"Lead kindly light, amidst the grey and gloom
The night is long and I'm far from home
Here in the dark I do not ask to see
the path ahead, one step enough for me"
A couple weeks ago I walked into our pediatrics ward to begin my morning rounds. A new patient and her parents awaited me on bed 10. Maria had recently been taken for surgery for a possible abscess in the back of her throat. Her surgery revealed very little, if any, infection there - but her neck still tightened and she complained of difficulty swallowing. After examining her, I adjusted her antibiotic coverage and IV fluids, moving quickly on to dozens of other patients that needed my help that day.
The next day I saw a note from the on-call doctor who had been called to see Maria because of a "fit" - which turned out to be a muscle spasm, commonly encountered in one of the diseases I've seen working here in Papua New Guinea and have grown to abhor - tetanus.
Over the next few days, Maria's body contorted itself in frequent, uncontrolled spasms - through which she remained conscious and alert but paralyzed. She could not eat or drink and pain etched itself more deeply in her young face. I remembered Lesley whose drawn out battle with tetanus ended when the spasms and subsequent paralysis overwhelmed his breathing and he died.
In a hospital with ventilators, the treatment of tetanus is difficult but largely successful. The patient is put on a respirator and strong medications given to halt the spasms while antibodies are given to help clear out the infection. Here, we haven't been able to get the antibody treatment supplied for a while and we have no ventilators. So we focus on "supportive" care - an IV antibiotic against the Clostridium organism, IV fluids for hydration, medicines to decrease the spasms - balanced against the need to not completely tranquilize the patient and halt their breathing. We also place the patient in the darkest room we can contrive, blacking out windows and minimizing stimuli which are known to trigger spasms.
Several days into this treatment, I entered Maria's room where her mother typically slept on the floor next to her bed, to avoid touching her and triggering the illness. As my eyes adjusted to the tiny ribbon of light allowed through the side of her window I noticed that Maria, who had each day been lying on the bed, was now sitting up slightly in her mother's arms. She forced a weak smile on her face and after I reviewed her IV drip and medicines, glanced at her mother who asked me a question that inspired this post:
"Em i askim inap i go autsait na lukim san"
"Can she can go outside today for a few minutes to see the sun"
In the darkness of that room, the tears that instantly rimmed my eyes were hidden, but my breaking voice choked out, "yes."
Often my patients are looking for a glimmer of hope in their struggles. A kindly light to lead them out of utter darkness. Sometimes that little hope goes against all medical reasoning, but I believe it is no less crucial. Maria's question taught me this in an instant.
"Each stumbling step where other men have trod
Shortens the road leading home to my God."
The next day, Maria's mother told me she was so happy to be outside that, despite having another fit in her room, she relaxed enough to eat a small amount. Over the next two weeks Maria waged war with tetanus - occasionally being thrown into muscle spasms, occasionally glancing at the ribbon of sunshine in her room, kindling hope and gaining strength.
After a month in the hospital, I finally put my pen to Maria's chart for the last time - not to sign her death certificate as I so often do, but to write her discharge order to go home.
Through a rough and stumbling road in that darkened cave, the Light had brought her home at last.