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coach mens shoes up with a dusky, unconscious, grunting 1 month old with saturations of about 40% and a tense, swollen abdomen. His pupils were fixed, his jaw rigid, and his body floppy.It was quite clear from the word go that this was a fading fast situation and we rang the paediatrician for help. we're bagging and masking him. Despite every effort with airways, fluid and antibiotics, we could do nothing but place him into his grandmother arms to die.The history was confusing. The grandmother told me he had suddenly become unwell just a couple of hours before. The mother said he had been grunting during the day and so they had taken him to the doctor. When we undressed him, his body was covered in herbs, the doctor's apparent cure for his ailment.We sat with the family and tried to answer their unanswerable questions. There is no reporting or investigation of deaths here, and so the family left for their home with the body. As they prepared to leave, the guardian added up their bill. Here is your child, and here is the bill. Less of a shock for the American doctors amongst us, although still gut wrenching. Much more of a shock for us used to just filing paperwork, making tea, and offering condolences after a death. I had never before thought about how much it costs to try to save a life, and how much it costs when everything fails. Turns out its 119 quetzales, or about 9.It was almost a relief to see an exacerbation of COPD and a patient with diarrhoea after the family left. Gateshead taught me how to deal with an exacerbation of COPD in my sleep, and the mind numbing distraction meant I had little time to dwell.At