A Button Away
By Skyler Cohen
Photo courtesy of Skyler Cohen
12/18/2024
Ambolangoda, Sri Lanka
A 10-year-old rushes into the Emergency Transport Unit (ETU), hunched over, with sweat running down his face, and blood spurting from the back of his head. His face is etched in uncertainty—his eyes glossy from his pain but eyebrows drawn up, most likely wondering what the doctors are going to do to help him. His parents flank him—his mother mirroring his expression of terror, his father pressing a shirt to the wound, trying to slow the bleeding.
There are four beds in the ETU, all currently filled up with patients, but one of the nurses helps a middle-aged man onto a wheelchair so that the kid can take the sheetless bed. The child climbs onto the bed and props his upper body up using his forearms so that the doctor in charge can examine the wound.
It was a dog attack, the dad said. A street dog apparently sprawled and bit the back of the kid’s skull, taking a chunk off leaving a deep wound and bite marks. Large lengths of skin are torn from the back of the kid’s scalp to the point where the layer beneath it, the periosteum, is starting to show.
One of the nurses carefully peels away the father’s blood-soaked shirt, replacing it with a thick gauze pad. As soon as the pad touches the wound, the child writhes and lets out a piercing shriek from the pain of the pad touching his raw skin. The mother, noticing this distress, rubs her hands against the child’s arm and tries to console him, but his mind is flooded with so much pain and torment it must have muffled what his mother was saying to him.
The nurse tries placing the pad again on his head again, but he flinches, twisting away. His father, tense with desperation, raises his voice—an attempt to command and control his son. The boy, shaking, closes his eyes tightly while tensing his whole body, getting ready for the pain of the pad. But this is only the beginning.
The nurses press the gauze just firmly enough to slow the bleeding, giving the doctors a chance to assess the bite marks and plan where to inject the prophylactic rabies vaccine. They huddle briefly, their voices low, while a nurse hands the attending physician a vial of the emergency rabies vaccine. In one swift motion, he draws up the clear liquid.
The child catches sight of the needle in the doctor’s hand, and whatever little composure he had remaining, shatters instantly. Terrified of what is about to come, he quickly flares his arms and legs to try and get off the bed, but one of the nurses is quick to pin down his arms and keeps him in place. The child’s parents then help her by pinning down both of his kicking legs. One of the doctors then helps the nurse and pins down his other arm. The kid’s face was contorted in an expression of raging panic, with tense eyes and a strained neck, trying to purge any part of his body away from the impending pain. He started to yell and regardless of how many people were still holding him down, tried desperately to escape.
The charge doctor started to approach the child, but his head is still moving frantically, all while screeching. He asked one of the other doctors to hold his head in place. Now, 10 arms are holding down the desperate child. The doctor inserts the needle quickly, but the screeching somehow gets even louder and then turns into visceral cries. The doctor takes no time and immediately goes for two other injections surrounding the site of the wound. The boy’s cries collapse into ragged sobs, his vocal cords stretched beyond their limits.
After the injections, one of the available nurses that was not restraining the child, places a clean pad over the bleeding wounds and starts to wrap gauze around the kid’s head. He is still crying, though the sting of the needle has dulled his senses, pushing him into something beyond pain, beyond exhaustion. His tears carve silent trails down his cheeks as the final bandage is secured. The pain from those tears will most likely be etched into his memory for a long time.
At last, the hands release. His mother pulls him into an embrace. His father rubs his back, murmuring words of encouragement. The nightmare, for now, is over. They inhale, together, a breath of relief.
The unfortunate reality is that this type of suffering is commonplace in Base Balapitiya Hospital. Earlier in the day, a woman came in with a dog bite to the foot and also had to receive the rabies prophylactic injections, and later that day, a man came in with a severe abrasion after having been in a tuk-tuk crash.
In this place, suffering is routine, and survival is a matter of endurance.
The boy, still wrapped in his mother’s arms, sniffles, his body shuddering with the aftershocks of fear. His breath hitches in exhausted, uneven gasps. The sharp sting in his head, the deep ache left by the injections—it’s all still there, raw and unfiltered.
For him, for all of the patients, there will be no morphine, no numbing agents, no temporary escape. There are too many patients and too few resources. And so, pain is not something to be managed—it is simply something to be endured.
1/11/2018
Baltimore, Maryland, USA
Salty tears trickle down the 14-year old’s sweaty cheeks to the corner of his mouth as his mother gently wraps her arms around him in the brightly lit emergency room.
It was a spleen laceration from an ice hockey game. The boy lost an edge and collided with a much larger opponent. The opposing player’s knee launched into his abdomen, leaving him with what he described as “gut punches on repeat” and agonizing pain.
The boy’s face strained as his mother supported his left arm in an attempt to get up. He slowly shuffled his way to a wheelchair and was then brought to an examination room.
“You have a severe spleen rupture, leaving you with less than a quarter of its original size,” the doctor said in a dull voice.
“Your recovery will take about nine months. No physical activity during that time. You’ll be moved to the Pediatric Intensive Care Unit where specialist doctors there will take good care of you.”
His recovery is painful and slow. He was forced to use a catheter for several days, to allow him to use the bathroom while limiting any movements that could worsen the injury. Most days during his recovery, he laid motionless in his hospital bed, with the cyclic pit of pain boiling in his abdomen that could only be interrupted from a press of a morphine drip button, bringing his abdomen pain down to a temporary simmer.
***
For me, pain was not something to be endured, rather just an inconvenience. Pressable. Controllable. Sedated on demand.
Four decades behind is what I felt separated my hospital stay in Baltimore compared to my shadowing experience in Sri Lanka.
At Base Balapitiya Hospital, the pediatric recovery unit had four vital signs monitors for over sixty patients. Children lay in half-rusted, sheetless beds, spaced only feet apart. Mothers sat close by, fanning them in the stifling heat, whispering comforts that had to substitute for any kind of pain relief. There were no TVs, no toys, no morphine buttons. Just time, fatigue, and raw endurance.
I, on the other hand, had my own room, a television, an Xbox, a steady rotation of nurses and specialists. And at my fingertips, a button that softened my suffering before it ever had the chance to fully surface.
Having spent time both as a patient in the healthcare system and working within it, one question keeps resurfacing: Why do some people suffer more than others and for seemingly no reason?
It is an ancient yet elusive question, one where an answer may take many forms.
A Hindu might say it’s the result of past actions and decisions. A Christian or Muslim might see it as part of a divine plan, something beyond human understanding. Karl Marx saw suffering as an inherent part of society, rooted in exploitation and economic inequality. Absurdism, in contrast, argues that suffering is random, without pattern or reason.
The injuries that I have suffered through, along with what I have seen some patients have to go through sometimes forces me to see suffering through the lens of Absurdism. There’s a kind of chaos to it all, a randomness that feels untamable, especially when some people seem to suffer endlessly while others are spared. I can’t make sense of it, and I don’t think I ever fully will, but what I have learned is that I have a choice. I can let the randomness win by default, or I can try and tip the balance through individual action, to not just make living a matter of enduring for others.
About the Author
Skyler is a fourth-year pre-med student at Northeastern University, studying Behavioral Neuroscience and Writing. He is passionate about using storytelling and creative nonfiction to bring visibility and humanity to global health crises. As a future physician, he hopes to center patient voices in his advocacy, believing that sharing their stories can foster understanding, empathy, and change.