Holding back Tears

Tuesday, September 10

Tonight, I admit that I am beyond exhausted.  I don’t feel well and the day was very trying.I held back tears that burned in my eyes, my throat, and my heart for almost 12 hours.  Now after a hot shower mixed with hot tears. I am done.

I thought of not writing. I know I will seem whiny.  I know it will cause some of you to worry. But alone and without power, this is my avenue to process the day and my thoughts.

The kids left for school happy and excited and I did remember to take a few pictures.  Patricia later acted out a fairly realistic display of her behavior yesterday on arrival at school with yelling and arms swinging, but she swears she did not cry today.

I headed to the wards at a little before 7 and found a large group surrounding one bed with a clinical officer who had been on call.  We had a one year old in a comatose state with gasping respirations. Marleen, a tropical medicine resident was there. There was a transfusion going and we immediately started working on the patient.  The child was completely unresponsive. Oxygen, fluids, OG tube were initiated. Attempts were made for a second IV line but no success. Anesthesia was called by the OR was in full swing-no other help was available.  Respirations became shallow and I started bag valve mask ventilation. We put the child on a CPAP machine. Then the child became apneic and again I started bagging. The heart rate stopped and we started chest compression.  Medicines were given but no improvement. The child died. I don’t even know his name.

Understand the scene, this is an open ward with about 3 feet between beds.  This is all done in front of an audience of mothers and small children. As we give compressions, we jostle beds with kids with malaria and TB.  The grieving of the mother is done in this situation as well. I removed the tubes and canulas as the mother was told the news. Again, the gut wrenching, heart stomping, suffocating wail of a momma looking at her lifeless child.  Then repeat with the father and other family.

I completed the cold clerical work of documentation.  We had done everything we could and the team worked well together with senior nurses doing a good job.  All of that rings so empty. And now ward rounds must go on for there is much to do. I blew my nose and pushed it all down.

Rounds continued with the family still openly grieving.  We moved from bed to bed with student nurses distracted and unhelpful.  We made plans for the day for the care of the patients and filled out slips for labs and tests.  A few were able to go home. After about an hour, the deceased child was rolled out on a gourney with mourners loudly following behind.  The weight of my heart makes it hard to breathe.

Everyone, meaning staff and students, seems to be sick as well.  Most of the students stayed home today. Marleen and I both are not feeling great and as we get to the end of rounds she felt that she needed to go home.  

The clinical officer, Susan, discharged one patient that was scheduled for a hernia repair today but because of a cough was rescheduled for next Tuesday.  They called from the pharmacy that the child was screaming in pain. They brought him to the ward and his hernia was large, hard, and tender. An incarcerated hernia.  We sent him straight to the operating theatre.

I had to stay during the lunch break because I was the only one on the ward.  The CO covering was gone from 11:30-2:20 which was quite frustrating. The new group of nursing students is also not very attentive or helpful.  At one point today , I asked 5 different students for help with translating before one agreed. It was bizarre.

At around 2 o’clock, Lisa and Rinske did come by to check on me as they had not seen me around and then went and got Taco Tuesday tacos and a soda for me and took it to the guesthouse.  I headed there with the idea that Susan would cover the last hour and a half. However, one of the babies from the children’s home was being admitted so I went back to the NICU to see him.  He looked sick and dehydrated so we started fluids, feeds, and antibiotics. Then I consulted on another who has been almost continuously seizing since delivery.

Back at Hope’s Inn, Hanna came to say her final goodbyes.  I have so enjoyed her and she has made my transition here much easier.  I will miss her greatly. Melissa and the girls also arrived. Enilise, Amelia’s adopted daughter, had a birthday today so they all went into town to eat and celebrate.

This evening Melissa was making plans to start the process of answering the concerns raised by USCIS in hopes of reversing the denial.  They may end up having to completely refile for adoption. It is crazy. We drank a lot of hot tea for comfort and sore throats.

And now, it is dark, we are without power again.  They are rotating power in different areas of Malawi and now is not our turn.  I am thankful for the hot shower I had a little while ago that calmed my nerves and drowned out the noise of my crying.  I feel better now, just raw and fatigued.

I know God is good.  I know He loves me. I know He is sovereign.  I know situations and feelings change but He is never changing.  I know when I despair He is with me. I do not understand days like today but I know that He does.  And I know that I am His and I will trust and rest in that alone.

So, dear friends, so that you will not worry or be sad.  Let me remind you there is also cuteness in this broken world. This is the face of a Malawian seeing a white girl for the first time!