the real question

Last week, the doctor who was on-call admitted a 5-month-old little girl.   The fever, the positive malaria test, and the seizures all pointed to what is, in Togo, a common diagnosis: cerebral malaria. The little girl seemed to have a bad case of it.  She seized all through the night, in spite of multiple doses of anti-seizure medication.

The doctor added antibiotics to cover her for bacterial meningitis, which is also (unfortunately) a common diagnosis.

The following morning, when my shift started, the doctor was telling me about the little girl when the nurses called us urgently to pediatrics. We ran over to find the little girl having such a violent seizure, her head arched all the way back, and the back of her head was touching her back in between her shoulder blades.

The girl's oxygen saturation dropped to a dangerously low point, so I started bagging her while the doctor ordered more anti-seizure medicine to be given in the girl's IV.

Another doctor joined us at the bedside.  "I don't think that's cerebral malaria," she said.

"What else could it be?" the other doctor asked.  "We've covered her for everything..."

The little girl stopped seizing for a minute, and then she seized again, her tiny body contorting violently.

"Oh my God...." one of the doctors said in a stunned, whispered prayer as the only other possible diagnosis dawned on her.  "She has tetanus."

As I bagged the girl, the doctors went to look up the treatment for tetanus.  They read that they needed to give the girl a tetanus shot, as well as inject tetanus serum into the girl's spinal fluid.  In between seizures, the doctor performed a lumbar puncture and injected the medicine.

They called the surgical team to take the girl to the O.R. to perform a tracheotomy.  The seizures made the girl's epiglottis shut so tightly, so she wasn't getting any oxygen.  So the plan was to create an artificial opening below the epiglottis and deliver oxygen that way until the tetanus infection started to resolve.

The baby's mother consented to the surgery.  The surgical techs came to wheel the girl to the O.R.  The baby's mother rested her hand on the baby's leg as a final good-bye....and that simple, gentle touch set off another round of seizures.

Her windpipe closed again. Her oxygen plummeted to 30%.  We bagged her, but the muscles in her throat were so tight, we couldn't get oxygen in.  We gave her round after round of anti-seizure medicine, but nothing worked.

Then the baby's heart stopped. We started chest compressions.  We gave her multiple doses of epinephrine. Nothing helped.

After 30 minutes of coding her, the doctor checked the girl's pupils, and they were blown.  She was braindead from the lack of oxygen.

With tears in her eyes, the doctor shook her head, and left to tell the baby's mother, who was sitting in a chair around the corner, weeping, surrounded by the moms of other pediatric patients.

From around the corner, we heard a heart-wrenching wail as the mother received the news that her baby was gone.

Slowly, the crowd of nurses and surgical techs left the bedside until it was just one nurse and I left standing there.  We removed the I.V. and the Foley catheter and peeled the EKG patches off the baby's chest.  I picked the baby up in my arms and held her while the nurse wrapped her with a panya of fabric the mother had brought in as a blanket for her baby.

My heart broke, but I was too angry to cry.

How can this be?  How can this happen? 

As I detached her from all the medical equipment, I looked over every inch of that girl's body to see how she'd contracted tetanus -- which usually enters the body through an open wound, like a cut or a burn.  The little girl had no signs of any open wounds, not even a scratch.  Except -- she had pierced ears.

That thought made me even angrier.  Angry at the universe.  Angry at Togo for being so poor and so slow to develop, it didn't offer routine vaccines for kids.  Angry at parents in the developing world who have the luxury of choosing not to vaccinate their kids, parents who will probably never have to watch their kids die a grotesque death from a preventable disease.  Angry at the way we spend money on stupid, unnecessary things while people who live on the same planet we do are dying because they lack very simple, inexpensive medical interventions.

I was also angry that the mom had to live with the knowledge that she had accidentally caused her baby's death.  By innocently, gently touching her daughter's leg to say good-bye, she had triggered the already-irritated muscles to contract again, which had closed off her baby's windpipe, which had killed the little girl.

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The following morning, during staff devotions, we talked about theodicy, the philosophy of God and suffering.  The doctors offered their erudite philosophies of how and why God allows pain in this world, and how, because he's God, he's justified in what he does, even though we don't understand it.

They went around the circle, contributing their thoughts to the conversation, and then it was my turn to speak.  I couldn't form sentences very well.  I wasn't very articulate.  I hadn't slept at all the night before, because every time I closed my eyes to sleep, I could still see that mother walking away from the hospital with her limp, dead baby tied to her back.

Here's the bottom line.  I don't know why God allows things like this to happen. All I know is that God is a loving father whose heart breaks even more than ours does at the suffering his children endure.

And I also know that it's easy to blame God for allowing suffering to happen, when it's really US who are allowing atrocities to happen to other human beings.  WE are the ones who find it so easy to use the resources, opportunities and wealth God's given us to make ourselves insulated, ignorant, numb, amused, obese, isolated and distracted.

In church on Sunday morning, we pray, "on earth as it is in heaven."

Do we really mean that?

And if we do, what does it mean to dream together about how God can use us, and everything he's given us, to bring heaven down to earth?

What would happen if we stopped asking the question, "Why does God allow suffering to continue here on earth?"

And started asking the real question instead: "Why do we?"



If you're interested in providing tangible help to people here in Togo, you can give to the Hospital of Hope's patient care fund, which covers the hospital bills of patients who can’t afford to pay for care.  Click here to donate.