Literal cake. And metaphorical bread-of-life type stuff too, but read on.
It is Sunday morning, and the misting clouds have lifted from the ridge leaving a day washed in intense sunshine. Not that I've sen much of this weekend. From 7:30 am to 11:30 pm yesterday (except for 2-3 hours mid day) and today has also involved quite a number of hours in the halls of Kijabe already.
In those 2-3 non-hospital hours mid-day yesterday, however, I got to go to an RVA party. A creative missionary-women's afternoon tea for the FOUR pregnant RVA staff members. There were funny stories, a "Parent Rap" music video (http://www.youtube.com/watch?v=N_NspDWssIY), fruit and cakes, a fashion show of various atrocities from the shared maternity closet modeled hysterically by belly-padded hams, including a finale inspired by a story from SEW about the practical African response to the speaker's father's great idea in T-shirt provision. LAUGHTER. There was also a great devotion by Darilyn B about going to Jesus in prayer in every situation, identifying the real enemy (world, flesh, devil not your sibling), and imitating God. I only got called about four times during all this (!) but managed to stay til the end, and really enjoyed meeting a couple of new women and praying for the moms.
As those who provided refreshments packed up, I asked for some of the left-overs because baby Patience reached her 2-month birthday Saturday (I have to use her name, because it is perfect for a child whose mother has spent 2 full months in the nursery feeding her infant encased in an incubator through a tube passing from the baby's nose into her stomach, with milk she the mother squeezes from her own breasts EVERY TWO HOURS around the clock). I had planned to make cupcakes or something, but didn't manage due to long hours of work in the hospital that morning. A few of the RVA women shared miniature scones and chunks of banana bread and snacks, which I wrapped in plastic then stopped and arranged on a plate from the hospital cafeteria on my way in.
As soon as I walked in, however, I saw that Baby L who had been born 8 days ago, whose swollen body seemed incompatible with life but who had pulled through an ICU stay and seemed to be healing, was struggling to breath. I quickly set the cake down (Mama Patience was later delighted, sharing her goodies with the other mothers, a true signpost of the hope that perseverance pays off) and started evaluating baby L, who was blue. The nurses were surprised as she had been (relatively) fine up to that minute. She was NOT fine now, and we awkwardly extracted her with her tangle of tubes and monitors out onto the resuscitation table and went to work. A chest xray confirmed my suspicion of a popped lung, a "pneumothorax", a known complication of the high-flow air and oxygen blended help she was getting called CPAP. For the next 4-5 hours I kept bagging her, as the paeds surgeons adjusted her chest tube, we waited for xrays, we pulled off air and fluid. At one point the labor-and-delivery nurses rushed in another non-breathing newborn who was big and blue and I ended up running back and forth between the two, talking my MO intern through an intubation and more help for that baby. Both were revived, and lived. Both could have easily been dead. If it weren't for the cake I wouldn't have happened to be in the nursery, and the delay in recognizing these problems and calling for help might have claimed one of their lives, or both.
It wasn't just the cake that carried me through that long day, it was also Darilyn's meditation on going to Jesus in prayer with EVERYTHING. I do pray for my patients in one opening-of-the-day public prayer, in many silent and desperate "help me God" ongoing prayers since I am in over my head more than half the time, and then with parents if a baby dies. But yesterday evening I was reminded to pray in every situation. With the staff, as we worked. Before I tried procedures. When I was making decisions. It was an evening that called for hard reckoning, smacking up against my own limits and those of this health care system and this broken world. Going to Jesus in prayer with all of the mess transformed it.
Because though two lives were clearly saved, two others were lost. One twin baby had severe congenital malformations of his jaw, ears, eyes, head. Thanks to a heroic effort by our excellent anesthesia nurse we passed a breathing tube into his invisible airway. But his degree of anomaly was not compatible with life, and after I prayed with the team (after a good number of advice phone calls) and made the agonizing decision that we could not solve his issues, he started bleeding profusely in his tube, and the answer was clear. I pulled it out, and held his limp little body as his heart wound down to beat its last. His mother was fully focused on the living twin, and protected herself by refusing to see him. So he had only me, and I felt he should die in someone's arms not left on a table. The second death was even more agonizing. A baby born of an acquaintance-rape situation, delivered in secrecy and with no hygiene, arrived cold and ill a few days ago. On Saturday morning it became clear that her bowels were infected with a life-threatening process called "necrotizing enterocolitis" . We put on aggressive antibiotics and fluids and oxygen and hoped for the best. But the worst soon followed, mottled skin, gasping breaths, cold shock, swelling, acidosis. I thought maybe the infected intestine had burst and called for my surgery colleagues as I intubated the baby. They opened her abdomen with a small drain hole for the cloudy bloody fluid right there in nursery but after two hours of ventilating, fluids, medicines, the surgical procedure, and even CPR, and a call to a more experienced surgical colleague confirming that even a survival of the night would not mean a long-term survival with such extensive death of the gut . . I had to admit we were losing this battle too. She no longer had a pulse. I pulled out her tube and she died in less than a minute, as I stroked her arms and we prayed over her too. Her mother was distraught, wailing, undone. As she poured out her lament, she sounded just like many Psalms. It was a raw moment of faith clinging to a God who has allowed the nightmare, for her in the baby's conception, birth, and death, all horrific.
Today saw Baby L back in ICU, back on a ventilator, though I still believe God can and might fully heal her. She's next to a one-year-old with AIDS. These days that does not mean automatic instant death, if we can bring him through his life-threatening other infections he could live for many, many years with treatment.
So cake was lifesaving, and prayer pulled us through some sorrows, and there is hope that tomorrow will be better.