one day (part III)
I’ve lost count of how many times the little girl with DIC and cerebral malaria has seized, and how many doses of anti-seizure medicines we’ve pushed into her I.V.
She’s getting worse.
Her pupils are not shrinking when we shine a flashlight into her eyes.
Early in the night, when I first started having to bag her, her oxygen saturation would go up to 100%. Now, no matter what I do, her O2 sat stays around 80%. Between the bleeding and the lack of oxygen, her brain is dying. And again, there’s nothing more I can do.
Her father is still standing behind my left shoulder, watching us try to resuscitate his little girl. In the U.S., we’d have intubated her and put her on a ventilator a long time ago, but we don’t have that equipment here. We have to breathe for her by hand, squeezing the Ambu bag 20 times a minute to push oxygen into her lungs.
In between seizures, I put my hand on her forehead and silently pray for her.
I want to yell, “Tabitha, arise!” like the Bible story.
Or, “Lazarus, come forth!” like Jesus said when he raised Lazarus from the dead.
“Little girl, WAKE UP!” I command her in my head. “In the name of Jesus, WAKE UP!”
But instead, she keeps seizing.
In my head, I know this girl is dying and will continue to get worse until her breathing stops. Then her heart will stop. We can start chest compressions, but there’s no hope of bringing her back.
My heart sinks with the weight of this knowledge.
After spending most of the night trying to breathe for her, trying to keep this little girl from dying, I finally accept the fact that the miracle isn’t coming. We’re going to lose her.
I explain to the father that we can teach him how to bag her — which is what happens here when a patient can’t breathe on their own. We teach the family how to use the Ambu bag, and the family spends hours breathing for their loved ones.
Or, I explain, if the family doesn’t want to bag her, they can take her home to die. Which is an ever-so-small comfort for this family, but a comfort none the less. For the Togolese, if they have to die, they prefer to die at home.
The father explains the two options to his wife in a local dialect she understands. Then the father suddenly walks quickly out of the pediatrics ward and disappears without a word.
I ask the nurse if she can bag the little girl, and I try to find the father. I walk around the hospital, and then I go outside to find that the sun is just beginning to appear on the horizon and the father, who is Muslim, is kneeling down on a patch of dirt, bowing towards the sunrise — bowing towards Mecca.
When his upper body rises from the ground, I see him still kneeling in the dirt, his eyes closed, the sun glistening off his tear-stained face.
I turn around and leave this man to his grief. And to his God.
When he comes back inside, he takes a long piece of fabric from his wife’s bag.
It’s called a panya.
In Togo, fabric is ubiquitous because women buy fabric to make a sling to carry babies on their back. And there’s no pre-made clothing, so families buy fabric and either make clothing themselves, or they take it to a seamstress or a tailor to have dresses and skirts and shirts and pants made. Fabric isn’t sold by the foot or by the yard; it’s sold by the panya, which is the length of fabric it takes to strap a baby to your back.
The father has taken the panya, the fabric they used to carry this little girl on her mom’s back, and is prepared to use it as a shroud for his little girl.
The nurse and I remove the sticky EKG leads from the little girl’s chest. We suction the blood from her mouth for the last time, and wipe the dried blood off her nose. We take out her I.V. and cover the hole with a piece of cotton and some tape. We remove the O2 sat device from her big toe.
When she’s completely free from all the wires and attachments, I help the father wrap his daughter in the fabric and carry her limp frame in his arms.
Her breathing is erratic, and I know she’ll be lucky to survive the walk home.
I put my hand on her forehead for the last time and pray a simple prayer similar to the one I prayed for the woman who died of TB.
I look into the father’s eyes, and tell him I will be praying for their family.
“Thank you,” he said, as he tucked the fabric under his daughter’s chin. “Thank you," he said again, bowing his head toward me. "Thank you. Your eyes are love.”
Those were the last words he spoke, as he and his wife turned and walked slowly towards the hospital door, knowing that in less than an hour, they would probably be digging a hole in their back yard where they would bury their dead daughter.
There’s a Robert Burns poem called, "Comin' Thro' the Rye."
It’s the poem from which the novel Catcher in the Rye gets its name.
In the book, Holden Caufield, a free-thinking kid who ran away from boarding school, sneaks into his sister’s room one night to tell her he’s alive and okay. As they talk in the darkness, he whispers that he thinks Burns’ poem is the key to his life's calling.
The poem actually says, "Gin a body meet a body comin' thro' the rye," but Holden translates the poem, "If a body catch a body comin' thro' the rye."
In his mind, there are lots of kids playing in a rye field beside a cliff. And he’s standing on the edge — if the kids get too close to the edge, he catches them before they can fall off the cliff.
I often think of medicine like that. I think of myself as a catcher in the rye, catching sick patients before they topple off the edge and die.
In the U.S., I lost very few patients.
But here in Africa, lots and lots of patients die (if you've read the One Day blog series, you know that I lost two patients in one 28 hour shift.)
And, after I’ve exhausted every medication and procedure and piece of equipment we have, I have to stand there helplessly and watch them pass away.
If a body catch a body comin’ thro' the rye….
For a brief second, I hold onto these patients, but a force beyond my control pulls them from my grip, and they fall over the cliff to their deaths.
If a body catch a body comin’ thro' the rye...
Sometimes it feels like I'm failing when I lose patients here. But maybe my main purpose here isn't just to prevent people from falling over death's cliff. After I've done everything I can, maybe the reason I'm here is just to touch them, just to hold them for a minute, just to look on them with eyes of love.
Just to help them gently over the cliff into the Arms of Love that have been waiting to catch them since the day they were born.
This is the third in a 3-part blog series about one 28 hour on-call shift at the Hospital of Hope. To read more, click here.