Wednesday, April 30, 2014

Now in the arms of Jesus

I knew he was pretty sick because he was sitting on the chair in front of the outpt line for patients who are too sick to wait in the line.  He was carried in by a women, I assumed was his mother, and they sat on the bench in my room.  As they approached my room, my mind was already working trying to figure out what was going on with him.  As I looked at him, I could see fear in his eyes, some pain as he struggled not to move, but also eyes of an adorable 3 yo boy.  His caretaker, told me that he was fine until 2 days prior when he started having some neck pain and was having difficulty opening his mouth.
Most kids are scared of doctors, especially "the white doctor who will give you a shot."  So crying, screaming, and flailing of their arms and legs are part of a normal exam of a child.  Thankfully, that wasn't the case with Lesley.  He was sick and he knew it, but he also seemed to know that I was there to help him, and he wasn't afraid.  So as I went to examine him, he didn't scream or cry, or panic, instead he sat as still as he could and let me examine him.  When I asked him to open his mouth, he did his best, I was concerned when he could only open it about 1/4 of an inch. 

As I started to work through in my mind, the diseases that prevent one from opening their mouth, my heart grew heavy.  From his exam, I was concerned that he had early tetanus, but I had only seen 2 other cases of tetanus, both of which came in late and had a clear history of a wound, so the diagnosis wasn't in question, but for Lesley I wasn't sure.  I asked more questions about rusty nails and fences, I examined his feet for signs of a puncture wound, but I couldn't find any.

I admitted him, treating him for tetanus but hoping he had something else.  I checked on him frequently to see if anything changed, and as the afternoon progressed, he started to have more spasms, and tightening of the muscles of his face.  This told me, it was definitely tetanus.  I discussed his condition with Carolyn, who was looking after him, as both mom and dad were away.  I told her that his condition was really serious and we were going to try all the medicines we had, but I wasn't sure how well he would do. 

As I talked to her, I talked to Lesley too, and let him know that we were going to try and help him.  He was looking at pictures on the walls of Jesus holding a child in his arms, and
I told him about Jesus watching over us, loving us and being with us, and he nodded his head as if he had heard about Jesus before.  Then I asked him if we could pray, and next thing I knew he had closed his eyes and put his head down.  As I prayed, I heard a little voice and opened my eyes to see Lesley praying to God with me, asking for God's help.  My heart melted then and there, seeing the faith of this little kid, and made me plead all the more for this little guy. 

We moved him to an isolation room, for darkness and quiet that first night, trying to limit sounds and other stimuli, which might make his body spasm.   I spent a good portion of that first evening at his bedside, with Carolyn.  We tried to reassure him when he started to cry from pain when his IV quit and we had to reinsert it, would hold him when he spasmed, and was just there with them, so they knew they weren't alone as he was really sick.  The whole time my heart was loving this kid, my head was telling me he is going to die, prepare yourself. 

I didn't want to prepare myself, I didn't want Lesley to die.  He was only 3, his parents weren't with him, and he had something of which I could do little for.  Treatment of tetanus requires cleaning and debridement of the wound, sedation to prevent spams, often intubation, antibiotics against the tetanus bacteria, and immunoglobulin to bind up any toxin it can.  Even with all of these treatment available, 30-40% of pts with tetanus die.  We were only able to try and sedate him, but could offer none of other treatment options.  In my time here both the patients we have had with tetanus died and I feared the same fate for Lesley. 

Over the next few days, his spasm got worse, involving more of his body, and more medicines were required to keep him comfortable.  He was sleeping most of the time and was awake very little.  Thankfully, his parents were both able to make it in before the end.  I would check on him a few times a day and make sure he was getting his meds and that his IV was working, but would try to not disturb him.   I prayed with Carolyn and for Lesley, knowing the end was coming. 
Thankfully, the end for Lesley was not that hospital bed.  I see Lesley in the arms of Jesus, just like the painting portrayed, and Lesley without pain and tears, but happy and smiling and playing.  A great reminder that this is not the end. 

Matt 19:14, Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these."