Friday, March 24, 2017

A night to forget

Amidst the rain pouring down on the roof, I hear the phone ring and look around my house for the phone.  Locating it, I hear a nurse on the other end asking me to come to the ER for a sick child.  Thankful for a vehicle to keep me somewhat dry in the pouring rain, I make my way to the ER.  Expecting to only find one patient in the ER, I am surprised to find an ER full of patients and their loved ones.

When more than one patient is waiting in the ER for a doctor, it can be hard to know which patient to see first.  I quickly glanced at each of the patients sitting or laying on the Emergency Room, observing them each for a moment, trying to identify the sickest one that needs my immediate attention.  As I am scanning the room, my eyes fall on the child laying on Bed 3.  He is laying almost motionless on the bed, his mom standing over him, hand holding his arm, his dad, crouched down at the foot of his bed, and make my way towards them.
As I got to the bed, I asked mom and dad what was going on, as I started examining their son.  They reported the diarrhea started just the night before, and that he has been weak since, but he wasn't vomiting, had no blood in his stool, and hadn't had any pig meat.  From their history, I would have expected the child to not be very sick.  All kids have diarrhea, but the majority end up being just fine and don't even see a doctor, but not this kid.  This kid was sick.  He wasn't moving, he wasn't crying, his eyes were open, but he wasn't looking at me, he was looking more beyond me.  As I reached out to examine him, his hands and legs were cold, his skin was mottled, and I was very concerned. 

I quickly asked the nurse to draw up some antibiotics, told the parents the child (18 months old) was very sick and that we would try everything we could and then we prayed.  As I was writing up his admission, I couldn't help but think we were too late, that this kid wasn't going to make it.  Despite those thoughts, I kept writing the orders to do everything we could to help him get better and prayed it to be true. 

After seeing him, I again scanned the ER and found another child being held in his mother's arms.  This kid was crying, was pulling at the oxygen tubing that was going into his nose, both of which seemed like an improvement from the last child I admitted, so I made my way to his bed.  Mom was holding her 3 month old son in her lap, trying to console this little boy who did not want oxygen in his nose.  As I got closer and looked at it, it was obvious that he was pretty pale and likely anemic.  Mom said he had been passing dark black stool for a number of weeks, and recently had gotten short of breath, so she made her way to Kudjip. 

She lives about 2 days away, and it wasn't easy for her to get to us, but she finally made it on this wet and rainy day and not too soon.  Her son was very pale, had lost a lot of blood, his heart was pounding in his chest about as hard as the rain was hitting the roof above us.  I was encouraged that he was crying and fighting, a better sign than the last child.  He, too, was shortly admitted with IV fluid, medicines and an order to give him a blood transfusion. 

I saw a few adults and then, another mom walked in carrying her small child.  The child had sparse, thin, reddish tinged hair and looked like small for his age.  As I approached, I could tell he was struggling to breathe.  A quick glance in his scalebook, reminded me that I had seen him just a few days before, but this kid was now much sicker.  He was malnourished, his ribs were protruding out and he was using extra muscles to breathe, making his ribs seem to stick out even more.  He had pneumonia which was complicated by his malnutrition and his body's lack of strength to fight off infections.   I talked to mom about him needing to be admitted, prayed with them and then wrote up the admission. 
A few hours later, while trying to sleep, I get a call from the pediatric ward, a kid was arresting, could I come.  As I quickly got dressed and made my way down to the ward, I was thinking through the kids I had just admitted, wondering which one they might be calling about.  When I got there, I walked past the bed of the anemic kid who seemed to be struggling and made my way to the wailing at the far side of the ward.  I found the parents of the child with dying crying as their son lay lifeless on the bed.  Our antibiotics and IVFs seemed to be too late, his heart stopped, then his breathing and we couldn't change it. 

As I finished with him, I made my way back down the ward to see the anemic kid.  His hemoglobin came back at 1.7 (normal is at least above 10), he had already received blood, but he started vomiting up blood, and was having trouble breathing.  I adjusted some medicines, and prayed with his mom, but I didn't expect him to be with us much longer.    The malnourished kid was still holding on, but I wasn't real hopeful that he was going to make it either. 

I left the ward feeling somewhat dejected.  We were in the middle of celebrating the 50th anniversary of the hospital, of celebrating the lives the hospital had touched both through physical and spiritual healing, and here I was heading home after one child died, with another one about to die and a third likely going to die before the sun came up.  Questions started flooding my head - wondering if I should have used a different medicine, should have chosen a different kind of IVF, if I had missed a diagnosis, if there was anything I could have done to help change the outcome of these kids.  There was nothing I could think of to do differently, and somehow as I laid in bed praying, I fell asleep.  

Before rounding the next morning, I went to the pediatric ward and found 3 charts waiting for me to sign.  I had admitted 3 kids the day before and all 3 had died.  These aren't the kinds of numbers that I want to blog about, aren't the kinds of nights I care to remember, but they happen at Kudjip, and I wish there was something we could do differently to prevent it.  I wish we could find a way to reach all the people in the bush, in the hard to reach places of PNG and give them early access to good medical care, I wish we could better help malnourished kids, wish we had a way to help them gain weight and strength quickly, had a weigh to change their home environment so they had all the food they needed to be healthy, I wish all the kids near us got all their vaccines so they wouldn't be at risk for preventable diseases.  I wish kids wouldn't die, wish parents didn't have to wait so long in naming their child, for fear they aren't going to make it.  I wish we had all the medicines, all the supplies, all the bed space we needed to care for everyone who was sick and needed our care.  Despite my wishes, there is still a reality, a world that I live and work in, where kids do die, where lack of availability of resources, vaccines, health centers puts kids at risk of dying way before they should.  

For the past 50 years Kudjip Nazarene Hospital has been a bright spot, has brought life in many ways to many families and sick patients, and I pray we continue to to make a difference in the lives of many who come by sharing Christ's love with them as we care for their physical bodies too.  Please pray for us as we continue to seek God to know how we can continue to be a light and to offer hope to those who come.