Tears

Wednesday, September 4

Today is hard to write about. The tears already sting my eyes as I reflect.  But I want to capture the moments, be present in the feelings, let my heart be soft, be vulnerable in my frustrations, and let this experience grow me. I want to share it with you, too.  Despite the millions of miles, ocean, countries and cultures that separate us. Tears are universal.

I did not sleep well.  Tuesday night is when I take my methotrexate shot and I quite frankly just don’t feel great.  Additionally, I stayed worried for one of the patients on the ward. I tried to recite all the scripture I have memorized about anxiety and fear until I fell asleep.  I need to add some to me repertoire. At 5:45, I called it a night and got up.

We started the day with chapel and it was lovely.  The singing, as always, was enjoyed and I also like that I know more and more of the Malawians and so the morning greetings are more genuine.  We sang It is Well this morning and the last verse is a little different and I really like it.  Wayne knows it to be one of my picked funeral songs and I think I prefer the Malawian end.

I went quickly to the pediatric wards to check on a few patients before the Pediatric outpatient clinic started.  My sweet friend with diabetes was doing well and excited because his 20 year old brother was coming to learn how to give the insulin and check his blood sugars.  He will be the one in charge of his care at home. Deborah the tiny one from the children’s home was much better and hungrily eating. The babysitter begging me to leave.  The one which kept me up is not great but is better, so I am relieved.  

I headed to Pedi clinic with Catherine.  I have really enjoyed my time with her so I was l excited. There was already a sweet line of little faces waiting.  The way we are working it now is that we have a nurse that sits between Catherine and I. While one of us weighs our patient, the other is using the nurse to get the history from her patient. Then while that one does the exam, the other collects the history, and then the nurse gives instructions to the first, while the exam is done on the second.  Needless to say, Eunice was amazing and probably very tired tonight.

Catherine and I stopped by the NICU to see one concerning baby and then chatted a little about career and stress on the way to the office.  We went our own way for lunch.

I went back to the guesthouse and made a crazy dry sandwich.  I haven’t been to the grocery in a while and it is getting a little slim.  I had a few bites and then got a voice message from Catherine requesting I join her in the ER.  I headed that way and about half way there got another message requesting supplies. I ran around collecting pedi blood pressure cuffs. Then I headed to the ER.

A 10 year old lay on the stretcher, fighting to breathe, with a low heart rate and tons of secretitions.  She had eaten corn with a pesticide on it (organophosphate). Here there is only one harvest season.  The maize is harvested and every 90 days they take a capsule of pesticide and sprinkle it over the corn and mark the date.  This keeps weevils from eating it but the chemical makes it unsafe to eat for 90 days. For the last batch of corn eaten this is done 3 times and then eaten 9 months after harvest.  This sweet girl roasted and ate corn that had been recently treated and now had the classic signs of chemical poisoning.  

The mother sat at the bedside.  This is a well known deadly problem here.  She understood the prognosis. Catherine had already started the IV fluids and medication to combat the symptoms.  The heart rate was slowing and the blood pressure dangerously low. We attempted to contact KCH (the major hospital) to see if they had an open pediatric ventilator.  There are 4 to serve a population of over a million. Then the loud and wet breaths stopped. We pulled the bed from the wall. I ran around and started to give bag-valve-mask ventilation.  No heart rate. Chest compressions started. Meds were given. I handed over the bag and went to rotate Catherine out of chest compressions. I started compressions, having to stand on my tip toes to reach the tall bed.  Counting our 15:2 counts for compressions and breaths. After a few minutes, some breaths, some movement. We listened and spontaneous breathing and heart rate had returned. We wiped our brows and put the oxygen cannula back.  We talked through further medication and treatment options and made adjustments.  

Then the dreaded cessation of breaths.  Again, no heart rate. I started chest compressions again with pauses for breaths.  Medication continued. It was good CPR as even our sad monitor registered the compressions as a heart rate, but each time we paused to check nothing.  An oral airway was placed. Then the secretions worsened and stomach contents were coming up. Suctioning and suctioning. One nurse rotated in when I needed a pause to catch my breath, then I would return.  For so many minutes we worked, and prayed, and sweat. To no avail. We agreed as a group it was time to stop.

We cleaned up the precious girl.  We removed canulas, IVs, and mask to prepare her for her mother.  I cleaned her face and wiped the vomit from the bed while my head throbbed and my eyes burned.  Trying to keep down the emotions. The world in which roasting the wrong corn can steal away a beloved child in a matter or hours terrifies me and makes me feel so helpless.

Then the aunt came in and received the news.  Here, culturally, the doctor does not talk to the guardians, it is the nurses. We stand back and wait in case of questions.  It feels almost like shirking responsibility with what I am use to but here the presence of a doctor is intimidating and scary.  You could see the news sink in. She turned to go.  

I swallowed the lump in my throat.  Then the wail, mom hearing the news outside the open window.  It made me want to just fall to my knees into the fetal position.  Catherine had red eyes, too. Instead, I focused energy on cleaning up the instruments, collecting the references we were using.  Again, there are just no words.

I did go back to my room just for a minute.  I needed to cry, blow my nose, drink some water, and get hugs from Melissa and Amelia.  I am so thankful for them.

Then I headed to the pediatric ward.  I ensured everyone had a note and orders for the day.  The lunch blood sugar was good and the brother was feeling confident about home care. The patient, who does a fist bump/jazz hands shake with me, was saying something that made the nurses laugh.  They finally said that he was saying he would like me to get him a ball. I think some people here believe the white people have all sorts of fun surprises in their bags. Lucky for him, he is right. I told him I would give him one when he went home.  He at least had me smiling. I told him it had to stay a secret or Nurse Anna would be angry with me. He thought that was funny.

I admitted a new patient and then the babysitter of Deborah gave me a hard time about wanting to go home.  She is sweet and loving and holds my hand. She gives me her best English. When I told her no but I was sorry “pepani”, she just giggles and squeezes my arm.

Then in walks the mother of the child who died and a little toddler.  The 1 ½ year old sister may have been eating the corn, too. Ohhhhh! We admitted the toddler to observe overnight.  Logic would say that the younger child would have displayed symptoms first if she had eaten the corn, but no one knows for sure and someone saw them together with it.  So we will watch and pray. The nurse explained. The mother now having to chose to go back with the body of her dead child to the village and leave this one or to stay in an open ward with her grief.  The tears made slick trails down her dusty cheeks and splashed onto the floor.

I wrapped up and headed back to the guesthouse knowing I was running on emotional fumes.  I joined the moms cooking dinner to get out of my own head. However, they shared a day of frustrations for them as well.  The housing in the area is full and there is no clarity on their timeline. Still no response from the embassy. Also, harsh and unkind words from the director of the guesthouse, have left them broken.  Again, hot tears spilled from all of our eyes. So much hurt, brokenness, heartache.

But Lord, ‘tis for Thee, for Thy coming, we wait;

Thy sky, not the grave, is our goal;

O trump of the angel! O voice of the Lord!

Blessed hope, blessed rest for my soul!