Fred

He was about ten or eleven, with a stocky build and puffy cheeks that made him look uncannily like a young Biggie Smalls. Of course the build and the cheeks were newly acquired; like most of the other kids in Kempala, he was on the border of being malnourished before his kidney disease relapsed. Now, the fluid building up in the interstices of his tissues gave him the deceptive appearance of being plump. During morning rounds, he sat under the bed, determined not to let me disturb his morning meal of bananas with a side of bananas. A small red transistor radio next to him noisily blared soccer match highlights in Lugandan. Both him and the flies that were enjoying his breakfast with him seemed content to slowly ruminate on the piping hot matoke, mashed non-sweet bananas, while the commentator wailed on about a recently scored goal. The room itself held about fifteen kids, each separated from the next by his or her parents' bedding supplies, which were spread inbetween the beds. Outside a quilt of orange, purple and yellow covered the grass on the hill; morning was laundry time, and the moms were out hand washing their previous days' clothes.

He did not like me pushing around on his fluid filled belly, but grudgingly agreed after a winnie the pooh sticker. His look was arresting; I did not think kids at his age had learned, or rather, had the life experience to discover, the facial expression for apathetic resignment. The flies too seemed to be cognizant of this; they flocked to his matoke meal in droves, arrogantly convinced that he would not spend any energies in keeping them off his meal.

"He has recurrent, resistant nephrotic syndrome".
"So, can we try immunosuppressants"
A chuckle that had by now, two weeks into the rotation, become irritatingly familiar, followed.
"Doctor, you forget that this Africa. This family cannot afford cyclophosphamide. We will give them a prescription, of course"

It was one in the afternoon and Fred was squatting next to the wall, outside the kidney unit, hanging out in the shade with several of his fellow puffy friends. They warily check me out as I approach. I ask him how he is and if he would like another sticker, in English. I get a weak smirk back. Fred was never one for flippancy, especially when talking with foreigners. I liked this about him; he had a "So what if you are foreign, I'm not impressed" air about him that I found amusing.

I was late for a lecture across the sprawling campus. The lecture was in the pediatrics department and I was still stuck in casualty. I passed laboratory specimen collection table and a familiar body habitus lying atop one of the tables caught my eye. It was him, but he was unconscious. His mom was next to him, muttering continously in Lugandan. I piece together that he had been feeling worse since yesterday and spiked a fever this morning. The attending on service agrees with the plan to start antibiotics, and with it being Friday, I leave the ward feeling pretty confident. I had found Fred by luck, in the nick of time, and antibiotics and fluids are fast entering his system to help his fight off his infections as I walked back to the guest house to pack for a fun weekend of sight seeing.

Fred died that weekend. While I was lounging on the banks of the Nile, Fred's body, weak with a lack of calories and anti-bodies that he had lost because of protein loss in his urine, gave up.

When I returned Monday morning, his bed was simply empty. No chart, and none of the nurses knew where he was. The flies that had gotten fat off Fred's meals were still buzzing around the empty plate lying under his bed.