, I asked the entire staff to gather around his bedside and I said:

“This child is very ill and I have never seen a case like this survive in the developing world. We are neglecting the other children in the room and I would like to extubate him, allowing him to die. Then we can properly care for the other children. However, I will not do this unless everyone agrees with the decision. What does everyone think?”

Immediately the day nurse and medical students said “That is OK”. The night nurse just stared at the ground.

I then asked her “Judith, how do you feel?”

She replied “We shouldn’t give up on this baby. Let’s continue how we are doing and I will work extra hard in the evening.”

I was worried about the care of the other children, but I was proud of Judith’s enthusiasm and compassion. I hesitantly agreed with her plan.

The team kept him alive until early the next evening and then he quietly passed away.

I am pleased the staff is fighting for their patients. Care was compromised for the other neonates, but no one else was severely affected.


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