More thoughts on Large Hearts

Beginning on Friday night when I got a quick panic call during dinner and ended up running into the hospital to admit a little girl to the ICU after brain surgery, up until 5 pm Monday when I walked out the door after work, it has been a harrowing weekend.  Nonstop, in a way that is unusual even for here.

Saturday morning rounds were still in their chaos of pending labs and confusing stories when I got the page to the operating theatre where 26-week twins were being delivered by C-section to save the life of their mother, who was dangerously ill, as well as their own lives.  We knew ahead of time they were identical boys sharing the same placenta and sac.  One was very small and sickly, only 530 grams.  The other had more than his share of the blood supply, and came out ruddy and relatively vigorous at 950 grams.  Thankfully the appendicitis colleague had not quite gone home so his wife who was waiting for his discharge agreed to run down and be an extra set of hands with these fragile twin boys for a while that morning.  We dried and resuscitated, intubated and gave surfactant, a medicine to help coat the immature lungs and make up for their difficulties.  I set up a little surgical area and inserted lines into both, then did something I've never done:  took blood from the baby with too much, and gave it to his brother with too little.  I spent most of the day fighting for their lives.  This was the mom's first pregnancy.  26 weeks is rarely survivable in Africa, even with our best care, the prognosis was not good.  530 grams is smaller than we have ever had a survivor. And the prenatal ultrasound was suggestive that the smaller brother had some congenital anomalies.

After the second dose of surfactant, as I felt I was losing the battle, I got this xray (only by physically going and pushing the xray machine myself into the nursery).  Almost no lung tissue seen.  An hour later, this tiny twin died.  The mom decided to name him "Success" and his brother "Blessing".  

Who would call an 8 hour life for a tiny tiny baby a success?  This struck me as a Kingdom paradox.  In his mother's loving eyes, he was a success, simply by existing.  Very sweet.

We pray his slightly larger brother, Blessing, will have a longer life, for the mom's sake.

It was an emotional weekend.  Nonstop admissions, I lost count, but about a dozen including Friday night.  Another teen with AIDS whose parents' denial and neglect meant he was starving.  Neurosurgical patients with acute infections, malnourished toddlers, unexplained seizures, jaundice, more prematures.  An 11 year old whose fear and sweet despair just got to my maternal heart (see below).  I ran home a couple times to find my kids foraging leftovers from the fridge. Once on Sunday I managed to mix up pancakes, but they were pretty much on their own.  The only half hour I spent out of the hospital from 8am to 11pm I found Julia making cookies:

These pretty much accounted for survival.  

I had four babies who qualified by their lab values for exchange transfusions, an hours-long technical and risky procedure for severe jaundice.  It took every ounce of courage and the Spirit to NOT do these transfusions and doubt the labs which seemed way worse than the babies looked. I held my breath to know whether I was doing harm or good, until today when the lab manager recalibrated and everyone's tests dropped back towards normal.  Whew.  I lamented missing RVA's play, but there was no way to leave.  

By this morning, after a 2-3 am bedside vigil for two more deteriorating patients, I was pretty fried. There were some happy stories, like a 13 year old girl with diabetes who had moved from death to life, smiling and alert and looking great. I had about four patients well enough to go home, and was juggling their issues, 23 babies in nursery, 18 on the ward, one in casualty and one in private clinic, two in ICU, not to mention the outpatients just grouping.  I would have been shot without rescue help from the inimitable Pete Halestrap, our ER doc who is spending three days to step in and lend a hand.  That's another story, but I am so thankful for his cheerful can-do willingness.  But when the little boy who had severe brain damage after a complication during surgical debridement at a local hospital last week of what should have been a simple, curable infection in his leg finally died, I was thankful to have the chaplain show up to help me comfort the mother.  Then this afternoon the post-op brain tumor little girl, a 5 year old, also died.  These and little twin A all had unsurvivable issues by the time they came to us.  But 3 deaths in 2 days takes a toll.  And as the father of the 5 year old said, straight out of the Gospels, "If only you had been there in August when this illness started, she would not have died."  Meaning the entire hospital team, not me specifically.  If only she had not been stuck with her resectable brain tumor for 3 months in a public hospital waiting for a surgical date.  If only we could do more, for more people.  

Which brings me back to the prayer for a largeness of heart.  

In the midst of chaos and overwhelming patients and not only lack of doctor staff but on Saturday only half the needed nursing staff, I want to pray to become a person who exudes grace.  When I told the 5-year-old brain tumor patient's father and aunt she had died, they did not hesitate.  Their first words were, "Thank you for all you did."  Thank you?  She died!  But they were able to look at me large heartedly, with grace, to be thankful.  Amazing.  In life's moments of harsh tragedy, I want a heart large enough to look beyond my loss, my exhaustion, my grief, to show kindness to others like these people did.

And when the next sad story comes into my responsibility, I want the largeness of heart to care.  To feel the tears welling up in response to his own.  To imagine my child in this position, to be willing to go the extra mile for cure.  

To not give up, not close off.  To hold onto hope, which becomes elusive, but is the only sure thing.