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Sunday, July 31, 2011

tears in the veil

There is a veil that obscures reality, that gives us the illusion of living independently and temporally in a dependent and eternal universe.  But occasionally there are tiny tears in that veil, gaps, glimpses of the great and whole and good and true.  Perhaps most of those occur on life's edges, the beginnings and endings, transitions into and out of this visible world.  

And it is good to name, to recognize, those moments.  

Today I sat with my arm around a 16 year old young woman, C., while her baby died.  C. had delivered her first child a few days ago at another hospital, and it was a long and ugly process I'm afraid.  C. was a teen, had dropped out of school pregnant, was living with her mother, and not really ready physically.  Her baby girl, Monica, came into this world limp and blue and gasping, in severe distress.  By the time she was transferred to our hospital she was convulsing.  She had meningitis, bacterial or herpetic we weren't sure so treated both, jaundice, evidence of liver damage, and respiratory distress.  For 48 hours we gently kept her alive with fluids and antibiotics and continuous positive airway pressure with oxygen.  But as I was reviewing other infants around noon today, the nurses working on a new IV line for baby Monica called me over to see her because her oxygen saturation was falling.  It was falling because she wasn't breathing.  At all.  We used a bag and mask to blow air into her lungs numerous times over the ensuing half hour, perking her heart rate up, but as soon as we stopped she made no movements or effort on her own.  I knew our ICU beds were full, but even if they weren't, this baby's brain damage I was pretty sure was irreversible and unsurvivable.  So I called her 16-year-old mother into the nursery, placed Monica in her arms, and kept vigil with her.  Monica never really breathed, but she had little agonal gasps of movement that went on for longer than one might imagine was possible, well over an hour.   We prayed.  We called C.'s mother on my phone.  We called in our on-call chaplain to sit and pray some more.  I agonized, was this the right thing, should I have tried harder or longer to keep her alive artificially.  C. cried, and I could have but pushed the tears down, and tried to tell her over and over that she was a good mother, that she had done everything she could, that she would be reunited with her perfect healthy baby in the new heavens and new earth eternity, that this was hard and sad.  And that her baby Monica could feel her love as she lay there in her arms.

Could she?  Well, the veil tore a little at the very end of this vigil.  Finally C., exhausted and grieving, told me she wanted to put Monica down.  I had checked the baby dozens of times, she was on a monitor, I knew her heart rate was still hanging in there low and soft, and though Monica was unconscious and a deathly grey-green color, she continued to have those little convulsive gasps every minute or so that kept her body from completely dying.  Nothing had changed, but I sympathized with C.'s desire to just lay the baby back in the cot and go back to her own bed.  So I took Monica from her arms, and she walked away.  I laid the limp jaundiced little body down and arranged her blanket, and looked up at the monitor.  Flat.  The second C. let go, Monica died.  

That was a holy realization to me.  Death was hovering, but the baby seemed to know when her mother was ready, was done and gone.  After at least an hour and a half of waiting, her heart stopped the instant her mother let go.  

There is so much more to medicine and life and every equation than the concrete things we an see and control.  I'm thankful for that.  I had to break death news to another mother at 2 this morning, a neurosurgical patient who was waiting for surgery and didn't make it.  Soon after that tragic scene I went to check up on one of the evening's malnourished-vomiting-diarrhea admissions whom I had suspected had a bigger problem, a telescoping of the intestines one piece inside the other, an unusual, potentially disastrous situation.  At 3 a.m. I found that the Paediatric surgeons had whisked him to the operating theatre, and I walked in just in time to see his purplish distended twists and fans of bowel glistening outside his abdominal cavity, and hear the surgeon marvel that  in spite of the intussusception and malrotation and volvulus, everything looked salvageable.  Two moms who brought their children for care and came away bereaved.  One who came for what she thought was a simple problem, and was saved from almost certain death.

No use trying to make it all add up, and make sense.  Instead I find comfort in the details, the way Monica's heart knew her mother's touch and then quit when it stopped.  The small glimpse through the obscurity of some who live and others who die, the glimpse that says there is more happening than meets our eyes, this is a drama whose stage stretches out to eternity, and the curtain keeps us from seeing the final act.

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