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Sunday, February 04, 2018

Perspective gained by space and time

"If you can see a thing whole," he said, "it seems that it is always beautiful.  Planets, lives . . . But close up, a world is all dirt and rocks.  And day to day, life's a hard job, you get tired, you lose the pattern.  You need distance, interval.  The way to see how beautiful the earth is, is to see it as the moon.  The way to see how beautiful life is, is from the vantage point of death." (Shevek, character in Ursula K. LeGuin's The Dispossessed)

As we slog through time sequentially, we don't always see the whole picture.  Hard things happen, and they are truly painful, and they become part of our stories.  But, as one of my characters says, they aren't the end of the story.  It's only from the vantage point of death, or eternity, that a life's full beauty can shine.  And to bring that sublime thought down to earth, it sometimes helps to look back a few months or so to feel less discouraged.

Friday was the last day of rounds with the current set of interns; they switch services every three months through their year, rotating in OB/GYN, Paeds, Surgery, and Internal Medicine.  They come in quite vague about babies and children, and often leave with some sense of accomplishment.  I noticed on rounds on Friday, the row of 9 of the smallest preems (2 per incubator and one yet-to-be-squeezed in, and that was before 2 more were born that afternoon . . ) every single one had appropriate increments of milk feeds in their nasogastric tubes and IV fluids in their veins, every single one was gaining about 1.5% per day of body weight.  THIS IS NO SMALL THING.  It takes time to learn how to gently and meticulously manage beings who weigh 2-3 pounds (this row is 800 to nearly 1600 grams).  On the other side of the room there is a row of the 1600-1800 size, tubes out, learning to breast and cup feed.  My other intern had appropriately corrected the management of a critically ill and dehydrated baby admitted overnight, and had thought through some of the more complicated cases on his service.  In short they had both come a long way.  We're trying to measure what we do with pre and post tests and a core curriculum, and both of these interns raised their score by 20 points over the 3 months.

It's also great to finally have the nurses settled.  December was chaos as the strike ended and assignments were reshuffled, then at Christmas and into January many took their accumulated leave (strike time doesn't count as leave . . ).  So finally we have the queen of Kangaroo Care (skin to skin warmth and nursing of babies by their moms) back in action. The twins pictured here were SO SICK at birth, yet to see them now you'd hardly remember it as they move into their third week.

At home on the weekend this is what my table looks like as I review labs and cases with the intern.  The point being, a year ago no one was following very closely, especially on the weekends.  So there's that.

These are the senior preems, Kangarooing.  When deaths feel overwhelming it's good to look and see the lineup of babies who make it through a harrowing month or more to grow enough to go home.

This is what 3 babies-per-incubator looks like.  Crowded or cozy?  It's an infection-control nightmare but the alternatives aren't great.  We don't turn anyone away.  Some are born at home, or at small clinics with no capacity to manage an infant, so are sent here.  My Medical Officer colleague who did her internship a few years ago, and is now working on Paeds, commented this past week that when she was an intern these babies were not surviving, and things are so much better now.  Good reminder that my perspective is so limited, and people looking over a longer interval see more change.

And it's not only the babies:  here are 2 moms-per-bed awaiting C-sections this week as Scott was working to get them into theatre.  I think the patient resilience of Kenyans, the willingness to share a bed and to endure discomfort and to sacrifice for their children, will win out over all obstacles, eventually.

This is a Monday pep talk to ourselves.  The point is, it's all disease and crying close up, but when you get the distance of a day or a rotation or a year or a lifetime, there is great beauty.

1 comment:

Hunter said...

Somehow, the palingenesis will be like this. The scope will be so large and the purposes will be revealed, and the remaking of all the pain will display the beauty of the scars...and it will all make sense. We will be, no more tears. Thanks for the pictures of pain. Like you, our longing for the restoration increases.