Life’s great irony is that sometimes what you need most is exactly what you’re least able to give yourself. That gap between the idea in your head and enacting that same idea with your fingertips.
One of the most startling examples of this is severe acute malnutrition.
Those in the worst state of emaciation are those with the least appetite. The more you waste away, the more your appetite diminishes. How can you reverse a mutually reinforcing destructive cycle: can’t eat, too starved; can’t stop starvation, won’t eat?
Last week we saw a 1 year old, the weight of a <1 month old (3.9 kg), that looked about …. 100 years old.
I can’t say that we weren’t shocked.
But part of being a doctor is being an actor. To pretend nothing shocks you and brush off an air of “I’ve seen worse.” It’s hard to say whether this is in order to encourage optimism on the part of the patient, or to hide our own very real reactions to suffering.
In this case, none of us could say we’d seen worse. It was the worst. None were able to keep our eyes retracted back in their sockets.
Sometimes in modern western medicine, you wonder whether your third party help is warranted. In the ED, the cardiac arrest patient arrives at the door after hours of paramedics pumping on their chest, and you wonder the futility of bringing a brain back to life that has been deprived of oxygen for an unknown amount of time.
In the ICU, life takes on a chemical-electric feeling rather than a biologic one. A heartbeat and breath not sustainable without an electrically-powered medication infusion machine and a ventilator. The lights go out and so too does life.
But in this case, the need for outside human intervention in my mind is not questioned. This little girl needed food delivered, and aggressively, regardless of appetite.
In the case of severe acute malnutrition, a tube is inserted into the nose and into the stomach. Refeeds by bypassing the mouth direct to the nutrient-absorbing organ.
Since we met this fragile little girl last week, whenever I am feeling a bit unfocused, a bit unwilling to engage with the world: I think about her and her strength in regaining the will to eat.
Lesson learned: don’t only be thankful for food, but be thankful for hunger. The fact that you feel it, and that you can act on it, is a gift.
Peru: Instituto de Investigacion Nutritional
WFP: World Hunger – A Billion for a Billion
WHO | Severe Acute Malnutrition
MSF Report: Food Price Crisis Masked Deadly Child Malnutrition
She did look about 100 years old. I loved her so much. I hope she makes it. Your thoughts are always poignant