its on

Typhoid season seems to be in full swing again now that rainy season has come to an end. My first patient of my first call weekend after vacation was a nine-year-old boy with high fevers and severe abdominal pain. He was very sick. In fact, he had been very sick for over a week before finally coming to the hospital. His story was typical for a typhoid perforation

We gave antibiotics and fluids and got him stabilized before taking him to the operating room. As soon as I opened his belly, pus and stool poured out. Often that release of abdominal pressure helps with breathing. But this time, he stopped breathing and his heart stopped beating. A surgeon's worst nightmare...

We fought for his life. We breathed for him. We gave medicine. We did chest compressions. He pulse came back. A few seconds later we found the hole in his intestine...typhoid perforation. But before we could fix it, his heart stopped again. For many agonizing minutes we fought to revive him. We couldn't. He was gone. We closed his abdomen, covered him with a sheet, and went to find his father.

After that, I just wanted to go home. To process. Looking back, there was nothing more we could have done.  I told myself we had done everything we could. That didn't make covering my patient with a white sheet any easier. It didn't make telling the father easier. It certainly didn't make preparing to operate on my next patient, another little girl with exactly the same diagnosis, any easier. She was so sick that the anesthesiologist insisted that I go tell her family again that she was very sick and could die. I did.

As I made the incision, I thought, "Dear God, please don't let this little girl die too. Please don't let her die."

Thankfully, she didn't die. She made it through.  So far, so have my other six patients with typhoid perforations this week. Many of them just barely. None of them without a fight. It has been emotionally exhausting, hoping with each incision that the child will live through the operation. Knowing that tomorrow morning when I go to the hospital, there may be an empty bed from a child who didn't make it through the night.

One hundred and twenty years ago, the typhoid fever mortality rate in Chicago averaged about 65 per 100,000 people per year. Now it is perhaps 5 per 1,000,000.  I hope someday we'll have the same progress here.