The suffering of the poor, grace at the fray

This past week was one I would not care to repeat, and am glad to leave behind.  After a relatively good first three weeks of February in ICU where uncharacteristically everyone got better and left alive (and where I was tempted to feel competent for a moment, fatal mistake), suddenly the deaths mounted.  We lost seven patients on our three Paeds services, and all but one were either my patients/former patients, or dying on my call coverage night.  Two were excruciating decisions that we had come to the end of care for unsurvivable conditions, which is a very weighty burden especially when not everyone feels the same.  Two were similarly severely impaired by chronic medical problems and malformations and though we were giving our all in ICU, after multiple resuscitations (including the classic heart-shock-paddles for one) we had to admit defeat.  One was a newborn that I just walked in on in the final moments, but had been delivered too early, and my role was just to back up one of my partners in the last moments. Those five were exhausting but I can live with the decisions and accept our limitations.  The other two, however, really hit me hard.  One was a 9 month old with spina bifida and pneumonia, who came in severely anemic with a failing heart and shock.  Not a great prognosis, but she actually improved for several days.  Her initial blood culture showed on the third day that she was growing a gram negative rod (bad bacteria) in her blood, and since we have many resistant ones, I changed her antibiotics.  Only it turned out that my choice was the one she was resistant to, and by the time the lab reports were final, she was deteriorating fast.  She turned the corner towards death so quickly and decisively, and I spent a long night trying to control spiking fevers and falling blood pressures and low oxygen until she succumbed.  But the hardest of all was J, the 15 year old girl we prayed for a couple weeks ago.  Her apparent brain tumor had turned out to be tuberculosis, and I was practically dancing with that result because she could be treated and cured.  After a week in the ICU she moved out to another floor, and I heard she was slowly improving.  She emerged from her coma and begun to talk a little, and even walk.  In fact she was being discharged when someone noticed that her spinal fluid was leaking from her surgical site, and decided to order a head CT.  So Thursday, prior to being discharged, she was sent in an ambulance with a nursing student down to Nairobi, a stable improving patient.  It's not clear what happened but her mom gave a history that she got an injection of something that "calmed her down".  All we know is that after the CT, on the way back in the ambulance, she stopped breathing.  And in spite of the efforts of the nursing student, bumping on our horrible road in the ambulance with a dying girl, she arrived with no pulse and cold not be revived.  

And that was the hardest of all.  I ran into her mom in the hallway later, and she hugged me and cried.  I have a child who is 16, nearly the same age.  Losing a baby is terrible emptiness and robbed potential, but losing a teen, someone you have known and watched grow, must be nearly unbearable. Particularly after we all thought the danger was past, and whom we expected to recover.  I felt deflated, punched, sorrowful.  Devoid of words.  And I was only the doctor, not the mom.

And the rest of the week wasn't much better.  Scott's 15 year-old bleeding girl in Liberia died after her family refused surgery.  Two of our Africa-based team mates lost close relatives:  Heidi's mother died of ALS just like my Dad did, and Lesley's 24-year-old sister died in a car accident driving home from a final family dinner with them.  We have a family of six from South Sudan who evacuated for medical reasons, as it turns out multiple large kidney stones causing months of pain.  One of the three remaining missionaries there injured his back, resulting in phone calls and considerations of security and evacuation, though in the end it seems muscular and he's staying put.  Accusations exploded against our school in Bundibugyo this week, with politically slippery types trying to agitate against our administration.  Kids at this school, RVA, are also tired in that mid-year slump where exhaustion sets in, and not a few have had to have compassionate leaves for mental and spiritual health reasons.  All of these situations have weighed on our hearts and filled up my hours in a week with 4 call nights and 3 extra guests spending the week at our house, with little sleep and lots of meals to coordinate and serve. I had two projects due as well, which meant that every moment was a push.  And did I mention the car trouble, or the sick dog?

So this weekend I wondered, what was God doing this week?  Why was it so hard, so full of death and defeat, so discouraging? 

And that brought us to Sunday, and Psalm 22.  Jesus quoted this song on the cross, the cry of the heart when one feels forsaken.  "I am poured out like water . . my heart is melted like wax . . my strength is dried up . . ".  The psalmists describes being utterly weary and surrounded by enemies.  Which pretty much sums up this week.  

In the middle, the Psalm transitions to faith.  "But you, O Lord . .have answered me."  Right in the middle of all the painful chaos, this promise:  "For he has not despised nor abhorred the suffering of the poor; neither has he hidden his face from them; but when they cried to him he heard them . . The poor shall eat and be satisfied."  All this because "The kingdom is the Lord's and he rules over the nations."

Terrible things happen in this broken world.  Seven bereaved mothers.  Bleeding.  Stolen breaths. Cars screeching off the road.  Hateful rumors.  Bad choices of antibiotics.  The psalm acknowledges this, and yet still holds onto two things:  God sees and hears and speaks, he enters and embraces us right in the midst of all this.  And God rules, his reign is slowly and surely setting all things right.

Wright calls this "something that doesn't cancel out the suffering, but that seems to grow out of it. . . These verses reach out, like the two arms on the cross; and they reach up, like the sign of the kingdom, pointing to the heavens.  You can't split them off from the long, dark pole of the cross.  . . they are the fruit of the suffering."  He writes of rescue and justice leading to worship.  All pivoting on the cross.

So I am praying to notice the God who comes to the poor in their suffering, the subtle ways He shows up to love and to rule.  Looking for signs that the world is being set right.  And as hard as this week was, it would have been a lot worse if God had not orchestrated a calm, competent, thoughtful, friendly visit from Dr. Becca Cook the very worst week of the year so far, and the very week when two other staff were gone.  I am thankful for ideas and companionship on the late night code runs, the early morning vent adjustments, the agonizing decisions.  

She was an RVA grad and fabulously successful academically, but more importantly has a heart for the poor just like Jesus does, and it was good to have her around.  

And once you start looking for God's mercy and rule, you see glimpses all over.  Here is our team community this week, expanded by Ann's parents and the Wallaces:

 And this morning, even though it was supposed to be an off week for Sunday School, all of my group chose to forgo extra sleep and come.  Love these guys.

 An impromptu party to watch England vs. Ireland rugby, when my pot of soup kept on giving and we all ate and cheered.

 Saturday I got to ride the bus with the team and watch basketball, and my favorite player, #11.

 And this smiling face and ginormous cookie awaited us this evening, a reminder that Jack's birthday is only 48 hours away.

 And we made it past the half-way point, the 29-day 29-day split of this separation which came yesterday.  Scott has now been gone more days than days that remain until his return.

Pray that we would keep grappling with faith, keep believing that the suffering of the poor is not forever, not in vain, not forgotten.  That God's mercy and reign keep moving in.  That the glimpses of community and refreshment this weekend will carry us through another week, even if the deaths pound on and the unraveling continues.  That there will be grace at the fray.