Mother’s Day

Tuesday, October 15

Today was Mother’s Day in Malawi.  Like everything else, the clarity of what exactly that means is non-existent.  It was a “holiday” at the hospital. That seems to mean, every department work it out for themselves.  Sam had decided he would round and then hit me with the “then I will take off the next day” plan.  It seems like a plan to round quickly and then be done and then still have credit for another day. That is fine.  Dr. Catherine had also said she would be around. Since the Malawian holidays don’t really have significance to her, she tends to work them and then take off on American holidays they don’t celebrate here.  Bottom line, I was not expected to work.

So, I had hoped to sleep in but the schedule, sun, and noise had me up by around 5 am.  I piddled in my room for a long time. I sent off receipts to Samaritan’s purse, organized my dwindling supplies, and counted my remaining kwacha to budget.  Then I made a cup of coffee. The Dutch medical students were up and ready to go work, which I was impressed with because no one would have raised a concern if they did not.  By this point, I was almost itching to check on Wisdom and a few other patients. The students said they would send a report. I settled in to have a long quiet time and it was great.  It offered profound reminders of who I am in Christ.

I didn’t hear from the students and could not stand it any longer.  I convinced myself that if I didn’t dawn my white coat, I would just be visiting and not working.  I walked into the ward to find Wisdom crying and breastfeeding. Dr. Catherine had come into the ward to check on the same patients and we rejoiced together over Wisdom’s miraculous progress.  Then we talked through Immanuel’s continuing fever. She agreed with the plan I had made yesterday and promised she was heading to her office and I promised I was leaving.  

I went back to the Inn on cloud 9.  Melissa and the girls were up and we had some breakfast and made plans for the day.  We had rented a car and it was brought at 9:30. We sat and talked to another ex-pat named Stanley and then loaded up to head into town.  I really enjoyed today taking pictures of people on the side of the road. When we travel with Malawians or a driver, I am hesitant to take pictures as i don’t want to appear rude or gawking, but I also want to have reminders of this view.  The amount of things carried on heads or on bikes is amazing. Goats and pigs strapped onto bikes are my favorite but hard to capture in a picture as you whiz by.  

We drove and got some money at the ATM first and then headed to the Wood Market.  These are basically just stalls in the capital where craftsmen sell their goods. It is a bartering kind of environment with lots of talking and pleading.  Melissa is good at it where I just cave. She took the lead and handled negotiations. We played a little bad cop, good cop with me agreeing to a slightly higher price than her last offer and that worked well.  I did buy some small figures alone at one point and then she negotiated a beautiful nativity for the same price. She remarked that she couldn’t leave me alone for a second, I reassured her the family of the carver I paid was very blessed.  It was all fun to see and experience.

We then went and had a lunch at a cafe.  They actually had a Mother’s day brunch going and many women were being treated and were dressed in their finest. We visited a few stores and then went grocery shopping.  My last visit to Shoprite. The best part is that today they had up Christmas decorations. Really?!?

We finished our shopping and headed to the car.  We were surprised by a rainstorm that lasted only a few minutes but was a delightful treat.  The trip home was uneventful, but with my perspective change of knowing this may be one of my last drives here I really tried to just take in the scenery.

Back at the inn, I checked in with the students and learned that the day had been difficult on pediatrics.  A child took a fall from a fence and had a head injury that was taken to the central hospital. One of the kids admitted with malnutrition also passed away today.  He had significant cerebral palsy and was very limited in any movement and was non-verbal. His malnutrition was really secondary to his neurological impairments but evidently he became very ill in the night and was very dehydrated this morning.  They started IVF on rounds but around lunch he died. So sad and it will mar the holiday forever for that family. Wisdom also had another seizure around lunch and had worsened from a respiratory standpoint.  

I felt so badly that Dr. Catherine had to deal with these patients today.  I have wanted to be her helpmate and feel like I let her down today. I know it couldn’t be anticipated and that Sam was actually the one to cover, but I still don’t like it.  She texted me as I heard the report that she was off taking family pictures and had heard Wisdom was not doing well.  

I slid into the white coat and headed over.  Wisdom lay in his bed in obvious respiratory distress.  His respiratory rate was very high and he had severe retractions showing his difficulty breathing.  His oxygen levels were low despite the highest level of oxygen per the nasal canula. I went to the NICU to have them set up the CPAP, they began assembling it.  I went to the operating theater to get the portable oxygen compressor assuming we would need to move him to the isolation room of the NICU.

 When I returned they had moved the CPAP to the Pediatric ward.  I made sure that Towera, the night nurse felt comfortable with the CPAP and how it works.  We placed Wisdom on the CPAP (this machine provides continuous pressure through a nasal cannula to help keep the lungs inflated).  He was immediately more comfortable with less retractions and a decreased respiratory rate. I went to check his oxygen level. The pulse ox would not come on.  The batteries were dead and the storage was locked until the morning. When you hear resource limited hospital, usually you don’t think batteries, but that was our issues.  I ran back to the inn and basically hollared for everybody to dig up some AA batteries and they quickly were produced. I ran back to the ward and put new batteries into the pulse ox.  It started with low readings and I adjusted the oxygen and then we got to 100%. Wisdom looked comfortable.

I documented our activities in the chart, checked his vitals, reviewed the medications, and offered smiles to his mom.  I reviewed his story and plan with the nurse. I headed back feeling more comfortable but hating that we now have Wisdom on our maximum support.  There is literally nothing more we can do but pray and wait.