I have been privileged to see many strange and wonderful diseases here at St Francis. Pathologies more advanced than the examples in textbooks, classic TB, advanced cancers, meningitis and a sample of the manifestations of HIV. There are a few things I wish I hadn't seen, although I'm probably better for the experience. One of the worst so far is an HIV positive 11-year-old girl with Burkitt's lymphoma.
We don't know how she contracted HIV - that's not relevant now. The large tumour in her abdomen, and the large tumour that is deforming her face and destroying her teeth are more of a concern at the moment. She lay there in pain on the morning ward round as we all crowded around, prescribed morphine, and decided how she would die.
Would we give her chemotherapy? It's just a short course, and we could do it here, but with her HIV, could her immune system cope? With such advanced disease, her chance of remission is incredibly high, so is it worth it? Save her from the lymphoma so she can die from some HIV-related illness? The alternative is to palliate an 11-year-old and wait for a few months for her airway to obstruct, her abdomen to completely fill with tumour and for her to die gasping for breath around a collection of rogue cells that we could have killed off for her.
In the end she got her chemo and we were all thrilled to see the tumour shrink over just a few days, so that she was able to eat, smile and giggle again. I hope it lasts.