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Friday, October 17, 2014

Tired of Death, Poured out, and yet glimpses of hope

I guess that title could be the tag line of our life.
This week I am mostly tired of death.
Two deaths, two days.  And sometimes I forget how draining it is.  The first was a blue baby.  Her name was the same as mine, which shouldn't be jolting but sometimes is.  She was born to a very culturally intact rural family, at home amongst the cattle, no immunizations or medical contact until she began to fail near the one-month-mark.  At Kijabe she presented with what was thought to be a pneumonia, then her spinal tap was abnormal so meningitis was suspected.  That level of infection tipped her barely-balanced heart into dysfunction so that she turned very blue.  Our best-guess non-expert echo was that the veins from her lungs emptied into the wrong chamber.  
I spent the day with my colleagues trying to stabilize her in the ICU, intubated, with drips and monitors and full-court-effort.  And on the phone to see if we could transfer her to the main government hospital where a cardiologist could give a definitive diagnosis, to know if there was any hope.  That night I was at her cot from 1 to 3 am, and back at 6-something, and again at nearly 8am.  At which point she was dying, and though I hated to give up, I had to make the call that the CPR and every possible medicine was not bringing her back.  The worst part is telling the mom.  The stoic group of men who had listened to the poor prognosis and were resisting the attempts to transfer the day before were now gone.  It was just me, the nurse, and the mom, whose clothes gave off the earthy smell of a kraal, whose face was far from stoic.  She wept, quietly.  She didn't want to touch the baby.  I held back tears, filled out the death form, prayed with her, held her hand.  

The next day it was a 3 year old with a brain tumor, who was a week out from surgery to remove what could be removed.  But the tumor had infiltrated his brain stem, the crux of all essential life processes.  Since surgery he had not really woken up fully.  He wasn't talking or moving, though he seemed to sense pain.  We had spent days in ICU regulating him, and now he was in our step-down HDU.  I had talked to the neurosurgeons about his case which seemed pretty hopeless, but they still thought if he revived he might be able to get radiotherapy, and perhaps have a chance of survival.  Irradiation to a 3 year old's brain stem is no small matter, even if there were more than two machines in the entire country, even if they family could afford it.  Yesterday afternoon I heard he was "complicating" from a CO intern who was running to the lab for blood.  So I ran to his bed and found him without a pulse or breath.  The nursing team sprang to action and with a colleague we did CPR and bagging breaths and a line and medications.  I appointed a timekeeper and said we would try for so many rounds and then accept his death if he did not respond.  Nothing.  

Again, the worst is going to find the relatives.  In this case an auntie who had spent her own savings to rescue this child.  His family was unable to care for him, his mom confined with a newborn a few days before he came.  She was determined to do her all, so she brought him all the way from Mombasa.  I found her with red eyes and streaming tears, being comforted by the chaplain.  Is it over?, she asked. Yes, I said, sitting down to put my arm around her.  Thank you God, she said with hands raised. Not the usual response.  She went on to explain that she had seen how much her nephew was suffering.  She knew that a full week out from surgery he should have been recovering, but wasn't.  And she had prayed that day, God, please just take him if he can't recover, don't let him go on suffering like this.  Wow.  It strengthens my faith to see the Spirit preparing someone like that. She had a sense of what to pray, and she met Jesus in that process.  If we truly believe in Heaven and healing and hope, then this boy's death becomes part of a larger story.  Yes we are sad for his family, yes we believe in giving our best care and fighting against cancer and infection and every other evil.  But when we reach the limits of the battle, and we lose, we lean on the assurance that the ultimate outcome is still Goodness and Love.

Walking with families through the valley of the shadow, the very essence, of death is a holy privilege.  I believe in compassion, information, the assurance of doing everything humanly possible.  I believe in praying and grieving.  In creating a safe space, in letting go, in closure.  I think we do a pretty good job of this as a hospital.  But it has a high cost.  Isaiah 58:10--if you pour out your soul for the hungry.  This is a job with a lot of soul-pouring-out.

And not always a lot of space for recovery and pouring-back-in.  But today as I reflect, I am thankful for quite a few other stories.
Precious, against all odds, is actually starting to breast feed. She cries and moves and looks at her mom.  Her little brain has a long way to go, but she is miraculously alive and recovering.  And her mom has been so touched by prayers for her daughter.
Little L, who was paralyzed in the ICU a couple weeks ago, is sitting and smiling.  He can only barley lift his arm and wiggle fingers and toes, but he is progressively strengthening.  He should go home today.

