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Tuesday, October 18, 2016

When Words Become Walls

Today I hit the proverbial wall, and reflecting on why, I think much of it was miscommunication.  Words were meant to connect us. Word can be synonymous with Love, with the extension of self to another person.  (The Word become flesh, and dwelt among us).

But when you're working in a new place and new language, perhaps words can do more to exclude than to connect.  We don't even know many people here, but the two young women who work in the guest house are two of the few we see daily.  So when one called in the pounding rain asking me to see her sick children, I thought I was helping by hurrying back to the guest house, only she had brought them to the hospital.  Communication fail.  She was very frustrated with me.  I felt terrible.

Yesterday I made many phone calls thinking I was connecting with the myriad of people who were involved in a particularly sick patient's care.  This boy had landed in the ward after a public hospital administrator from an underserved eastern region of Kenya somehow connected with a visiting team of Texas doctors who would be working nearby . . and loaded 50-some cardiac patients on a bus across the country to see the cardiologist, hoping some kids might be chosen for free surgical trips to America.  It was a news splash in the paper, and medically kind of crazily haphazard, and not surprisingly one of the kids was so sick he didn't make it to the visiting doctors and landed instead with us.  I am not going to belabor the ins and outs of who said what, but after much effort we got him a space at Kijabe (where the visitors were headed today) and an ambulance to take him there.  Sorted.  Only I walked into the ward this morning, and there he still was with his dyspnic breaths and distended abdomen.  The uncle insisted that he was waiting there because the regional doctor who brought the kids to our town told him to do so; the regional doctor however insisted that the uncle refused to go to Kijabe.  Who knows?  It took more people and hours to sort it all out with the regional doctor insisting he would take over and take the patient back where they came from . . . only for me to get a call two hours later from Kijabe saying they landed there anyway.  So many conversations and versions of why things did or didn't happen, all to land right back where they were supposed to be, only 24 hours later.

Then there was the lab result that was days late.  Thinking I could show how it's done, I went to track it down (TB test results for a pretty sick malnourished child, so important).  IN THE VERY LAB where the tests are done, the people doing the work told me directly that though they had seen the paperwork there was no sample.  The intern was positive he had taken it there.  I went to find out where it could have disappeared to . . . and found another lab worker who said the sample was IN THE MACHINE at that moment, the machine the first two were using.  OK, maybe that sounds simple, but again multiple people, enquiries, time, resulting in confusing and contradictory stories.

Or the one moment I thought maybe I was helping teach some people, taking extra time on a 10 year old with a hemoglobin of 3 to teach physical exam points (hear the gallop?  Feel the spleen?) and list a differential.  We discussed the work up.  We ordered some tests to be done on the patient's blood before the life-saving blood transfusion.  But they weren't.  And the trainees looked at me and said, "you never explained that we had to do that".  Obviously what I thought I said wasn't what was heard.

Maybe all this sounds trivial, but when it stacks up in a day, when everywhere you turn you're in the dark . . . it's words making a wall that isolates rather than a bridge that connects.  And I wish I could say that I patiently endured, and gently sought understanding.  Oh no, I did not.  It was not a shining missionary day.  I complained.  I criticized.  I pointed out gaps.  I begged.  I badgered.  I knocked on that wall with a sledge hammer instead of looking for the keyhole.  Pretty much a failure day, for sure.

So, maybe the wall will add a layer tomorrow when I face the consequences of today.   Prayers appreciated that instead grace will seep in, somehow, that the damage won't be irrecoverable.  I am not enough for this transformation.  When words walled me out, I forgot the cross, the way of suffering, the way of love.  Ironically, the final exclusion came from the regional doctor team who arrived in their ambulance, and refused to shake my hand as I greeted them.  I had forgotten how dehumanizing it is, the infidel-foreign-female-leperousness too impure to touch in a handshake.  My awkward hand, hanging in the air, untaken, the perfect symbol of a day gone wrong.  Reaching out but ineffective, a gap not crossed.  

Tonight we're both tired, tired of wandering into a maze of uncertainty where we're not understood and don't understand.  I know we should read our own cheery blog posts on how to cope.  Perhaps we cam start to survive by communicating with the one other person we get, each other.  As Scott was doing other things in Labor and Delivery he took note of a nursing student trying to assess a mother in labor, and saw that the fetal heart rate was stressfully high.  Upon further assessment he realized the baby was in danger, and the mom would need an emergency C-section, added to an already busy theatre day.  As he wheeled her into the operating theatre, he texted me while I was on rounds.  In this hospital it is not standard care for the peds team to come into the operating theatre, but Scott realized the baby was going to need more care than the nursing student assisting him could offer.  Come in 15 minutes, the text said.  So I tried to sort out the preemies I was rounding on then walked over.  Due to the fact that this isn't done, I couldn't get anyone's attention, so I had to walk in barefoot, no gloves, no mask, no gown . . . to find the limp baby with a barely detectable heart rate and no breathing, her mouth full of a bulb sucker.  Oh well.  I tried to teach the nursing student what to do as we gave the baby breaths, and watched her come to life.  Apgar 2 at the first minute as I arrived, and then 8 and then 9.  Yeah.  If words in a text, words of explanation and instruction while working on a baby, could bring life in those five minutes of the day, maybe there's hope.


K Galvan said...

Keep up the good work! His tender mercies are new every morning!

Rachel said...

Jennifer, you and Scott are in my prayers. Thanks for being so transparent.

Anonymous said...

Pulling and praying for you in this challenging time.

Larisochka said...

Boy do I recall these days....and live them in some ways again in Pittsburgh, although, thank the Lord, we speak the same language! Praying for you and trusting in the good that He works through all the struggle. Much love!