It was the ants

I think it was the ants that really got to me.  I knew today was going to be long and hard.  Wednesdays almost always are.  Our team begins with early prayer, rotating focus on different members, and today we prayed for Anna, Luke, Caleb, and Nathan.  With Luke and Nathan it is an unsettling time of decisions and transitions, and both are such great godly young men . . . so that no doubt began the day with more emotion than usual.  Then I was the first person in the ward, trying to get a jump on the day.  As I breezed through the doors and headed to the store room to put on my white coat and get my clipboard, I greeted patients and glanced about.  My heart jumped when I saw the toddler lying on a mat on the floor directly beside the store door.  I have seen dead bodies that looked more alive than that.  His color was a corpse-like cross of pallor and sickly yellow,  and he was motionless, still.  I bent down to feel for a pulse and as I moved back his blanket, the stench of putrid peeling skin wafted out.  And then I saw the ants, tiny ones as colorless as the child, crawling around his eyes, over his shoulder.  A shudder-inducing emergency-inspiring disaster, a child in an advanced state of malnutrition and decay,lying there with a caretaker who seemed lost and listless herself.  But he was alive.

And so the struggle began.  Soon other staff arrived, and I had great help. Though his heart was beating and he would moan when moved, caring for Baluku was like running a code.  Assign jobs.  Pay attention to the time.  Think globally of what could make the difference between life and death in the next few hours.  Get labs, take a focused minimal history.  Mom died two months ago when he was two, grandmother is the caretaker, first noticed a swollen abdomen a few weeks ago . . . then was admitted to another hospital for over a week where he became worse and worse until they transferred his care to us at the last moment.  His edematous body with fragile peeling skin made IV access nearly impossible, so within five minutes I gloved up to insert an intra-osseous line, a brutal needle that pops through the cortex of a leg bone in order to give a child fluids through the vascular network of bone marrow.  Travis walked in at that moment and got his first chance to use this simple, useful technology on a real human being.  Meanwhile there were two other critically ill patients on the ward, another 30-or-so admitted, and another dozen-or-two waiting for outpatient evaluation.  Crazy.  So once the intra-osseous line was in and the initial fluids pushed, we left Heidi, bless her heart, to warm water and clean him, to monitor the spooning of milk, to push the syringes of transfused blood slowly into his leg.  She spent hours hands-on with this child.  And by afternoon, with blood and antibiotics and fluids and bandages, with a cozy blanket (one of the last of Annelise's friends' gifts), the possibility of survival  was there.  Not likely, but possible.

Somewhere in the middle of this, I went into the store room again for something, and ran into Nathan who was scrambling for something else, and had a quick cry.  I think it was the ants crawling on Baluku that seemed so overwhelmingly sad.  Nathan is one of those dependable, honorable Scott-like guys that sometimes gives the sympathetic word that breaks down the resolve.  I've seen so many malnourished kids, so many tragic stories, so many deaths and near-deaths.  I don't want to ever reach the point of not being emotionally punched in the gut by a child like Baluku.  Nor do I want to reach the point of running away, tempting as that was today (a new diagnosis of AIDS in another child, another baby whose parents took him for horrific teeth-cutting now in shock on oxygen and fluids and blood and looking very likely to be this lame mom's 10th (of 13) child to die, another baby with half her nose eaten away by some bacteria leaving a crusty gaping hole through which she breathes, burns and wounds and pus and malaria).   So a quick cry that acknowledges this is NOT RIGHT, and then a deep breath and hands on the next medicine or syringe or whatever was needed, and on to the next patient.

The ants can not have Baluku, yet.