Grace, the little girl who wants to go to school, I found with a coloring and sticker book yesterday, courtesy of visitors.  She flashed me a huge smile.

A boy "I" with diffusely swollen joints, severe pain, a raging fever, a month of almost continual suffering . . . was alert, talking, and without fever for the first time after getting the right treatment.  Hooray.

One of our most connected, visionary, wise, committed docs (Mark Newton!), came back from his frequent trips to America, this time with promised equipment courtesy of General Electric.  This is a new GE ventilator and monitor being installed in ICU yesterday.  We need at least two more ventilators for our new Paediatric HDU/ICU area when the new BKKH wing opens in 2015, and nine monitors.  As our care improves, the sickest patients find their way here, and we need more space and equipment to care for them.

This is our very own Dr. Nthumba, who was a surgical trainee back when we came here to have babies, and now is the head of Medical Education, one of our most senior doctors, and a leader in Africa.  He is featured in a WHO video about how to "first do no harm" and prevent poor outcomes in our patients, focusing on using teamwork and communication and checklists and attitude to reduce surgical site infections.  We had a meeting about this today.  I don't do surgery, but the principles of reviewing problems, addressing systems rather than assigning individual blame, learning from mistakes, building collaborative relationships, welcoming team work and input . . . are excellent and the kind of atmosphere I want to work in.  I love our Paeds team and believe we are solidly moving in this direction.  

Then there are smiling teenage faces that lift my spirits.

This past weekend was a midterm holiday so we ended up with first one, then two, then three, then four senior boys in the house.  On the left Jack and John Amos are working on college applications, the comfortable way.  Nothing like a dog and a hammock to improve your writing.  I spent the weekend editing essays as fast as they flowed out.  Which is a good way to re-appreciate how amazing these kids are, resilient, funny, wise, true.   To the right are a bunch of kids who came for lunch yesterday to celebrate Rich's 18th birthday.  We made pizza in spite of rain, and celebrated this kid who has been a loyal and polite and godly friend to Jack since the day we moved here.  Most of the guys in that photo have played sports together on multiple teams nearly every season for five years.  They are also in our Sunday School.  Plus Acacia and Adrienne, who bring class and some decent pizza-making skills to the whole process.  Sadly a group of RVA students staying with a missionary in Nairobi last weekend were robbed at gunpoint as they entered her apartment.  One of the boys came back and stayed with us afterwards as they debriefed and recovered (not pictured).  Please pray that his new computer which had all his college application work, including his musical portfolio, would be miraculously found and returned!   And that he and the other kids would find comfort in Jesus after a very traumatic experience.  RVA ranked as the #2 high school in Africa in a newly published report, which is a continent of over a billion people and many good schools, particularly the prep-schools in South African and the International Academies in most capital cities.  So that's another thanks, for the teachers and students and dorm parents and counselors and cleaners and administrators and drivers and coaches and community that make this place possible.  

It is Spiritual Emphasis Week, and we've been grateful to hear Gospel-centered from-the-heart solid truth from Eugene Cho and a great worship team the last two nights:

Thanks would be incomplete without mentioning our supportive Serge team here.  Karen, Ann, and Bethany have prayed and cooked and listened and walked.  Here we are on a rare hike, to Big Fig:

And even more thanks to our extended team in the USA, especially the Crumleys, Bolthouses, Harteminks, and others who have reached out to our college/grad school kids.  Julia was able to fly out and visit Caleb for an Officer's Christian Fellowship retreat; Luke had a great Fall break with friends followed by a Christian medical fellowship retreat.  We miss those three so much, it is a draught of fresh water to see them connect with rest and with families who love them and with each other.

Let me close with a last thanks to Carol Logan, who left us a bag of mint M and M's as she departed.  Wow.  It's the small things.  Pretty awesome.

We are tired and poured out, but not defeated.  We have hope, and green minty chocolate, and each other, and you.  Thanks.


Jelsma Journal said...

Praying for you... we understand a small portion of what you are facing. Praying that spiritual emphasis week breathes some refreshing into your lives. Thanks for the work you do and the compassion you live each day.
Jocelyn Jelsma

Anonymous said...

I don't know you or your ministry but I am a kindred spirit missionary in Haiti. I was so refreshed and encouraged and blessed to read your blog. we forget so quickly when we are weary and discouraged that we are not alone. So here's to you my friend, may God continue to reveal the blessings to you daily in the midst of a very physically, mentally and emotionally draining work. May you continue to stay rock solid, firmly planted on His promises and knowing that He is faithful. I just finished off a bag of miniature m&m's myself that were left behind! "Here's to toiling on!!!