I have continued to face death on a regular basis, each instance unique in source and circumstance, but never less tragic. A recent example occurred well after midnight (I was on Call), when I was asked to come help a boy in the Pediatric ward who had stopped breathing. I arrived within a minute and found the staff pumping air into his lungs, but it was unclear if they had done any chest compressions. He didn’t have a pulse, and appeared lifeless.
While starting chest compressions, reading the boy’s chart (possible diagnoses of both pneumonia and gastroenteritis), and teaching the nurse how to effectively give breaths through the mask, I learned that the boy (named Isaiah) had stopped breathing 15 minutes before the nurses had called me. My heart sank. The chance of getting him back was slim to none. I ordered STAT Epinephrine, but the dose had to wait a minute for the medication to be found, and another minute for me to decipher the miniscule writing on the snap-top vial to calculate the appropriate concentration/dosage. In the US, shocking the heart is another life-saving tool, but I had no such option for the boy. We took turns performing chest compressions and bagging air into his chest, but even with Epinephrine on board, Isaiah’s pulse never returned.
When I finally approved stopping CPR, the words “I’m so sorry” quietly edged their way out, and the boy’s father folded into sobs beside me. I placed my arms around him, squeezing him tight, letting him just weep, and whispered my sorry over and over. The lifeless boy in front of me, maybe 4 years old, was handsome and well-muscled. I envisioned him playing and smiling, as I see every day with the local kids, and I tried to imagine the memories of him flooding his father’s mind. I asked if everyone would be OK praying, and a small gathering formed around Isaiah’s bed – his parents, the nurses, and even the parents of neighboring patients. We thanked God for the boy’s life, and for welcoming him Home. We asked for the family to have peace in their grief, and for all present to trust Jesus in and through life’s hardships.
The clinic day was coming to a close, and being Friday, I'd been watching the clock. Just one or two more patients and I'd have a refreshing walk home in the cool rain. For the last couple hours, I'd been hearing loud cracks of lightening, their peals of thunder rolling across the valley. One of my last patients had taken me into the ER to finish some paperwork. It seemed a little busier than usual, the ER nurses and a couple other docs entrenched at various beds, sterile gloves bloodied in varied procedures - draining pus, stitching a laceration, setting a broken leg.
As I busied myself with paperwork, I heard the front ER doors bang open, followed closely by five men carrying a teenage boy. He was limp in their arms, and one man was careful to lay his head down gently on the triage bed. I didn't jump in right away, my first thought being maybe he'd had a seizure. Within a few seconds, I'd turned around again to see the nurse starting chest compressions. This wasn't good. I joined her, and couldn't find a pulse. Taking over chest compressions, I asked for someone/anyone to find a face mask and get breaths going. An older PNG man hovered close beside me, his flannel shirt steaming with rain and sweat, probably the boy's father or uncle. "What happened?!" I asked him. "Lightening on the mountain" was his reply.
The boy's chest was cool and clammy under my hands, his body rocking limply with each compression. I didn't see any obvious burns where the lightening might have entered/exited his body - apart from his GCS of zero, he had a healthy teenage physique. After a minute or two, he still had no heartbeat or spontaneous breaths. Resuming CPR, I asked for more information, specifically how long ago he had been struck. Every answer from the surrounding men was different, but even the shortest report was over 30 minutes. He had been at the top of a nearby mountain, and he had been carried, then driven, to our ER. I realized then that not a single thing I did would bring him back - he was long gone. I asked a nurse to get Dr Bill - knowing he would be able to confirm my assessment. More importantly, I was sure Bill would know the right way to tell the family, who were waiting pensively around the bed, and at the door.
Veteran in every respect, Dr Bill McCoy swept in on the scene, assessing and taking in every detail (as he does), and I gave him a brief report of the relevent information. He checked the light reflex of the boy's pupils, and shook his head. "It's been too long. I'm sorry." So after a brief five minutes of CPR, we stopped. Even if we had somehow restarted his heart, his brain had already gone far too long without oxygen.
Uncle Bill turned to the father figure standing beside the boy and reiterated the futility of any further intervention. The man refused the notion, and indicated that we must continue with our CPR to bring him back. I was glad (for the 100th time that day) that Bill, and the great blessing of all his experience, was present. I'm sure that if I was alone, even knowing the futility, I would have extended the hope of all present with many more minutes of CPR, intubation, and medications. The fact remained - the boy had died somewhere out on that mountain, a terrible truth which required the sure resolution and empathy of Dr Bill.
Agony broke over the countenance of the man, and he threw himself on the boy, his own wailing cry echoed in crescendo by two, then six, then countless men and women in and around the ER. Silent, I was out of place among them, and retreated from the scene respectfully.
The perfect vitality of youth had been ripped in a split second from the boy by a seemingly random event of nature. Can we shake it off, saying he was just in the wrong place at the wrong time? ...or do we demand of God why He would allow such a painful burden to fall upon the family?
~ ~ ~ ~ ~ ~ ~ ~
As I busied myself with paperwork, I heard the front ER doors bang open, followed closely by five men carrying a teenage boy. He was limp in their arms, and one man was careful to lay his head down gently on the triage bed. I didn't jump in right away, my first thought being maybe he'd had a seizure. Within a few seconds, I'd turned around again to see the nurse starting chest compressions. This wasn't good. I joined her, and couldn't find a pulse. Taking over chest compressions, I asked for someone/anyone to find a face mask and get breaths going. An older PNG man hovered close beside me, his flannel shirt steaming with rain and sweat, probably the boy's father or uncle. "What happened?!" I asked him. "Lightening on the mountain" was his reply.
