I can see it happening again. More than the observations and the signs, I can see it in his eyes. Maybe it will be days; probably hours; possibly very sudden. Sooner or later he will give up.

​

The day began as usual, if usual means anything. I have only recently arrived here, working for a humanitarian organisation in the former earthquake zone of Kashmir. After my morning battle with the flies, I walk to work squinting in the bright sunshine and avoiding the rubble. The noise of the gushing river beside me no longer registers in my head like it used to. The green hills on either side of our valley reach up steeply to the sky and if you look closely you can see tiny people wandering up and down, getting on with their daily business.

​

I do the morning ward round- the usual mix of frustration, interest and humour- and then move reluctantly towards the behemoth they call “Outpatients”. I dive into the heaving mass of people and find my seat in the corner greeting everyone as I do so. I take a deep breath and prepare myself for the relentless onslaught of crying babies. So engrossed am I in my present child’s dilemma that I barely notice the little baby being admitted by one of my colleagues. A glance to my right, shows a small bundle wrapped in maroon cloth from head to toe being held tightly by his mother. He makes a moaning sound which worries me. I make a mental note to check on him soon and carry on.

​

Later I visit the ward and have a game of “medical tennis” with one of the other doctors, where we discuss different interventions.

He says, “It works.”

​

“It” makes no sense to me.

​

He says, “This is what we do here.”

​

I’m in charge, I have the power of veto, but realise that I probably can’t just rely on things that make sense with this baby.

I agree.

​

Yet another night on duty, where inevitably I get some pointless call in the early hours. “Maybe I should go and check on that baby?”, I contemplate. I tell them when to call me, but they rarely do. I trudge across in the darkness still planning my return to bed and concerned about my latest insect bite.

​

He’s not better. I want to turn around. I probably won’t be able to help him anyway. But he stares at me and my legs move towards him. I step into the ward and move past the line of sleeping mothers cradling their babies. His mother, the only one who is awake, looks towards me as though her son’s saviour has arrived. Surely this foreign doctor with all his knowledge will be able to do something. I keep my head low and avoid her gaze.

​

“How’s he been?” I ask, knowing the answer that will be given and the reality. He is lying at the top of the bed, motionless apart from his rapid breathing. The size of the bed makes him look disproportionately small. I run through his chart and check on his observations. His distress is mirrored by his numbers. His saturations are falling. Has he been waiting for me to arrive before collapsing? I am struck with resentment that he’s doing this to me. I reprimand myself and go back to my pity and desperation.

​

I try firing whatever weapons I have at him. I feel better as I’m doing something. There is suddenly hope on the ward; I never meant to cause this. I keep my fingers crossed, say a small prayer and sit down and wait.

​

He’s getting worse. Doesn’t he realise that I’ve hit my “Oxygen Wall” and can’t give him anymore? I adjust the monitor, hoping vainly that that is the cause. I then occupy myself trying to work out how to improve the system. I conclude that I can’t. My heart sinks again. I’d like to call for help but, I am The Help.

​

Surely he could try a bit harder? I try whispering to him. He doesn’t notice. He’s not staring at me anymore, just staring. I decide to hold a different mask over his face. This improves things a little and makes me feel a little closer to him.

​

I have been avoiding eye contact with Mum and suddenly feel guilty. I try to talk to her, but our languages do not coincide. She just gives me a trusting smile. I then try and explain through a nurse, but see my sentiments lost in her brash dictation. Does she realise how bad he is, I wonder?

​

I start to feel scared. I want to pick him up and take him home. I’m sure that with all our fancy Intensive Care, he would be alright. The whole situation seems so unfair!

​

I’m probably kidding myself anyway. I re-focus. What else can I do? I run through all my available medications. Maybe this one will work. It shouldn’t work. But what have I got to lose. We start giving it, his saturations drop further. I panic and stop it.

​

We have to bag him. What are the nurses doing? Can’t they see how desperate he and I are? I bark out some orders. Things then move quickly and his saturations normalise. Maybe I should have done this earlier. But then they fall again. What do I do now? Do I intubate him? I can’t keep him ventilated. I should have spoken to Mum about this before.

​

Let’s see what happens. I feel so hot. I’m sweating under the heater. I have cramp in my hand. But I can’t stop now.

​

His saturations very slowly improve. I feel relieved. But his heart rate is not what it says on that monitor. In fact it’s nowhere near. “Start chest compressions!” Iorder. I try giving drugs and fluids, but he just deteriorates. I finally relax and come to a consensus with my nurses.

 

We stop.

​

His eyes are now permanently staring.

​

We inform his mother, but she already knows. As do all the other mothers on the ward, who have been watching the entire spectacle. I clean him up, wrap him in his maroon cloth and hand him back to his mother. She thanks me for trying. I apologise for not being able to save her son. Her lack of emotion surprises me. Maybe the earthquake has deadened even the response to death here.

​

I wash my hands, trying to clean away my memories and emotions. I then sink into a chair outside and despite feeling nauseous, drink some sweet Pakistani tea. The nurses console me and tell me how the other doctors have been through similar experiences. They seem to be taking it all in their stride. I can’t remove the imprint of his eyes from my mind.

​

As I walk back to my compound, cutting through the cool morning air, the sun peers over the hills and lights up our valley. I listen to the crashing sounds of the river and think about my poor little baby. I wonder if I should have done something different? I wonder if I should have put him through all this? I wonder what his parents are thinking? I wonder about his futile existence? I wonder “Why”?

Meanwhile I get changed and ready for a new day.