Kiss Goodbye

It's Tuesday night, but the week has already been long enough to be a month it seems.  Between the nurses' strike in Kenya leading to floods of patients, our fellow-consultant visitor getting sick and leaving and doubling the remaining workload, missing one of our two medical officers each day, well, it's been intense to cover about 40 inpatients including ICU, all paeds admissions, deliveries, outpatient consults, emergency room, etc.  From 8 to after 6 both days I was on the go without so much as five minutes to take a break and get a drink of water, let alone food.  Plus overnight call Monday night, much of which was spent in the ICU in between smaller issues in casualty (pneumonias, a swallowed coin) and on the floor.  Our patients are complicated, with severe malnutrition or AIDS or meningitis or TB or extreme prematurity or congenital anomalies.  It's a lot.

So by 5-6 pm this evening I was pretty spent, as my colleagues and I labored over the life of baby Agnes.  Agnes came to us last week severely dehydrated from vomiting constantly in her short few days of life.  It turned out she had a completely blocked intestine, congenitally not formed correctly, and would need surgery to survive.  Only we couldn't seem to get her stable enough to get to the theatre.  Many of us spent hours trying.  Supporting her breathing, checking xrays, suctioning, fluctuating her fluids, monitoring her labs, putting her on the ventilator and then back off and then on and off again.  Her intestinal problem was complicated by a heart defect and pneumonia.  Last night she was still fighting valiantly, and I stood by her bed through the wee hours of the morning tweaking her oxygen settings and expanding her lungs.  This morning she looked at me as I examined her, and I remembered this is a little person not just a patient, and we're her only chance.  But by late afternoon she was deteriorating rapidly, and at 10 days of age the hope of corrective surgery was dwindling.  When she remained blue and unresponsive on maximal therapy for several hours, my colleague the paeds surgeon and I made the difficult decision together that we were prolonging an inevitable death and the emotionally drained family was not served by this.  The kind and amazing chaplain Mercy came and prayed, and held Agnes' mother.  Together my colleague and I pulled out her breathing tube and wrapped her in a flannel blanket and handed her to her teary mother to at last hold, after all those days of wires and tubes and machines and lights.  

Agnes gasped a few times, grey and still, and within ten minutes she was dead in her mothers arms.  

By that time it was just me and the chaplain.  I said the things I usually try to say.  This was the fourth child who had died on my watch since Monday morning, and I think I was protecting my heart with a bit of distance.  So I was able to tell the mom about how she would see Agnes whole and well in Heaven, about what a good caring mom she is, about how Agnes knew her love and touch, about how sorry we all were, about how she could take her time.  Her tears rolled down quietly as she touched her baby.  Gently Mercy prompted her to lay the little body back on the bed.

But she just stood there, as if she couldn't quite bring herself to walk away, while we waited.  

And then she leaned over and gave Agnes a goodbye kiss.  

There was something so tender about that action, so resigned, so human, that the tears I had thought would remain at bay finally came.  

It is a holy and awesome privilege to be present as life begins, as babies take their first breaths, as children are healed.  But it is even more holy and awesome to witness life ending.  The solemn finality, the heartbreak, the courageous acceptance of our limitations, the entrusting a soul into the eternal realm, the gentle presence with those who are mourning, and those who are passing.  

Tonight I pray that Agnes' mom's heart is held up with an unnatural peace and confidence that all shall be well, in spite of the evidence to the contrary.  That in the end the time between this kiss and the next one will fade to irrelevance as she greets Agnes hello.