Cruel To Be Kind?

I didn't come into children's nursing to cause pain and distress to children. Quite the reverse. And yet that is exactly what I've been doing this morning. This is something I'm struggling to get my head around. It's just not ok. And yet, in the situation I felt I had no choice.

A 5 year old girl came into Chikwawa hospital with a significant burn to her hand. She had accidentally knocked the cooking water pot off the fire in her small hut. The injury happened yesterday.  She did not receive first aid. Cooling the burn under cold running water for 20 minutes immediately as we would at home is simply not an option. Nor did she receive pain relief, and it has not been kept clean. She's burnt from her elbow to her fingertips. In the UK she would be seen by a specialist burns & plastics team and go to theatre for the wound to be properly cleaned and dressed in a sterile environment. Here, that is not possible.

The function of her hand is at risk, and I know that we must clean the wound and get rid of the blisters. I also know this will be agony. There is little pain relief available, and nothing particularly strong. We have a little sedation which will keep her a bit calm and hopefully affect her memory of the procedure. We wait for the sedation to work but even with that she's crying and screaming. She's in pain and great distress. Pain that I am causing.

We do our best to treat the wound but I know she can't take much more.  And neither can I. We dress it with what we have available. It's not ideal but hopefully it'll be good enough. I'm aware that others on the ward are witnessing this - privacy is hard to come by here - and I worry that we are destroying all trust in our team.

The child drifts off to sleep in her mother's arms after the procedure. I go outside for a few minutes and cry. Tears for the pain of this child, for the compromising of my standards, for the lack of fairness in the world.

The team support me. They remind me of the lack of choice, the need to be cruel to be kind.  Later, one of my team mates tells me she has just seen the child playing and having lunch. Her mother smiled at my colleague. Perhaps her mother understood and accepted. Perhaps the child has forgotten. 

Hopefully I will too.