I have put my faith in my education and dedicated myself to continuing the effort of supporting people's health with the knowledge imparted to me over the past two years. Doubts certainly cross my mind as I question if what I am doing is effective, right or even necessary, whereas other times my faith is supported by the curative effects of medicine. There are nuances to the body which we cannot control, but we must rely on continued research to improve best practice techniques. Despite occasional skepticism and my desire to permit my body to heal without medicine, I will take cold and flu medication just to reassure myself that I support the practice that I preach. The advancement of science has helped us prolong life and alleviate illness, but occasionally signals are left unnoticed or the wrong test is ordered, despite the good intentions and full payment of diligence. Sometimes medicine can't control everything it encounters and last week entailed two very difficult patient cases who were both attended to properly, but something was missed.

The first day of last week brought a newborn child into the world who was the child and grandchild of two very close friends of the clinic. Being a boy in Guatemala, he was the prize of the family and of course incurred a higher cost from the birthing midwife. Tuesday the warmly wrapped baby was seen by a medical provider because he was crying a lot which worried the family, but everyone at the clinic received reassurances from the mother she had been told his crying was merely part of his adjustment to a whole new world. We received word that he had no fever, his lungs sounded good, heart sounds were regular, and there were no abnormalities upon exam. But modern medicine missed something with this newly born human being and with Thursday morning came the devastating news that he had passed during the night. Thursday morning was brutal for the clinic as we were slammed with patients, a new group of medical students started their first day at Primeros Pasos and there was a penetrating cloud of sadness pushing into the conscience of every team member at the clinic as we dwelled on the well-being of our close friends.

Almost everyone involved with Primeros Pasos attended the burial, which was held 10 hours after the baby's passing. The sadness of this death was not directly penetrating to my emotional core, but watching people I care about suffer so acutely pulled tears from my less than stoic eyes. The casket was tiny, emotions were high and the grandmother of the baby was as strong and beautiful as I've ever seen her. She was not visibly weeping, but her soul was drenched in tears as the trauma of losing her 2 day old grandson wore heavily upon her posture. We slowly followed the casket from the front gates to the back hill of the giant cemetery and the whole time Lauren, myself and another medical provider all watched the sadness, absorbed the pain and questioned what had the modern techniques of medicine missed on this precious child that could have prolonged his life. We wished we had more information or could review charts and have a long discussion trying to discover the cause of this death, but we were not working, we were mourning.

The other patient that pushed our emotions into a puddled mess was a 5 year old boy. He came from a town over an hour away and his mother spoke for him because the boy only spoke Kiche. I went in to see this patient alone, but I retreated within minutes for the assistance and expertise of the medical director. He was cute, just as most of the children we see at Primeros Pasos, and he was still shy at his young age, but quick to smile and laugh. As I was speaking to the mother, I realized his expressions were becoming more worried and he started to tear up. I asked him if he was scared and he nodded and I reassured him that there would be no shots or painful procedures and he brightened up. After his mother told me he had swelling near his neck, I began my exam while she finished telling me his story. There was a hard and barely mobile mass at the base of his neck on the right side and he flinched when I touched it. Upon examining his axillary region, I noticed a 3 inch scar, which his mother remembered to notify me was from when surgeons removed a mass 3 months ago. My heart dropped and I asked her what the doctors said about the mass after pathology and she didn't have any idea. She said they hadn't told her what the growth was and after the surgery they just sent him home without further treatment. No chemotherapy, no radiation and no extra patient education except a discharge three months ago and now I may have lied to this child about there not being any painful procedures, I just wouldn't be part of the process.

I palpated along his small chest between his armpit and the mass on his neck and found other small masses, then excused myself with my head low and desperately needing the doctor's second opinion. The medical director entered, examined the child and then we stepped out to discuss treatment options. It was either an ultrasound and biopsy or a direct referral to the hospital. Since he wasn't eating well because it was painful to swallow, we elected for the hospital. It was likely that this child had some form of cancer that was initially in his axillary lymph nodes and it spread before the surgeons could remove all of the cancer cells. Now the growth was in his cervical lymphatic chain and would be a much more complicated treatment, especially since he was having trouble swallowing. In August he had zero follow up care or pathology results to confirm any form of diagnosis, but he was back in the medical system 3 months later with swelling of other lymph nodes in his lymphatic chain. The medical director and I sent the mother and child to the hospital and hung our heads for a 10 minute discussion that basically entailed multiple derivations of, "What can we do?"

It was a week of what ifs and how comes as we watched children struggle. We pondered what type of care the child with the likely cancer would have received in the United States. What if he had the resources for prolonged treatment and follow up chemotherapy? Or how come children are suffering? How come nothing was picked up on the exam of the newborn? Because sometimes medicine misses, but oftentimes it misses something that we cannot yet see. Thankfully medicine usually remedies most ailments and with more research, better resources and continued diligence, we will continue to prolong life and alleviate illness, but for now we share condolences and look to the future from Xela Guatemala.