At 12:49 this morning another Tchadien baby died. Probably another at 12:48 and 12:50, because Tchadien babies die all the time. But I don’t know about them, I do know about this one. It is the same old story, little tiny baby, a few months old, shows up at the hospital, high fever, grunting respirations, dehydrated, pale conjunctiva. I can’t count the number of times I have seen it since I have been here, malaria with pulmonary complications. Despite all that, the nurses are usually able to get an IV in, and get fluids, dextrose and quinine going. The baby is put on oxygen and over the course of a few hours or at most a day or two deteriorates and finally dies. I think I have seen one baby leave the hospital alive after coming in with those symptoms and being treated like that. But that is all we have, it is all we can do.
Usually I am on the periphery, there really is not much for me to do, it is mostly nursing care, and not even much of that once the IV is in, the oxygen is on and the meds are given. Tonight was different. Around midnight I heard Brandon call out for me. He is in the room at the end of the house and it seems the nurses have decided the best thing is to get him up, and have him call me. So Brandon told me that the nurses needed the keys to get the oxygen concentrator because another baby with fever and respiratory difficulties had arrived. I gave Larpur, the nurse, the keys and went back to bed, waiting. Sure enough 15 minutes later, “Doctor Scott, the nurses need you to come put in a central line.”
My first reaction was, ugh. I was pretty sure what I would find, and I was not disappointed. She was a little tiny baby girl, perfect, cute as can be with an oxygen mask on her delicate little face. She had the usual grunting respirations, her oxygen saturation was 90%, which is not bad, but soon started to fall, 80% then 70%, back to 75%, but steadily down, down, down. Brandon was right, the nurses wanted a central line so they could start fluids and quinine and dextrose (these kids are all hypoglycemic due to the malaria).
I had a dilemma, it was clear this little girl was going to die, and very soon, and an IV with fluids, quinine and dextrose was not going to save her. Her problem was her lungs, and I am not going to start intubating these kids, just not even going to go there. The last thing I wanted to do was to start poking her with a sharp needle, and making her last few minutes even worse. On the other hand my nurses are pulling out all the stops to save this little baby, and now was not the time for a discussion on the ethics of when it is time to stop treatment (read torture) and let someone die peacefully. Besides my French is not good enough to allow for that kind of discussion. So, right or wrong, I decided I had to let my nurses know I cared enough to help them try. Unfortunately, we have these little pediatric central line kits, and I knew where one was. So I used a little lidocaine and spend the next 15 minutes trying to get a femoral line in. All the while the grunting respirations worsen, the oxygen saturation drops to 60 then 50 then 40%, and finally the pulse ox quits working. But she is still breathing, and the nurses continue to look everywhere for a vein. I can hardly get more than a drop of blood from her groin, so I try for the internal jugular a couple of times, feeling guilty the whole time. What am I doing? We need to just let this poor little baby go. Finally, I felt like we had done enough and I told them to call the family, she is going to die, soon. So the grandma came in and was too upset to stay. I tried to get her to hold the little one, but either the message never got through or it is just not done that way in Tchad. It was time for Johnny, Brandon and I to go back to bed.
Usually as we walk back to the house after working together we talk about what happened and I try to do some teaching. Tonight I was too upset, and too conflicted. I had just tortured this little baby, and why? To show my nurses that I cared? How crazy is that? At the house I filled a water bottle and thought about what we could do different, what is the right way to care for these kids. All I could think of was the fact that when I left she was alone, putting all her energy into breathing, probably not really conscious, but still alone. And then I thought about Jon and Lindsay, how would I want them treated if they were babies again and were dying. And so I decided I was going back, that this baby was not going to die alone, not without a human touch, at least I could do that.
Back at the hospital I found that the baby was not alone, well sort of not alone, 2 nurses, 3 nursing students, and a grandma were all in the room. But no one was touching the baby. The nurses were still trying to figure out how to get quinine in her, Larpur was drawing some up in a syringe. I guess she was going to give it IM since there still was no IV. So I went over and laid my hand on her chest and abdomen and tried to gently stroke her. I tried to let her know that another human cared, I didn’t want her to die without feeling some kind of touch. It was probably just a couple of minutes and she breathed her last breath and was gone.
I don’t know for sure why I am even writing about this. It is not to diss my nurses, they really put their hearts into trying to save her. It is not because I did anything special, in fact most people probably would have stayed with her and not gone back to the house to begin with. And people die all the time, even in the first world. Most of you have been with someone when they died, so my story is not unique to Africa or Tchad or Moundou. I guess I am writing about it because it was a very unique experience for me, because it touched something inside me that doesn’t get touched very often. Even though I have had lots of patients die through the years, very rarely have I been with them as they breathed their last breath. And whenever I have been there it is always a very moving experience. But even deeper than that, tonight I put aside the doctor and became a human. I let myself feel something, it was good, a little painful, a little scary, but good. She wasn’t just another patient, she was a dark skinned Lindsay, or a dark skinned Jonathan, and I felt the grandmother’s pain. In a couple of hours I have to get up and catch the bus to N’djamena to meet Bekki, who is flying home as I write this. If I could I think I would cry myself to sleep tonight, but since I don’t cry, that probably won’t happen. I guess a virtual tribute to all who have ever lost someone they loved, which is all of us, will have to do. That and a prayer adapted from John the Revelator, “Even so, come quickly Lord Jesus, and put an end to all this sin and death, amen.”
For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.
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