Yesterday, I hit the proverbial wall, after finding a pale, stiff, low-oxygen, responding-only-to-pain child correctly identified as the sickest on the ward and in need of attention . . . but due to a broken system of overlapping cracks had been admitted 24 hours before and still not received any dose of malaria medication for her heading-towards-fatal disease, had not been transfused, had an IV that had filled her tissue with fluid, had no antibiotics given. To be fair, we get dozens of kids a day, literally admission rates always double-digits and often over 20, most of them with malaria. Our ward is a tangled web of blood transfusion tubing. I always find a few kids with vital signs and diagnoses that should land them in an ICU. A few hours into the mess I can barely remember who is worse off than whom. And most days Scott finds his proverbial hundredth sheep where an intervention saves a life or two, and I plod through everyone to make a careful list of the top ten sickest and what they need so the nurses and whatever student or volunteer is hanging around can focus. We look at starving children and go into fixing mode with calculation and instruction. We make a list of out-of-stock essentials and procure a few hundred dollars of medicine or transfusion tubing or tape or whatever is missing. We try to connect with the government, the referral options, the system above and beyond us, to be a voice for those who can't. We revive whom we can and teach a little as we go and accept the imperfections dissolutions and disasters. Most days this is enough. Most days. I don't know why but yesterday morning, after our 1 kg preem kept stopping her breathing overnight, the sickest malnourished child with the hemoglobin of 2.0 still withering, and this new admission looking like she was within a half hour of death from a preventable and treatable disease, it was suddenly just too much. None of the staff on the roster (2-3 nurses per day shift, 1 on nights, for 60-80 patients) had arrived. I walked out into the hall to start looking for someone to call. The charge nurse Olupah walked in from the opposite direction, arriving, and said, how are you doctor. I said, not OK, and she looked so genuinely alarmed and concerned that I just burst into tears.
I not a big crier, doctors never cry here, staff are not emotional, which is 99% of the time good and necessary way to cope with this reality. But she whisked me into a side room and closed the door and gave me a huge hug before I could even object to COVID spacing. . . . and it was so genuine. We both talked about what was breaking down, where the issues were, and what needed to change, landing on the delays from lab (which is inundated with patients and not keeping up) and the tendency towards passivity when the in-charges are not present. Just a few minutes. Olupah is a shining star in a sea of sorrows, and I'm grateful for her. I composed myself and wiped off my face and went back out to battle.
And it was a battle, hours of it, with not a ton of victory.
In my read-through-the Bible, yesterday and today covered the whole book of Ecclesiastes. Not a place I often land, but what a relevant book for this time and this mood. The words of the Preacher, it begins, the reflections of a man known for wisdom. Chapter 8 ends with a discourse that sounds amazingly relevant: the consequences of a good life and an evil life do not stack up the way we expect in a just world, because the sentence against evil is not executed speedily. Expecting to equilibrate good with reward (or evil with punishment) is futile. This leads the Preacher to two conclusions. One, similarly to the book of Job, the work of God is mystery. Two, the best we can do then is to live our lives doing meaningful labor in which we find some satisfaction, and to enjoy the present food and company, marriage and meals.
That's pretty much it. On the one hand, relish lament and mystery: Sorrow is better than laughter, for by a sad countenance the heart is made better (7:3) . . . On the other hand, do and enjoy good: nothing is better for a human than to eat and drink and for one's soul to find good in one's labor, to look for the beauty God put in the world and embrace the longing for eternity God put in our hearts (2:24, 3:11-13)
Sounds pretty simple. Most of the time we can get it. Name the losses. Don't put God in a box. Create community, cook meals, find humour, celebrate the little glimpses of goodness. Accept our limits. Don't give up.
And as if Ecclesiastes wasn't quite enough, Bethany's book was excerpted in a magazine this week prompting me to re-read a chapter this morning I needed to remember. Then Lindsey on our team sent me this quote from a book I have yet to read, This Too Shall Last (Ramsey): "Walk into the barren, empty places of your pain, because this is where God will fill you with himself. This liminal space is where we hate to go but where God is always leading us. Don't run from what does not make sense or try to explain it away. Dissonance is the birthplace of all abiding Christian hope. Embrace mystery as the place God dwells. Embrace your suffering as the paradoxical place where you will be made whole." That's the surprise of the Gospel right there, the cross leads to resurrection, suffering is integral to the process of glory. Also any quote that combines liminal and paradoxical pretty much sums up all that is important about life.
So the day after Juneteenth marches, the day that coronavirus cases are again rising, the day that holds neighbours knocking on the door to explain their hunger, and most of our closest relationships stretched thin over miles and days. . . Let's stay in the dissonance a bit longer, looking for God.
