Life Lessons

Across the Siem Reap River from our apartment is a temple.  We see it from our balcony.  It’s a classic Cambodian Buddhist temple with lots of gables, peaks, and pointy serpents on the corners of the red tiled roofs.  We saw a lot of temples like this in Thailand, and there are a lot here in Cambodia.  But this one is unique.  Kittens live there.  As does a sweet, toothless, Buddhist nun who feeds them rice and fish.  They follow her around with devotion.  Catherine is there everyday, heading out on her own across the bridge to pet the kittens and hang out with the nun.  There are four kittens with variations on tabby.  They are definitely from one litter.  There are also two, tiny, wobbly, black kittens.  Or there were two.  The smaller one died.

When she first met the kittens, Catherine quickly attached herself to the smallest of the smallest kittens.  She has always been a champion for the underdog (or undercat in this case).  She would sit for over an hour in front of the nun’s small home with the little, black kitten curled up in her lap.  The cat would purr, and Cat would relish life.  But one day Cat told me there was something wrong with the kitten’s eye.  Her eye crusted with pus.  We took a wet washcloth and some eye drops to the temple.  Wiping away the pus I could see it was not an eye infection but an abscess above her eye.  Although the kitten had already lost weight, I told Cat to have hope.  The abscess was already draining.  That was the first step in healing.

We went back the next day with the wet washcloth and found the kitten weak and even smaller.  We offered her milk.  She didn’t want any.  We offered her water.  She wouldn’t drink.  We gave her a tiny piece of milk-soaked kitten food.  She spat it out.  In desperation, we shoved two pieces of kitten food down her throat.  I had hoped a wee bit of calories would energize her.  Then she might take some water and food on her own.  Later that morning Bill and Cat went back to the temple and searched for the kitten.  They found her under a bush.  She was breathing hard.  She couldn’t stand.  She was dying.  They visited a vet who only offered a vitamin shot should they bring the kitten in.  I came back from work to find my daughter at the temple crying, the nun standing by her side, both looking over the kitten.  The nun gave Cat tissues to wipe her eyes.  They didn’t share each other’s language, but they shared their sadness as the kitten grew weaker.  We finally convinced Cat to go home before the kitten finally succumbed.  The next day Cat went back to the temple to visit the remaining kittens.  The nun had buried the kitten next to a stupa.  She had placed incense and a candle over the grave.  It was so kind and so bittersweet.

We are in Siem Reap so I can work at a children’s hospital here.   I have been spending my mornings on teaching rounds with the residents.  One morning I had a long discussion with the team about a two month old baby with pulmonary hypertension.  The residents were content to say that the pulmonary hypertension was caused by the pneumonia   This just didn’t make sense to me.  The pneumonia had been brief and mild, not enough to cause pulmonary hypertension and the subsequent heart failure.  After trying to argue their case they agreed to get one more echocardiogram (ultrasound of the heart).  The baby had already had two, and no heart defect had been detected.  When I came in the next morning the baby’s mother was packing up to go home.  I didn’t understand.  The baby had been on oxygen the day before.  The residents at that time were arguing with me why the baby needed the oxygen.   The third echocardiogram, however, revealed a new diagnosis: total anomalous pulmonary venous return, a very serious heart defect.  This was the cause of the pulmonary hypertension and the subsequent heart failure.  And there was nothing to do for the child until the cardiac surgery team arrived in April.  Though they might not come until May.

There is another child whom I’ve fallen for.   He’s about five months old but weighs only 2.5 kilos.  His face and arms and legs are so skinny.  He looks like a little old man.  His father sits at the bedside with a worried look but smiles broadly when I sit down on the bed to examine his baby.  The baby first came to the hospital two months ago with diarrhea and was severely malnourished.  His belly was distended with gas.   He was fed in the hospital and then sent home with soy formula which the hospital supplied.  Then the hospital ran out of soy formula.  He was switched back to cow’s milk formula.  He came back to the hospital again with diarrhea and was severely malnourished.  His belly was again distended with gas.  My fear is that he may need an elemental formula.  Even if all he needs is a soy formula it’s available here.  Right now he’s doing okay with the cow’s milk formula.  I so hope it works.

I don’t usually get torn up about death.  As a doctor, I’ve seen quite a bit of it.  The kitten was small and weak.  Sure I wish the vet had more to offer, but even with good medical therapy, the kitten didn’t have much of a chance.  It sounds awful, but I don’t even get too upset by a baby who came to the hospital a few days ago dying.  By the time he came there really wasn’t any way to save him.  For me it’s the children we know how to fix, but we just don’t have the right stuff whether it’s the right people or the right equipment.  The baby with the heart defect may not be able to survive the two or three months until the heart surgery team arrives.  Another baby needs a special formula, but he just can’t get it here.  This feels so wrong.  And it makes me sad.