"A febrile seizure".....

for no less than thirty minutes! (Insert frowning face with teeth clenched and hands to head in disbelief here). I felt like flopping and pulling a tantrum like the futbol players, but it wouldn't get me or the kid anywhere.

An MO at a district hospital asked me to review a patient on peds. He introduced him as a 6mo old boy who had had a "febrile seizure" but who hadn't "awakened". He apparently had a fever of (40.5C (>104F) and started to seize. I asked the mother how long he had seized and she said 15 minutes, then during the ride in the taxi for another 20minutes, then in the ED for another several before he got some anti-seizure meds. On exam he was somnolent and still stiff in his arms and legs. I wondered about cerebral palsy and asked about his birth--"fine", and how he was before he seized--"laughing and normal". OK, so I might not the brightest bulb in the chandelier but this ain't no "febrile seizure" as these are usually less than 5min and kids awaken without trouble. To be sure, it is a "seizure with fever" which is more deadly if unrecognized. I responded internally with...well, those that know me can fill in the blanks.

It occurred to me that he might still be in status so we gave him another hit of diazepam, just his second in TWELVE HOURS ( way too infrequently) and he softened into a deep sleep...with a stiff neck and an encephalopathic mental status. There were so many areas where this child had fallen through the cracks and where we had let him down that I couldn't begin to count. The MO was a touch chagrined and at my behest transfered him to a higher level of care to be CT'd and tapped. At least he was on antibiotics.

My left hemisphere desperately wanted to scream obscenities. But my right hemisphere, and this voice in my head that sounded remarkably like Lynne, held me back and instead I got a doozy of a headache. I got home, found the beer and, again, those that know me can fill in the blanks from there. This morning? Another headache but for a wholly different (and admittedly stupid) reason. More existential angst to chew on...... The good news is that "living color" are still there and thriving as they await adoption.

I went to Lobatse on Thursday this week , a national holiday and therefore quiet, to see a woman with a chronic condition. During our discussion I asked her about what it was like growing up in the area before paved roads, piped water, reliable schools and the like. What did she enjoy then, what was it like? She misted up and got a far away look in her eyes as she described a pastoral life that was as fun as it was dusty and muddy. Her parents were members of the ANC so they had to be careful of assassination by the Afrikaners from just over the border, 15km away. An amazing life.

We are in the dry season where everything is covered with a fine layer of dust. Interesting that the high end cars, of which there are more here per capita than any other place I have been, are all dust free. They are cleaned daily by the "help".

And to think that the people that have made it to 90 y/o have lived more that twice their life expectancy at birth. They have endured amazing hardship and don't view it that way at all. They have had a rich life and are rock hard. Incredible.