PS. Not to be emotionally manipulative sharing a low point, here is some data on COVID-19 and Africa. The Lancet put out a paper this week with various mathematical models of what the impact on children under-age-5, and maternal (the two biggest sources of lives lost prematurely) mortality will be.
Olupah doing her usual
I not a big crier, doctors never cry here, staff are not emotional, which is 99% of the time good and necessary way to cope with this reality. But she whisked me into a side room and closed the door and gave me a huge hug before I could even object to COVID spacing. . . . and it was so genuine. We both talked about what was breaking down, where the issues were, and what needed to change, landing on the delays from lab (which is inundated with patients and not keeping up) and the tendency towards passivity when the in-charges are not present. Just a few minutes. Olupah is a shining star in a sea of sorrows, and I'm grateful for her. I composed myself and wiped off my face and went back out to battle.
And it was a battle, hours of it, with not a ton of victory.
Next patient after the above story, 2 yrs and 2 months old, 11 pounds and that includes edema, abandoned by his mom due to marriage conflicts and finally in the care of a paternal grandmother who noticed this was not OK.
Thankful for the clinical officer student who was running back and forth to lab for bags of blood.
Only patient I've had rocking a mask . . .
Meanwhile in theatre, a remarkably efficient C-section for cord prolapse that ended with a perfectly good baby.
Standing room only? not really even room to stand.
One of the tiny lives that breaks one's heart.
In my read-through-the Bible, yesterday and today covered the whole book of Ecclesiastes. Not a place I often land, but what a relevant book for this time and this mood. The words of the Preacher, it begins, the reflections of a man known for wisdom. Chapter 8 ends with a discourse that sounds amazingly relevant: the consequences of a good life and an evil life do not stack up the way we expect in a just world, because the sentence against evil is not executed speedily. Expecting to equilibrate good with reward (or evil with punishment) is futile. This leads the Preacher to two conclusions. One, similarly to the book of Job, the work of God is mystery. Two, the best we can do then is to live our lives doing meaningful labor in which we find some satisfaction, and to enjoy the present food and company, marriage and meals.
That's pretty much it. On the one hand, relish lament and mystery: Sorrow is better than laughter, for by a sad countenance the heart is made better (7:3) . . . On the other hand, do and enjoy good: nothing is better for a human than to eat and drink and for one's soul to find good in one's labor, to look for the beauty God put in the world and embrace the longing for eternity God put in our hearts (2:24, 3:11-13)
Sounds pretty simple. Most of the time we can get it. Name the losses. Don't put God in a box. Create community, cook meals, find humour, celebrate the little glimpses of goodness. Accept our limits. Don't give up.
This shirt epitomizes party in the miasma of malaria. Enjoy the food and the babies in spite of all the mess.
And as if Ecclesiastes wasn't quite enough, Bethany's book was excerpted in a magazine this week prompting me to re-read a chapter this morning I needed to remember. Then Lindsey on our team sent me this quote from a book I have yet to read, This Too Shall Last (Ramsey): "Walk into the barren, empty places of your pain, because this is where God will fill you with himself. This liminal space is where we hate to go but where God is always leading us. Don't run from what does not make sense or try to explain it away. Dissonance is the birthplace of all abiding Christian hope. Embrace mystery as the place God dwells. Embrace your suffering as the paradoxical place where you will be made whole." That's the surprise of the Gospel right there, the cross leads to resurrection, suffering is integral to the process of glory. Also any quote that combines liminal and paradoxical pretty much sums up all that is important about life.
So the day after Juneteenth marches, the day that coronavirus cases are again rising, the day that holds neighbours knocking on the door to explain their hunger, and most of our closest relationships stretched thin over miles and days. . . Let's stay in the dissonance a bit longer, looking for God.
PS. Not to be emotionally manipulative sharing a low point, here is some data on COVID-19 and Africa. The Lancet put out a paper this week with various mathematical models of what the impact on children under-age-5, and maternal (the two biggest sources of lives lost prematurely) mortality will be.
Baseline deaths are too many, but most scenarios show a significant increase. And interestingly the main solutions in the accompanying tables are readily purchasable items: food, antibiotics, oxytocin. Sometimes we feel a little guilty for propping up the failing system with a bag of medicine vials and IV tubing and a load of our BBB paste. Then we read the actual data and think, this is the labor under our sun, to which we are called. Peanut butter and artesunate and blood and a quick dose of a medicine that contracts the womb, that's about the difference between life and death. So if reading this kind of hard story leaves you restless yourself, by all means look around locally and get your hands into protests or poverty alleviation. But you are also welcome to join us in the BundiNutrition (food) or BundiMedical (medicine) funds.
No comments:
Post a Comment