Deep Breath

Deep breath. 

 

I arrived at Tenwek hospital last Wednesday. It was nice coming back to a familiar place though many of the people I have worked with in the past are currently not here. I knew it would take me a while to readjust to hospital medicine and the best way to acclimated fastest is to jump in head first, right? My first day on service I was on call that night. It felt like it took forever to get those wheels turning in my brain on rounds that morning. Our peds team consists of myself, a family medicine physician, 2 medical officers who are very well trained, and several residents and students. For my first few days there was also another pediatrician from the states helping with the service and I was so thankful to overlap with her some. The service overall seems busier and has more critical patients than I remember having last time. With each day of rounding I settled into things a little more. 

 

We have already had a significant amount of pathology. In medicine that can be fun and interesting to see strange and varying diseases but at the same time it is usually not good for the patients. In my first 4 days of work I have seen HIV, TB, Cryptococcal meningitis, Pneumocystis jiroveci pneumonia, cerebral malaria, filariasis, toxic epidermal necrolysis that progressed to Steven Jonson’s Syndrome, a ventriculoperitoneal shunt infected with Giardia, multiple abdominal abscess that seeded a pneumonia in a kid after surgery (from an outside hospital), rheumatic heart disease and heart failure, nephrotic syndrome, little babies with multiple congenital anomalies or intraventricular hemorrhages, multiple pneumonia cases, and liver failure from herbal meds. Right before I came, the team did an exchange transfuse for a baby with a bilirubin level that skyrocketed. Thankfully I got to discharge that kid home recently. Praise the Lord!

 

This weekend I was on call and the patients kept us on our toes! On Saturday I ran my first pediatric code since residency and by the grace of God it was successful. An infant pulled out his breathing tube and his heart rate dropped because he couldn’t breathe. We had another baby admitted that evening for pneumonia that initially did well on oxygen but worsened throughout the day. That night we decided to intubated after trying CPAP. It took us a good 1.5 hours to get her to stabilize and I was very concerned that we would lose her right there. We battled and fought for these two infants most of the weekend. Multiple times I thought one would not make it. And of course they both decompensated around 1am last night. I spent about 4 hours at the hospital trying to stabilize them both. I was so thankful for the 7 hour time difference between here and the US. It allowed me to ‘phone a friend’ who walked me through how to stabilize these very sick lungs. A few of our other really sick kiddos seemed to be improving yesterday and I was very thankful the Lord had sustained us through the weekend despite how critical so many of our patients were. I felt like if I could get them to Monday with the whole team then just maybe they would make it. However, as I was getting ready for rounds this morning I was paged to the bed of our infant with TEN/SJS. He looked so much better yesterday that we started feeding him because we knew he had to have the nutrition in order to recover. But, this morning he aspirated on his food. When I arrived, the surgical team was intubating him. For 3 hours we worked trying to get oxygen to his lungs. The problem was that his disease was also inside his throat and esophagus and he started bleeding internally with all our efforts. He passed away at 10:30 this morning. At the same time one of my pneumonia kids starting fighting the ventilator and decompensating. I was literally running between both beds for over an hour. At one point we all stopped and I just laid my hands on one baby and prayed that the Lord would intervene. We tried everything we could think for them both. Then suddenly, the oxygen level in my baby with pneumonia picked up. I don’t actually think we did anything. But I know God answered our prayers. As of right now he is still okay but still so sick. And then just like that, after 3 hours of running around and one baby dying, we had to pick back up and go see all of our other patients. My morning ended with a hard conversation with a mother who’s baby is terminally ill. I had to explain that her baby will most likely die in the next few days and there is nothing we can do. I sat with her for a while as she wept and we prayed together. 

 

I have definitely had moments the past few days where I had to stop and take a deep breath remembering where my strength comes from. Much of this can be overwhelming and it is easy to throw your hands up because it is so obvious that you’re not enough. I had a moment one night as I was staring at a ventilator wracking my brain for what to do (that has been happening too much recently) where I started question why in the world I came or ever thought that I could be useful here. It is too easy for the enemy to get a foothold. I stayed up that night refreshing myself on details of ventilator management. It got me thinking on the delicate balance of striving hard to do our best but then leaving the outcome to the Lord. Yes, I want to be a better physician for these kids and their families; not only to better serve them, but also because I represent Almighty God. And yet, I have to be able to lay it all on the alter for God to do what He wishes with my sacrifice. Yet, this is not a new thing that God requires. Did He not require the very best of Cain and Able on the alter? And so, I’m learning to always strive to be better; not for my glory, or even better patient outcomes, but simply that I may be able to lay my best on His alter. It is a hard lesson. 

 

The baby that is currently giving us the most problems is an 8 week old baby I admitted a few days ago from an another hospital with severe pneumonia. They had him on some antibiotics for a few weeks without improvement and he then started dropping his oxygen levels. The medical officer on with me that night is very good and so when she called I knew something was up. He had to be intubated because he couldn’t keep his oxygen level up otherwise. But he is a very strong baby and was fighting us like crazy. We were breathing for him but he resisted every breath so that the oxygen was not getting to him. If only he would give it up he would be able to breathe. We had to sedate him heavily to get him to calm down enough for him to stabilized. His body needs to fight this infection, but then stop fighting us when we are helping. 

 

But am I not in a similar situation with God right now. I need to fight to learn and strive to better understand disease and pathology in order to better help my patients. But I also need to surrender those same patients to the Lord. How many times do we have destructive behaviors and fight God with all we have because we don’t like what He is doing. We know He only does good things. He is a good father and knows how to give good gifts (Matt 7:11). But just like this infant sometimes when He is refining us (maybe disciplining us, maybe not), we resist that unpleasant sensation/situation and fight with all we have. But are we not really just making everything worse? We know from Scripture that He calls us to surrender, and when we do He has His way in us which is for our good and His glory. Are we going to surrender on our own? Or will He have to force us? Thankfully, in the end God will have His way in us. We have the hope that He will finish what He starts in us. Unlike this infant, we can trust that no matter how we mess things up, God is powerful enough to still have His way. But we can definitely make it harder on ourselves. Obviously, we can and should still have emotions during these times. And expressing those is healthy and part of how God made us. But maybe we don’t have to resist Him. Lord, I don’t like what you’re doing and I’m hurt/angry/sad/etc but I know you are God and you are good. So, I surrender to whatever it is you are doing and trust it is for my good and your glory. 

 

If only my little 8 week old could learn that same lesson . . . 

 

Thank you all for your prayers. They are felt and very needed. Please continues to pray for these very sick children, for their parents and families during these hard times, and for the team, that the Lord would continue to sustain us. Please also pray that in the midst of the crazy and business of the medicine that the Lord would give me more opportunities to pray and talk with patient’s and families of His goodness and love.