Living with Death

Almost every day someone dies at Kudjip Hospital (or is carried in already dead). In most cases, it seems that death may have been prevented, had the family brought the patient in sooner, or had the nurse identified something was wrong and notified the doctor sooner, or had the physicians better diagnostic tools and medicines. 

Coming from a large tertiary care hospital in Virginia, I have grown accustom to excellence in patient care, with the best diagnostic teams and tools moving at lightning speed to predict and reverse whatever ailment threatens a patient's health or life.

In the Third World, everything moves slower, staff are not as well trained, diagnostic tools and medicines are not always available or reliable, and to my fresh, forlorn perspective - death is an anticipated and acceptable part of life.

Coming to Papua New Guinea, I was told to "expect the unexpected" and brace myself with the Lord's patience. In the midst of facing multiple deaths in a 24 hour period, a Kudjip colleague invested the time to hear my concerns and questions, and offered this counsel:  Maintain an abundance of Grace for the hospital staff/system, who (like all of us) are in place to serve The Lord’s work, and do so at optimal capacity. 

When I see things that could have been done sooner or better, I am yet overcome with frustration, with grief for the loss of precious life, with a WHY for every little aspect of the patient's course of illness and medical care. 

On my first day working in the hospital, the Pediatric Team (at that time Dr Susan Myers and myself) were consulted by our visiting surgeon regarding a toddler who had been badly burned some time back. Maybe 3-4weeks prior, Joshua (about 7 months old) had crawled into a fire, badly burning his head, neck and shoulders. He had since received grafting procedures, and most of his burns seemed to be recovering. The reason we were consulted was because the boy had experienced worsening fevers for several days despite being on antibiotics. After reviewing Joshua's chart, speaking with the nursing staff and his mother, and performing a thorough exam (he appeared “toxic” – i.e. VERY sick), we decided the most likely source of infection was a venous catheter in his neck, which had been in place for over a week. With hygiene being what it is here, having an IV in place for any extended period of time poses a serious risk for a bloodstream infection. The problem with removing the line was that Joshua had no other IV access through which to give antibiotics and fluids. I was reassured by his mother and the nursing staff, however, that he had been tolerating oral medications and breast feeding, so we added another antibiotic (to be given “IM” – intra-muscular), and the surgeon removed the line later that afternoon. 

Overnight, Joshua continued to have fever, and was more dehydrated upon my exam the following day. What was even more worrisome, was the inconsolable high pitched cry which he had developed overnight - something I had previously seen with the altered mental status caused by meningitis (brain infection). In addition, Joshua had developed random areas of bruising on his face and limbs and his head bandages were damp with bloody drainage from the remnant of his left ear canal (for my medical followers - he was pancytopenic, suggesting DIC). We moved quickly to help Joshua in this critical time: I performed a Lumbar Puncture to evaluate for meningitis, and placed an IO line (big IV into the leg bone), through which we bolused fluids and broadened still further his antimicrobial coverage. After I placed the IO, Dr Erin Meier showed me how to place a cast around the line to keep it in place. Since this was only a temporary measure to provide fluids and meds, our surgeon agreed to take him for another "cut-down" IV in the morning. 

Sitting at Joshua’s bedside, I watched him moan with each breath, and took in his flaccid appearance, eyes glazed, limbs hanging limp. I waved my hand over him to chase off a fly – they’re always present here, but in that moment, their attendance irritated me more than usual. His mother and grandmother watched me, waiting for some kind of analysis, anything to help guide their wavering emotions.  With help from a nurse, I slowly explained in Pidgin that Joshua was very sick, that the medicines and fluids might help him, but that he might die from this infection. Holding their hands, and placing one hand over his chest, we prayed for him then – for healing, for peace, for Jesus to be present. 

Pediatric Ward Mural
Jesus welcoming the children

Anytime I am present on a ward, it seems all eyes follow me (parents, patients, even staff), investigating my intentions, judging my ability, hoping for my attention. As I left Joshua and his family behind, the collective weight of those eyes left me feeling small…had we done enough?…was there anything else that could be done?

Walking into work the following morning, I learned that Joshua had died sometime during the night. I nodded my head, having partly expected it, but felt the WHY’s re-emerging as the hopeful part of me disintegrated.  The nurses told me he had stopped breathing, and there had been foam coming from his mouth. Was his fluid rate ever reduced after the original bolus? How long was it before the nurses noticed he was getting worse? How long before the doctor on call was notified? So many unanswered questions, and no hope that the answers would help. 

Facing the unknown, Rachel and I developed a mantra for our year in Missions, which we frequently state to one another as a gentle reminder: 

No Expectations, No Limitations.

I cannot hope to control or change what I experience, but I can and do trust that God has a plan, that He is training me for even harder things, and that He will use me regardless of my circumstances. In the Light of this Truth, frustration is replaced with Faith, emptiness with Hope, and disunity with Love. 

1 Corinthians 13:11-13
When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I put childish ways behind me. Now we see but a poor reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known. And now these three remain: faith, hope and love. But the greatest of these is love.

Ultimately, I encounter every day some aspect of the Kudjip community which renews my hope (see video below), and I give thanks to God for the opportunity to share in His work. Please join me in praying for Kudjip Hospital - for our staff, our resources, and for our patients - all reliant on God's merciful and miraculous power. Thank You!

Pediatric Ward Prayer