the joy and the pain

The Joy
*******

Kids are so resilient.

Alexander came in last night. He is five. He has a wide smile that displays his two rows of carefully lined baby teeth. Some children are nervous and scared when they come to the ship.

Not Alexander.

He sat on his bed with his mom laughing and enjoying the new scenery. I thought he might like to play with some toys, so I got on the floor and pulled out a huge box of chunky lego blocks and began building a small city.

At first, Alexander was hesitant to join me but after the slightest invitation he flashed a sly smile and came down from his bed. He grabbed two connected blocks and began to race it around D ward yelling, "Beep Beep." Seeing his enthusiasm I proceeded to create a road and a series of bridges for the "car" to drive under.

Alexander is all boy. As he drove the car around the ward he made a series of car and fight noises that little boys seem to have the infallible ability to make. Growing up I was always jealous of my brothers superior noise making abilities. Because he is all boy, I though he might enjoy crashing his car into my buildings and bridges. I was right.

For almost 20 minutes I built houses and bridges and Alexander rammed his car into them and they came tumbling down. His laughter was riotous and his joy oozed through the room.

It rather amazing to me that I can pass this off as work. Ahh, the times I love nursing.

The Pain
********
"Your getting another patient."

Soon after the words were spoken a small boy walked into D ward with his mother. Alexander was already here.

As I bent down to greet my new patient I has to stop my eyes from staring at the golf-ball sized bulge that was protruding through his right eyelid. This skin was taught and small, pink pieces of flesh stood in place of eyelashes. Scant red drainage eclipsed any view of the eyeball and outlined his under eye.

Five weeks ago the bulge started growing. Now it was stealing his vision. But Alexander didn't eve seem to notice it was there. All night he smiled and laughed. He played with blocks and balloons. He stripped down into his underwear demanding that his mother gave him a bath.

I couldn't help but fall in love with him; he is such a joyful soul.

Today Alexander had a biopsy done. When he came back from surgery he slept for a few hours but as soon as he arose he made fast work of utilizing a crayon on his bed to hold the 40 ish male patient in the bed next to him hostage ( I don't know if was a sword or a gun or a combination of both). I wish you could of have heard him laughing.

The biopsy results came back quickly; Alexander has Burkitts lymphoma. The surgeons will probably have to remove his right eye.

Burkitt lymphoma is a type of B-cell lymphoma. In 1956, a British surgeon called Denis Burkitt was working in central Africa and described this unusual type of lymphoma, which is very common in children. This became known as Burkitt lymphoma.

When treated promptly, western medicine can cure 70% to 80% of Burkitt's Lymphoma. But Alexander doesn't live in a country with western medicine and treating a golf ball sized bulge can hardly be considered "prompt treatment".

My roommate Michelle, who runs our palliative care program, has watched six kids die of Burkitt's in the past couple of months. In all of those cases each child was receiving chemotherapy at a local hospital, but hospitals here aren't like the ones at home. There aren't any blood tests of epigen shots. There aren't onco specialists or dietitians. Parents bring the child for the chemo medication, if they can afford the cost of transportation, and then return to wherever they are living. That's it.

Alexander's mom was teary eyed when she received the news. I can't imagine her helplessness. Sadly, it's a regular experience for parents here. Liberia has one of the worlds highest under five mortality rates; almost 25% of children die before age five.

Alexander has his spunk on his side. He will be a fighter. One of Michelle's Burkitt's patients is still making it through his treatments. I hope Alexander will be number two.