Tuesday, November 1, 2016

Silent Hearts

You liberate me from my own noise and my own chaos

“Dr. Mark – the patient is going into arrest”

Nearly every day I hear these words from one of our nurses. When I do, I generally drop what I am doing and accompany the nurse back to the hospital ward, harboring all kinds of doubts about what will come next.

Usually, a patient lies on their bed, with nursing students around them trying to give them artificial breaths and chest compressions while family members look on in fear. As I arrive, a small opening appears and I go to the bedside. Sometimes I tell the nurses to give medications, sometimes I take a turn giving compressions, sometimes I put in a breathing tube.

Then during a pause in our efforts, I kneel at the bedside and place a stethoscope – that quasi-mystical symbol of the medical profession – on that patient's chest. In this moment the nursing students are quiet, the staff stop speaking and the family members hold their breath with their eyes all fixed on me.

And I hear nothing. No heartbeat. No familiar sounds of life.

I look at the patient's mother, father, son or whoever is standing watch over them and I say, “Em i dai pinis” - “They are dead.”

And the wails of the family erupt. Sometimes they throw themselves onto their deceased loved one or onto the ground, howling for them to return. I lower my head, say thank you to the staff and attend to my other patients while the students return our resuscitation equipment to its place and the family grieves.

Lately I have struggled with the number of patients who die here. Every day I left the ward thinking, “What can I really do, in the end?” Medically, I had nothing else to give and each day people kept losing their fights and dying. I grew tired of putting my stethoscope on silent hearts.

But one morning, as I sat looking over my garden and the mountains of PNG in the distance, I realized something.

Every moment that went quiet, while I listened for signs of life in a dying patient, meant an opportunity to listen for something more. Those moments take on an intimate sacredness. I can use those times to close my eyes and let Christ fill up the silence.

It is there that I will know you and you will know me

One afternoon, our midwife Sylvia came to let me know about a patient who recently arrived from a rural health center named Stella. Stella was expecting her first baby in a couple weeks. She couldn't have been more than eighteen. She felt contractions for a couple days and went to her nearest facility, but despite hours of pushing couldn't deliver her baby. They sent her to Kudjip.

The nurses evaluated Stella and came to get me. “Doc, I can't find a fetal heart tone”

As I wheeled the ultrasound machine next to Stella, she gave me a soft smile, despite her pain. With her contractions a baby's scalp was visible, but had an unnatural color. I placed the ultrasound probe on her abdomen, looked for a minute and then told Stella the news – her baby had died.

Her cries filled the room - the entire ward. And I wanted to run away.

But I stayed with Stella, her mother and our nurse Theresia. Stella pushed. I pulled with a vacuum. Theresia coached and supported her. We delivered Stella's deceased child after a very difficult process requiring some extensive suturing. I dripped with sweat and removed my surgical head-light to complete some paperwork.

The baby lay silent next to the bed and Stella slept under some anesthetic.

And I paused. The nurses had left. Stella was quiet. Her mother had gone out. There were no cries. I stood by her bedside listening. And I felt like I knew God's heart – as He felt the loss and grief that filled that room. Yet with a mingled affection for Stella who had survived this ordeal, would wake up and recover, and who could one day find restoration and hope again.

A few days later I sat on Stella's bed with her and her mother. I explained to her that I felt she would have children again, that they would likely be healthy, that she hadn't done anything wrong to make this baby die and that I wanted her to come straight to the hospital the next time she was in labor. These bereaved ladies smiled while holding my hands in theirs. And in a quiet moment I could only think, “sorry” and went on to my next patient.

Someone needs to be able to think medically when the noise and chaos drowns out everything else. Someone needs to direct the nurses in what medications to give. Someone needs to determine if we continue our efforts. And finally, someone needs to pronounce that patient – dead or alive. I have to be in that moment.

But Christ chooses to be there.

He chose it two thousand years ago, and keeps choosing it today. In the places of the world where babies die before they see a sunrise, where families are divided by conflict, and where children watch their mothers succumb to AIDS.

He enters to speak in that moment when someone's heart goes silent.

1 comment:

  1. Heartbreaking...
    I only got a taste of this (that vague heart sinking feeling) in my short time over there. People keep asking me to tell stories and I find I have few happy ones, but, it wasn't a sad time while I was there. It was just life. And death. Joy. Suffering. Hope. Despair. That jolting rhythm of up-and-down life that we sometimes try to avoid in favor of the "ups." And why wouldn't we? It feels good to be happy. I learned, it sometimes feels good to be sad, to feel the hardship and injustice of broken humanity--to share God's heart. I love that Christ CHOOSES to be there while we HAVE to be there. That's beautiful. Thanks for sharing your thoughts and experiences.