Monday, January 19, 2015

Kinder tomorrows

"Black clouds are behind me,
I now can see ahead.
Often I wonder why I try - 
hoping for an end.
Sorrow weighs my shoulders down
and trouble haunts my mind.
But I know the present will not last,
and tomorrow will be kinder."

At eight in the morning on Saturday, I began rounds on our postpartum ward.  I prepared for a hard day of call, anticipating a lot of work after a very busy week following the holidays.  I wasn't disappointed in that aspect.

After seeing a few patients a nurse summoned me to our pediatric ward to evaluate a patient "going off" - a phrase the nurses use here when it seems that a patient is close to dying.

Waity came to Kudjip with mouth sores creating pain with eating.  Unfortunately, Waity was adopted a few months ago and didn't breast-feed, leading to a vicious cycle of infections and diarrhea causing malnutrition.  Two days prior, I thought Waity would die in the emergency room - the nurses couldn't get any intravenous fluids to him and he wasn't conscious.  After placing a metal catheter into a bone of his leg, I was able to give him antibiotics and fluids.  The next day Waity looked miraculously better.

But it wouldn't last.

Waity's frail body couldn't tolerate the infection, despite our best efforts to fight it off.  Now, as I looked at his family gently patting his hand I knew the worst was coming.  The nurses resuscitated Waity but without success - he passed away and the all-too-familiar sounds of howling grief filled the ward.

A little boy further down the ward from Waity named Franky also struggled through the day.  He had Down's syndrome, as well as a congenital heart defect causing his breathing to be labored.  His six-month old lungs and heart worked hard to get him enough air, even while receiving medicines and supplement oxygen in the hospital.

I explained to his family that his condition was incurable.  He might improve a little by getting medications and oxygen for a while in the hospital, but eventually he would die from his heart condition.  I prayed with his mother almost every day.

Every tomorrow I hoped would be kinder for Franky - but every day he struggled to breathe unless connected to his oxygen.

After rounds a couple days ago, as I packed up my stethoscope preparing to go to our outpatient department, I took a last glance down the ward.  Several families whose children were sick came from a long distance away and didn't have friends or relatives to get them food during their stay.  I saw Franky's mother gather additional food from her bag in the corner and walk up and down the ward, handing it out to parents who, like her, hoped that their children would improve.

Some hours after Waity passed away, Franky took a turn for the worse as well.  I had nothing else to offer him.  I couldn't bear to stay in the ward listening to another mother let loose her grief.

Now Franky is in an eternal peace, breathing easily without any pain, but his mother feels his loss as she makes the journey back home without him.

Yesterday I went on to lose two more patients: Ruth - whose leukemia got the best of her, and Elizabeth - who suffered a tragic death after developing Guillan-Barre syndrome, a condition normally survivable with the use of ventilators.

My first few months at Kudjip, I looked at my call days as learning experiences.  So many of the diseases were new.  I performed multiple procedures and even some surgeries.  Calls concluded and I felt I learned a good deal.  But then the adrenaline rush of practicing in a mission hospital wore off.  And I got to the end of my calls remembering the faces of the patients whose last moments I could only watch and pray through.

And I just hope for the next day to come - so I can recover from the realities of the hurting people here in Papua New Guinea.  And one of my colleagues arrives to face whatever the hospital has for them.

"For we will surely die and become like water spilled on the ground, which cannot be gathered up again.  Yet God does not take away a life; but He devises means so that His banished ones are not expelled from Him."
-2 Samuel 14:14

Yesterday, Rachel struggled through the labor of her first child.  Her body's contractions weren't effective and after a few hours without progressing, I gave her oxytocin, a drug to help strengthen them.  After some time on this, it seemed there was no way for her to deliver her baby.  I went to talk to her about performing a non-emergent C-section because of her failure to progress.

But her baby wasn't happy with the labor.  Heart tones that sounded out at 140 a few moments ago suddenly dropped to 60, and stayed there - a bad sign.  I turned off her oxytocin, gave her fluids and oxygen and checked her cervix, praying that she was ready to deliver quickly.  Seven centimeters - not enough to help her with a vacuum.  We mobilized our OR team but I knew it would be at least fifteen or twenty minutes before we could operate - and Rachel's baby may not have that long.

 Sister Vero got the OR ready while brother David raced in to provide anesthesia, I placed a catheter to drain Rachel's bladder.  The movement helped the baby come down and she could nearly deliver.  I pushed the remaining cervix around the head of the baby and told her to push.  The baby was coming down but its heart rate was still just 60, far too low.  I took a risk and applied a vacuum extractor to the baby's head, pulling skyward while Rachel pushed.  In a minute, the baby was out on the bed, screaming and crying - beautiful sounds on the obstetrics ward.
"Mother, listen to my heart,
Just as one beat ends, another starts.
You can hear no matter where you are"
-Punch Brothers 

Three other babies delivered safely at Kudjip yesterday, and I couldn't help but consider that though we lost four lives there are four new healthy babies in our postpartum ward.

They won't be a comfort to the families who have lost loved ones.  But for this missionary doctor - I think of those four babies, I look at today's beautiful sunshine, I enjoy the presence of my wife and children.  And even though I won't forget the faces of those lives I couldn't save yesterday,  I continue to hope for kinder tomorrows.

No comments:

Post a Comment