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Thursday, December 15, 2011

Snickerdoodles and CPR

That could be the title of my life, I guess. In the last 24 hours (I am not making this up) our life has included the following disparate moments, often within the same hour.

Bedside with Ryan, a nearly two-year old twin whose TB-filled lungs caused his heart to fail and nearly cost him his life. After a month in the hospital he is smiling, reaches out to shake hands, precarious, his spindly legs splayed out, not yet catching up to his largish head. Tremendous progress, but he is still oxygen dependent. Sympathizing with his patient mother, who cares for him day and night, we begin to discuss plans for home oxygen. I mention, as a last minute thought, that the oxygen can't be in a room with a flame, so they will have to keep Ryan separate from the kitchen. Oh, wait, she begins to balk, in Swahili. It turns out that this lady, her husband, and her four children all live in one room. They cook and sleep and exist in it. She can't cook outside, because the wind causes the fire to burn down too quickly, wasting precious fuel. She decides that since her husband has taken the other three kids up-country to the grandparents for Christmas, she really doesn't need to get home until it's time for the older children to go back to school, so she'll stay as an inpatient praying for Ryan's improvement. What an impossible dilemma: breathing or eating, one twin or the other.

And then I'm home for a couple of hours, making Snickerdoodles in my safe and efficient oven, in my 8-room house for six people, with my thriving healthy kids. Mixing brilliant red and green food color, rolling in the cinnamon sugar, fighting off snitchers.

Because yesterday evening, the annual Kijabe women's cookie exchange occurred. I had kind of been feeling like we were among the only ones left here, but last night one of the dorm apartments was packed with RVA women and girls, all bearing plates of every variety of cookie, sipping coffee and juice, greeting. I think it is the first time I've ever been to one of these, and as one might expect this event has a long tradition and a specific sequence and plan. You basically take home as many cookies as you bring, but an assortment. It was a good thing I brought Julia because just when it was time to collect on the goods, I got paged back to the hospital.

And a few patients later, only an hour after the cheery companionable atmosphere of women in red sweaters, a buzz of chatter over the strains of Christmas music . . I was kneeling on the floor of maternity responding to a complete cardiorespiratory arrest in a post-partum woman. I happened to be closer than Scott so got there just as the nurses were realizing that the springy mattress made resuscitation impossible and we all pulled the heavy lady, thin mattress and all, onto the floor. Just as I was wondering what the adult dose of epinephrine was and how long my arms could keep up the chest compressions, lo and behold, an INTERN showed up. The strike was CALLED OFF AGAIN and unlike 99% of the doctors she was not waiting for the morning but came straight in to take call. We took turns ventilating and compressing until Scott arrived and intubated the lady, but in spite of everything we were unable to bring her back. So there we were on the floor, kneeling around the body of this woman, in a crowded passageway in full view of a handful of other patients. She was unmarried, had delivered a baby with severe malformations who came to Kijabe for surgical care, and while here she developed what was probably a pulmonary embolus. Scott had to go tell her hysterical sister who was caring for the baby. Tragic.

I was home a few hours somewhere between midnight and 4, replenished my energy on Christmas cookies and tried to sleep a little, though we both got numerous pages. Our spastically blinking blue tree lights are a beacon in the dark when running back and forth in the wee hours. Scott left for an emergency C section (his third of the day I think) a while before I was called back to see a shriveled jaundiced little baby I had admitted a few hours earlier who was basically dying. I spent the rest of the night trying to stop that process, as it turns out, unsuccessfully. Intubation, bagging, xrays, labs, fluid bolus, an epinephrine AND a dopamine drip, ICU, but he still didn't make it. He was also a twin, the firstborn in a hospital without a handy doctor, he was born unattended and probably suffered some damage even then. A week later he was infected and gasping and his heart just gave out. He was another victim of the strike perhaps, both at his birth and in the many hours visiting three hospitals before finding care at Kijabe.

Back home (hooray for Thursday and Mardi!!) I make tea, notice the milk is sour, know my kids and Scott are about to wake up hungry, and remember a great oatmeal muffin we used to make from the Jane Brody wedding-present-cookbook-before-I-could-cook-anything era of food in our lives. I find the recipe on line, use the sour milk and oats and dried blueberries to make a double 24-muffin batch that three teens completely consume within two hours. We linger at the counter together, spreading on butter and locally made jam. Big treat of the morning: the annual Schubert Christmas package. Julie grew up as an MK and she gets it. She finds a puzzle for us every year, and sends it in time to reach before Christmas. Something about the continuity and thoughtfulness of that is so reassuring.

Meanwhile Scott is up and out and back on the ward while I stumble through a Swahili lesson. He checks on his middle-of-the-night C-section patient, who was HIV positive, which always makes surgery a bit more risky and tense for the surgeon. As they chat he asks the baby's name. Shekinah. Intrigued he asks her how she chose that name. And then has one of those "you aren't in Bundibugyo anymore moments". She replies, doctor, don't you know that's Hebrew for the transcendent presence of the Glory of God. He asks her where to find that in the Bible and she replies, google it. Really.

The afternoon is devoted, at long last, to Caleb. Who is one essay away from finishing and submitting applications to 8 universities for Engineering programs, in case he does not get into the Air Force Academy. Scott, Caleb, and I all sit by his computer as he uploads answer after answer that he's been working on for weeks, checking through one last time for spelling and commas and missing data. Caleb's humor in the whole process has us laughing a lot, which is remarkable in our sleep deprived state, I think with every step closer to done his burden feels a little lighter. He's a remarkable kid, with some very solid and meaningful statements about life. Each school looks better than the last. Soon it will be out of our hands, and in God's alone. I notice that the more he writes, the better it gets, the later essays being the best, which makes me a bit more of a believer in English classes.

Back to the hospital one more time at dusk, to visit my house-worker's sister-in-law who burnt both legs badly when she accidentally spilled a jiko full of burning charcoal on them. I am wearing loose running pants and tennis shoes and have my hair in pigtails. No white coat, no stethoscope. I truly think for a moment as I walk in the gate, no one will recognize me, I look just like all the other visitors. Oh, then I remember, I'm white. So much for blending in.

Patients and packages, death and muffins, hospital and family. All mixed together hour by hour in a messy paradox of life. Snickerdoodles and CPR.


Amy said...

Happy the strike is over! I heart Julie Schubert she is my continuity clinic nurse among other things. Your posts always make me miss Kenya even in the crazy calls.

Heidi said...

HOLY SMOKES! so much in this post, I love it! love for the hand-shaking-return-of-life-moments in TB and malnourished kids, the return of the interns from their strike during your ADULT cpr episode!, the memory of hovering and snitching as we baked cookies with my mom at christmas time, Caleb and the lucky school that will get him as a part of their educational/life community, the fact that Scott is back in the practice of medicine and getting to do so many sections, the thought of you and Julia mingling at an age old Kijabe traditional cookie exchange...and on and on. Oh the glory and the gory. advent greetings from St. Louis!

Karen said...

The Shikinah story cracks me up. So glad that Caleb is so close to being done. Awesome man.
Thanks for living in the real world, caring for those around you and sharing with us.