The boy's chest was cool and clammy under my hands, his body rocking limply with each compression. I didn't see any obvious burns where the lightening might have entered/exited his body - apart from his GCS of zero, he had a healthy teenage physique. After a minute or two, he still had no heartbeat or spontaneous breaths. Resuming CPR, I asked for more information, specifically how long ago he had been struck. Every answer from the surrounding men was different, but even the shortest report was over 30 minutes. He had been at the top of a nearby mountain, and he had been carried, then driven, to our ER. I realized then that not a single thing I did would bring him back - he was long gone. I asked a nurse to get Dr Bill - knowing he would be able to confirm my assessment. More importantly, I was sure Bill would know the right way to tell the family, who were waiting pensively around the bed, and at the door.
Veteran in every respect, Dr Bill McCoy swept in on the scene, assessing and taking in every detail (as he does), and I gave him a brief report of the relevent information. He checked the light reflex of the boy's pupils, and shook his head. "It's been too long. I'm sorry." So after a brief five minutes of CPR, we stopped. Even if we had somehow restarted his heart, his brain had already gone far too long without oxygen.
Uncle Bill turned to the father figure standing beside the boy and reiterated the futility of any further intervention. The man refused the notion, and indicated that we must continue with our CPR to bring him back. I was glad (for the 100th time that day) that Bill, and the great blessing of all his experience, was present. I'm sure that if I was alone, even knowing the futility, I would have extended the hope of all present with many more minutes of CPR, intubation, and medications. The fact remained - the boy had died somewhere out on that mountain, a terrible truth which required the sure resolution and empathy of Dr Bill.
Agony broke over the countenance of the man, and he threw himself on the boy, his own wailing cry echoed in crescendo by two, then six, then countless men and women in and around the ER. Silent, I was out of place among them, and retreated from the scene respectfully.
The perfect vitality of youth had been ripped in a split second from the boy by a seemingly random event of nature. Can we shake it off, saying he was just in the wrong place at the wrong time? ...or do we demand of God why He would allow such a painful burden to fall upon the family?
 |
| Mourners gathered outside the ER |
~ ~ ~ ~ ~ ~ ~ ~
Not two days later, I was on call and was asked to come to the ER for a young man without a pulse. Two clarifying questions later, I realized he was in fact dead, and the nurses needed me to come proclaim his death for all the family present.
The ER doors were crowded with people, some peering, some wailing, and two young men were lying in the road, crying, making gravel angels beside where I parked. The small gathering parted for the white skin doctor, and I found the inside of the ER just as crowded with spectators and mourners.
He was the only person occupying an ER bed, surrounded by sobbing figures - one women wiping her head and face with his feet. I went to his side, placed my stethoscope over his still heart, and held a single finger to my lips, for which all but a few went silent. No beat, no breath, pupils widely dilated and fixed - I shook my head and offered "Sorry" to those meeting my gaze.
In the prime of his life, he had walked off the Rugby field and then collapsed, never to awaken. Had he sustained some fatal injury? Did his heart simply give out? Did he needlessly later die in the hour spent at a small local clinic? Sadly, I have begun to learn only some questions are worth investigating.
As an odd punctuation to the grief of the moment, I noticed a young man purposefully approach the deceased, then abruptly swing a round house kick at an older man standing bedside. The young man's face was etched with grief and anger as he followed quickly with a hay maker right, shouting his accusations for all to hear. Having been first to notice the assault, my instant response was shouting !HEY! a couple times while stepping in to stop the attack. Common sense caught up with me quickly however, and I pulled up short of the ensuing tussle. There were already security personnel in the ER, and they readily elbowed their way in, separating the two, and threw the younger man outside. Pastor John and the nursing staff were also present, and were quick to remind all present of the heavy fees and penalties exacted upon those who fight on Hospital property. Whether or not the young man's explosive anger was directed justly, it's hard to imagine what feelings I would have in the face of losing a brother.
~ ~ ~ ~ ~ ~ ~ ~
Two verses come to mind. The first is Job's prayer following complete ruin of his life, the second is from Romans 8, declaring our hope in future redemption.
Job 1:20-22
At this, Job got up and tore his robe and shaved his head. Then he fell to the ground in worship and said: "Naked I came from my mother's womb, and naked I will depart. The LORD gave and the LORD has taken away; may the name of the LORD be praised." In all this, Job did not sin by charging God with wrongdoing.
Romans 8:18-25
I consider that our present sufferings are not worth comparing with the glory that will be revealed in us. The creation waits in eager expectation for the sons of God to be revealed. For the creation was subjected to frustration, not by its own choice, but by the will of the one who subjected it, in hope that the creation itself will be liberated from its bondage to decay and brought into the glorious freedom of the children of God. We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption as sons, the redemption of our bodies. For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what he already has? But if we hope for what we do not yet have, we wait for it patiently.
~ ~ ~ ~ ~ ~ ~ ~
My mother recently sent me the Serenity Prayer, which I have reflected on - I hope you also will ponder its powerful Truth.
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this sinful world as it is,
not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him Forever in the next.
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