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Wednesday, April 29, 2015

Crumbling edges

This may just be the post-call weariness speaking.  But it strikes me that being a paediatrician in a place with high mortality looks more like mopping up in a war than it looks like enhancing the health of the thriving.  Some days the sadness just starts to crumble the edges of resolve.  Generally one wants a doctor who is decisive, firm, unshaken, tough.  So it is hard to sometimes find the space for genuine human emotion in the face of sorrow.

And in a place like Kijabe, the sheer volume and complexity of the ways evil takes its toll on the weak keeps us in motion, from battle to battle.

The last 24 hours included some joy for sure.  I never lose the wonder of a baby being born, the matted bloody hair followed by slippery shoulders and the gasp of reality as a living being separates from his mother and wails.  The mom's shivering exhaustion, tears of relief.  Holding her infant up to her tired lips for a kiss.  I think my intern last night had never seen a birth, so it was fun to walk him through the miracle, and fun to join Scott who was doing the OB side of call.  But there are a thousand ways for things to go wrong.  Around midnight I was in the delivery room with a mom in labor.  Only she had a baby only half-way through gestation, nowhere near ready to breathe.  I noticed her only living child was born in 1997, so basically my kids' age.  Since then she had known only sad endings, and she was braced for another.  I explained to her that we would not be able to save her baby, and held her hand.  I offered to pray, and then checked the file to catch her name.  Julia.  Ouch.

Then there was the five-month-old whose mother watched her dwindle as she struggled to make enough milk.  Or the mom whose child with cerebral palsy came in with seizures and difficulty breathing.  Or the neurosurgery patient with the sunken eyes of dehydration from his gastroenteritis.  Or the articulate 11 year old boarding student with panic attacks, responding to family tensions.   Seven admissions before daylight.  Early morning consultation with colleagues about a mysterious parasitic leg swelling, about the lesser of many evils in keeping a baby with an intestinal malformation alive, about what intrauterine infection was most likely to explain another infant patient's small head, cataracts, pneumonia, liver inflammation.  And on to the day, soldiering through, evaluating, teaching, helping.  Being tough.

But two cases today stood out to me, in that crumbling-edge glimpse of sorrow and beauty.

The first was a 2 year old, AA.  Well, he turns two on his birthday tomorrow.  His parents traveled three days on trucks in the flooded sop that is rainy season to make it here from an insecure area in the north.  His parents' dress was traditional and set them apart from the average local people.  AA was born with a spinal cord defect called meningomyelocele, and the accumulation of fluid in the brain ventricles called hydrocephalus plus the crooked spine and compressed chest that usually accompanies this.  He weighed 5.8 kilos (about 12 pounds) at age 2, watching a bit anxiously from his mom's lap.  He had been seen earlier by the neurosurgery resident for a huge open wound on his back, then sent over to paediatrics.  At first I pondered how we could possibly help this boy's nutrition, what infections might be pulling him down, what we could get done in a day, how they would manage in their remote home.  Then the dad made a speech." I have four children", he told me, "and I love them all.  But I love this boy the most.  He is God's creation too.  I love to carry him around with me, and show him to my friends.  Can you please give us a medicine to make him want to eat?  We try so hard to feed him.  He doesn't have an appetite."  Well, I was blown away.  These were not neglectful parents, going through the motions of seeking care.  They were sacrificing a lot to get this boy help.  I decided to admit him and try to get him on a path of nutrition, growth, healing wounds.  He's one of hundreds, thousands of disabled children that pass through our doors every year.  Taking on the desperate love of all those parents trying so hard. . . crumbling.

Then an hour later, a call from casualty.  I rushed up to find a 15 year old boy who was only inches on the life-side of that fine line between life and death.  J was dying from AIDS.  His wasted body was stick-thin, his skin covered with the dark spots and nodules of an HIV-related cancer, his lips bloody with another infection, his head barely more than skin stretched over a skull, his blood pressure too low to record.  But somehow he was awake, and tried to talk to me.  His oxygen mask was uncomfortable, and he was thirsty.  My mind could barely grasp the level of suffering this teen must have endured.  He was a little younger than Jack, and about an eighth of his weight.  Where do you even start, 15 years too late?  How did his parents let him get to this point?  Where did the whole system break down, losing track of him for the last year and a half since his last visit to Kijabe?  Is it too late for hope?  What kind of world is this, that events way beyond J's control would have sentenced him to a slow and terrible extinguishing of life?  What could we do that wouldn't make him worse, tip him over the line towards death?  How can I as a paediatrician, a mom, a person, look at this?  How can I look away?   Another crumble of resolve, of equanimity, of professional distance.

One can not doubt evil when conversing with a skeletal teenage AIDS patient, when touching the wounds of a baby who will never walk.  And so we reach for faith as the evidence of all that is not seen, of redemptive endings and no more tears.  And some days, faith feels like a distant stretch.  But the very clear not-rightness of these cases raises the stakes.  Evil can not have the final say.  Holding on to love.

1 comment:

Laura Ziesel said...

I have been overcome with sadness here in America at things much less present to my every day life. People have been telling me to protect myself and look away from the painful things for a bit, but I feel sorrow in this privilege -- to be able to look away is not something everyone can do. But this contemplation, of the privilege of looking away -- has led me back to those passages in Job where the Lord recounts to Job how much he sees and how little Job sees. There are the bits about the birds, and the animals giving birth, and all of these other hidden/private moments in the lives of God's creatures. And it struck me that while God also has the privilege to turn away, as I do, He does the opposite and stares full into the face of the death and suffering and sorrow. He turns His face to see it all, to enter it in the most helpless way, and to absorb it into Himself. And then of course, He shows that it will all be made new one day. Anyway, all that to say, the Lord knows our pain of seeing these heartaches, and He keeps His gaze full of them and on us. Love and prayers to you as life seems more jagged than usual these past months.