Anne Fraser - Her Very Special Boss

Kirsty felt her cheeks flame at the implication. ‘I can assure you,’ she said stiffly, ‘a relationship with anyone is the last thing on my mind.’

Subconsciously she fingered her now bare ring finger. ‘I’ve had enough of men to last me a lifetime.’ She ignored Jenny’s curious look. ‘I’m here to work and to learn. Nothing more.’ She drained her coffee. ‘Sorry.’ Kirsty grimaced, suddenly aghast at the turn the conversation had taken. The kindly doctor in front of her must think her rude. ‘I’m not usually so prickly, it’s just…new place, new people, new challenges. It’ll take me a day or two to settle in, I guess.’

By the time Jenny left Kirsty outside the outpatient clinic, with a hasty apology that she had another Theatre list due to start, there were several patients sitting outside, waiting their turn to be seen. Most of the women still wore traditional dress and despite the intense heat had their children strapped onto their backs with thick blankets. For the most part the children seemed quiet—subdued even. One little boy squatted in the dust, lazily poking at the ground with a stick. When he looked up Kirsty could see that one of his eyes was sticky with what looked like a chronic infection. She tilted his chin—he needed something for his eyes, the sooner the better. She glanced around and spotted a nurse moving between the patients, taking histories and writing notes. Kirsty guessed she was probably assessing who needed to be seen first. Just before Kirsty could grab her attention she noticed a young woman clutching a bundle to her breast. There was something in the woman’s posture—an air of despair—that made Kirsty catch her breath. She moved closer, and gently lowered the blanket to reveal a small, painfully thin child who was making no effort to take the proffered breast of the young mother. The child’s face was so thin it seemed almost skeletal, the skin clinging to the fragile bones of the skull. Flies settled and buzzed around the tiny mouth and closed eyes. For a heart-stopping moment Kirsty thought the child was already dead. She felt for a pulse and was rewarded with a faint flutter beneath her fingertips. The child was still alive, but surely not for long. With one swift movement she lifted the infant up, its tiny frame feeling no heavier than a feather, and rushed into the department. This child couldn’t wait. It needed fluids in the form of a drip straight away or he or she would die.

Ignoring the wails of the young mother, she searched frantically for Greg. She found him crouching in front of an old woman, examining a suppurating sore on her foot.

Greg took one look at Kirsty’s anguished expression and stood up.

‘What is it?’ he asked, bending forward to look at her small bundle. ‘Not another case of marasmus—starvation,’ he said despairingly. ‘OK, bring her into the treatment room and let’s see what we can do. If there is anything we can do.’

Within moments the small child, a girl, was lying on the couch, her mother sitting close by, her eyes flitting from Kirsty to Greg. One of the nurses had joined them and was talking to the mother in rapid Sotho.

‘The child stopped taking the breast two days ago. She’s been sick for over a week. A traditional healer gave her mother some herbs to give her, but when they didn’t help and she stopped taking the breast, the mother decided to bring her to us. It’s taken two days for her to get here.’

While the nurse repeated the history, Greg and Kirsty had been searching for a vein in which to insert a drip. Kirsty knew that they had to get the small child rehydrated as soon as possible.

‘I can’t find any in her arms. They all seem to have collapsed,’ Kirsty told Greg, fear catching her voice. They had no time. The child could die if they didn’t treat her right away.

Greg looked up at her. ‘Slow down. We’ll find one. Look here just above the foot. We’ll need to do a cut down. It’s not ideal, but it’s all we have. Have you done one before?’

‘I have, but I’d rather watch you first, if that’s OK,’ Kirsty said. This child was so small, so desperately ill. What if she was too slow?

‘You’ll have to do it, I’m afraid. You may have noticed my right hand only has restricted movement. It’s fine except for the most delicate stuff.’ Kirsty could only guess what it cost Greg to admit his limitations. At the same time she admired him for it. She had once seen a doctor attempt to perform procedures above his capabilities and the results had almost been disastrous.

Greg noticed Kirsty’s hesitation. ‘You’ll be fine. I’ll talk you through it.’

Somehow his belief in her gave her confidence and with very little assistance from Greg she performed the procedure perfectly and without any wasted time.

‘Excellent job.’ Greg’s praise was fulsome and genuine and Kirsty felt elated. She thought that she might grow to like her job here.

‘OK, let’s get her started on the usual regime.’ He directed a few rapid words towards the mother.

‘She’s three years old,’ he translated for Kirsty.

Once again Kirsty was horrified. Three! It wasn’t possible. The child looked no older than nine months, a year at the most. She was so tiny.

‘Obviously we can’t use her age to work out how much we need to give her. By my guess she weighs just over eight kilograms. Could you pop her on the scales?’ he asked the nurse.

The nurse scooped the child up and laid her gently on the scales.

‘Just right—eight kilos,’ she told Greg.

‘Any thoughts on the dosage we should be administering?’ Greg asked Kirsty.

Kirsty thought frantically. She had completed six months in paediatrics as part of her houseman jobs. But the children there had been so much bigger, stronger than this child in front of her. She had never seen anyone in such an advanced stage of starvation before. How could she have? But she remembered a child, physically handicapped, who had been brought in following a severe episode of diarrhoea. The child’s condition had been similar to if not quite as drastic as that of this child in front of her.

She was about to hazard a guess, but Greg hadn’t waited for her response. He adjusted the drip and straightened up. She could sense the fatigue and something else—could it be anger?—behind his professional exterior.

‘We’ve done everything we can for the time being. It’s in the lap of the gods now.’ He tossed his gloves into the bin. ‘The main problem is caused by formula. The government spends substantial sums of money promoting breast-feeding, but the problem is with the women who are HIV positive. The danger of them transmitting the disease to their infants through breast milk is just too large, so they are encouraged to give their babies formula. Unfortunately formula is too expensive for most of them, so they start diluting it to make it go further. Then the children simply don’t get enough calories or nutrition. And as if that isn’t bad enough, a large number of the outlying villages still don’t have access to clean water. So the women mix the powder with water from the river. And what you see before you is the result.’

‘Can’t we do anything about it?’ Kirsty asked. ‘Surely it’s just a matter of education?’

Greg smiled, but there was no humour in his eyes. ‘Education and clean water. That’s what is needed. In the meantime…’ He let the words hang in the air for a moment. ‘In the meantime we do the best we can. Come on, Kirsty, as you’re about to see, there is plenty more for us to do.’

‘But doing the best we can isn’t enough . Is it? Not if children are still dying?’ Surely he wasn’t going to tell her there was nothing they could do to prevent this? He didn’t strike Kirsty as a man who let anything stop him from doing what was right.