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Sunday, April 23, 2017

Looking for Mercy

Walking out of church this morning, the sun went behind a heavy cover of clouds.  Our little rented house requires a ten minute walk, dusty, steep, uneven roads strewn with rocks.  Mid-day glare and heat can be intense, so the cloud cover was a relief.  Which reminded me that the same clouds which last Sunday obscured our Easter Sunrise can also be a mercy.  A protection.  If everything we are and everything we do was exposed to the burning holiness of God's glory, we'd be crisps.

It's been a long week.  

I suppose I don't want to get used to deaths, but some days are harder than others, sometimes the heart more fragile.  Friday morning we biked to the hospital as usual.  I had known in the evening that two babies in the Newborn Unit had worrisome lab results, and consulted about them, so before the teaching conference at 8 I thought I'd just take a peek to know what awaited us.  They were side by side under the eerie blue lights that treat jaundice.  Baby H, the first, looked up at me wailing.  She was vigorous, and while still battling infection, looked better than she had the day before when I was doing a lumbar puncture and noting deepening jaundice and lethargy.  Baby F lay quietly in the next bassinet, with a light blanket over her, IV dripping.  The night nurses were preparing to sign over to the day nurses, so all 4 (2 per shift) were coming into the room, and I began to remind them that phototherapy is not very effective if the baby is covered.  As I unwrapped F, I thought, this one is so still, is she alive?  Turns out the answer was, no.  I tried to resuscitate her for the next 15-20 minutes, pretty much alone, giving breaths with a bag, doing chest compressions.  A nurse helped me with adrenaline and with tubing to connect the bag to oxygen, but otherwise they continued their sign-over.  The baby had probably been dead for fifteen minutes or half an hour by the time I found her, she wasn't cold and stiff but she had no response to my efforts.  Most likely an infection that our antibiotics could not reach.  An hour or two later, after seeing the dozen sickest ward patients in our acute room, I was back to round with the team.  We reviewed baby H, and now that baby F had died, the next patient in the line was also a critically ill newborn who had presented the day before with severe breathing difficulties, also due to an infection we thought.  He was on CPAP, our highest level of oxygen therapy, but the hospital was running out so only two concentrators were supplying all of the babies.  The intern started to present this one, and I noticed he was grey and not breathing.  Was he dead too?  There was a faint, low heart rate still, less than 20 I'd say, but with bagging oxygen into his lungs that started to come up.  His IV was out, we noticed when trying to give drugs, and checked the notes.  Last fluid was midnight, now it was mid-morning.  It could have been a low blood sugar, or progression of infection, or the marginal oxygen supply, but though we worked for an hour and had him back most of that time, he eventually died too.  Two babies in two hours.  And with both, the sense of not only fighting the disease, but also fighting the inertia of a system overwhelmed by numbers and unconvinced that intervention matters.

There were 30-40 other babies besides those two.  One was a twin I had found dying two weeks ago, just like the stories above, but she is almost ready to go home.  There are several little 2-pound preemies, and many exposed to AIDS, and a massive 5-kg (11 pound) baby whose mother delivered naturally, and several sets of twins who are on the small side, and a few born at home who come in with infected cords, and some who convulse after difficult deliveries, and two with mentally retarded mothers who have to be helped to feed their infants.  On the ward there are 50-60 kids, many being rescued from malnutrition, AIDS, TB, respiratory viruses, asthma, dehydration from bad gastrointestinal infections, pneumonias galore, kids with CP, with kidney disease, with burns, with rashes.  Two dying out of a hundred in a morning, well, one could say that's a 98% success.  But it doesn't feel that way.

When I am saddened by loss, and frustrated with the system, I want to blame someone or something.  But the same glory of God that would fry those bacteria and zap the malfunctioning equipment and sear the passive-aggressive attitudes would also singe my pride and self-righteousness.  We need the clouded mercy of God's delay in setting everything right.  That cloud gives us time to change, to embrace goodness by choice and not by being overwhelmed by the power of the glory.

This job is relentlessly cross-cultural, fraught with uncertainty, daily pushing limits.  But one day I believe we'll realize just how great the Mercy has been that has surrounded us.


Jill said...

I wanted to leave without a word of encouragement because I find none coming to my mind that aren't sad, worn, lifeless phrases. Tiny little bandages to bind a gaping wound. You are indeed standing in the fray. I see. I hear. God sees. God hears. We stand with you and yet you stand alone. Paradox. (PAIR of docs!)

Judith Shoolery said...

I realize reading Jill's comment, that even though words fail me at the discouragement that surrounds you in your work, I want you to know that I continue to pray for you and Scott and all of your dear ones and for Ruth and Dave. I am delighted at Caleb's good news. May God watch over you and bless the work of your hands and heart.