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Thursday, May 24, 2012

Out of Eden . . .

. . and back to reality.  

This week felt a little Job-ish.  Perhaps it is my African world-view.  Africans don't mention the good news of a new baby, or praise their happiness, for fear of attracting jealousy from evil spirits.  But there is Biblical precedent, when Satan challenges God to allow some loss and testing to seep into his life of abundance.  And so we landed back in Kenya from paradise.  And promptly paid the price for our week of joy.  Infections in multiple body systems, the kind of wipe-out fever, two of the last four nights on call (one blessedly benign for much-needed recovery, the other typically sleepless with a deteriorating patient needing intubation and ICU admission), meetings and responsibilities and rain and mold and just the challenges of survival.  We're back to real life, but thankful for the divine hedge which protected those days away.

I like to win.  I like to fight a disease and see a rescue, a recovery.  And while that often happens, and makes much of the above worth the effort, sometimes I utterly fail.  Turanta died yesterday morning on my watch, after a week and a half of trying to get the upper hand against an infection in his brain.  My second 15-year-old previously-healthy boy to succumb to meningitis in the last month or so.  The first, James, was a 35-day battle that we eventually did win, though initially I didn't have a lot of hope, he overcame sinusitis that spread to meningitis and brain abscesses to walk out of the hospital normal.  Not so with Turanta.  This tall lean Maasai boy fell ill a few weeks ago, and bounced from a couple of other hospitals with inadequate care as his infection progressed.  By the time he came to Kijabe he was in bad shape.  Still he improved initially, then entered a slow steady slide towards death, progressing from alert to confused to restless to responding-only-to-pain to completely unresponsive to brain dead.  Yesterday morning after consultation with others and confirmation of his absent reflexes, I sat down with his older brother to explain that he was essentially gone, that his heart was only still beating because of the ventilator her was on.  Turanta's elderly parents were unable to come, so this adult brother was functioning as the caretaker and responsible family.  In the conference room with the chaplain and nurse I prayed and explained and held it together pretty well until the brother thanked us, and started to cry himself.  People have told me they have never seen a Maasai man cry.  As a mother of a 15 year old myself, I found this death very very painful.  The graciousness of this brother overwhelmed me, he accepted God's hand in the entire situation, thanked us for our effort, and agreed to discontinue life support.  He even agreed to a post-mortem (unusual) in case we can learn something that helps others in the future.  I pushed for this, because I want to know what we were treating, what we were missing, what we could have done.

I never saw Turanta when he was well, but I can imagine him running across the valley, or sitting around a fire under the stars, or kicking a football, or jostling with friends in school uniforms between classes.  And in fact I went almost straight from his death to watch my 14 year old son play rugby, his own long legs running, his strong arms tackling as we cheered his team to a narrow and hard-fought victory against the JV team of Nairobi School, currently the top Rugby school in the league.  Then we caught the final games of the girls' volleyball match where I have a 14 and a 15 year old on the team, again a close contest and hard-won victory against a nearby Kenyan school.  Then we were invited to dinner with another station family, between us and visitors there were about 8 or 9 teens around that huge table laughing and telling stories and eating heartily, seeming invincible.  But they aren't.  I love these teen years and yet patients like Turanta remind me of the fragility of these lives. There but for the grace of God any of these kids could be.  

So we continue to walk this path, reveling in the moments of Eden made bittersweet by the immediate juxtaposition of loss.  I begin to glimpse the paradoxical reality of Psalm 23:  thou preparest a table before me in the presence of my enemies.  The feast is spread in the valley of the shadow of death.  Post-mortem to rugby game, ICU to family meal.  

Both are reality.

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