COTW: Pancytopenia and God With Us

(from Eric)

A few weeks ago, I rounded on the Pediatric service, and was told about a 10-year old boy named Emmanuel, who had been in our hospital for several days with some fever and confusion.  We see this a lot, and by far the two most common reasons, which are Severe Malaria and Bacterial Meningitis, didn't appear on his tests.  But the tests aren't perfect, he was still being treated, but stubbornly not improving.  Then his nose started bleeding.  A lot.  And he started vomiting blood.  Needless to say, it was disturbing for everyone involved.  

It was a pattern I had seen before, several times in Kenya.  I asked for a Complete Blood Count ("CBC", but it's "NFS" in French), and it confirmed my suspicion that his platelet level was practically nothing.  And he was anemic.  And his white blood cells were decreased, which made him overly susceptible to any kind of infection.  We call this pancytopenia.  His bone marrow has stopped many all of the major components of his blood.  What causes it?  Lots of things.  Can we figure that out here?  No.  Could we treat the problem even if we could uncover the cause?  No.  Can we just give him a big blood transfusion and consider it fixed?  Malheursement, No.

Along with the medical student taking care of him, we talked to the mom about the situation.  We did give him a transfusion as a temporizing measure, but the situation did not look good.

Every night before going to bed, Maggie and Ben pray for sick people.  The following night, Maggie wanted to pray for "that boy at the hospital that might not be able to get better."  I wasn't sure what she was talking about.  Apparently, she had overheard us discussing the case and wanted to pray for him.  I told her that his name was Emmanuel.  Fresh off the advent curriculum, Maggie's eyes lit up.  "Emmanuel, that means 'God With Us!" 

It was hard to pray for him, in a sense.  My technical mind knew that the prognosis was grim.  I could pray for his healing, but what are his odds of survival when he is actively hemorrhaging, and we have no tools to stop him?  And here's Maggie, praying to her Heavenly Father for a boy named "God With Us".  What am I going to tell her if she later asks what happened, and the truth is that he has now gone to be with God.  There is life and hope even in such discussions, but I wasn't quite sure it was a conversation I wanted to have with my 4-year old.

For many nights in a row, she prayed for "the boy whose name means God With Us", and I prayed with her.  Alyssa is running the pediatric service, and she told us that he had woken up, stopped bleeding, and she was sending him home.  (Yes, this is, in fact, the same boy from Rachel's hunger post.)  Unlooked for, Unexpected, Afraid to Hope.  God is with us.  We will continue to pray for him, since he is far from cured, but there is hope kindled, and maybe the surprise of it will be enough to teach me to hope a little bit more.