Medicine in Coco: Stark reality and vibrant hope

[I wrote the majority of this a couple weeks ago, but am just now posting it. Sorry for the long absence.]

I remember the first time I saw someone die. It was my junior year of college, and one of my rotations was in a hospice center. The old man passed away right in front of me, and it was weird because I didn’t know how to feel. He was supposed to die; that is why he was in hospice. And yet, death felt so unnatural. I remember heading back to college and talking to one of my professors. I said it felt weird to have experienced something so profound and to then come back to a college campus where I was expected to eat lunch and joke with my friends, then go take notes on the “fine arts.”

Now, a full, four years later, I’ve seen more people die than I care to list. As an ICU nurse, I have turned off life-support and stood quietly in the background as family members sobbed over the loss of their loved one. I have responded to “code blues” to intervene in those precarious moments between life and death. I’ve watched life slip away, and I’ve seen life restored. And most of the time that is all so weighty and heavy that you just can’t process it, so you leave it at work—in the locker with your favorite pen and your stethoscope. Once in a while a case comes along that is different from all the rest, and it rides home with you, a weight around your heart and an endless source of pondering for your mind. Or a special patient comes through, and every once in a while, you think of them and wonder how they are doing.

Somehow, here in Coco, the losses sting a bit more and the victories taste sweeter. I certainly don’t remember every C-section we do or remember every patient that passes away at the hospital, but I do remember a lot more individuals. I think it is because we are intervening in the lives of people who have little other option. We see very desperate cases that have run out of options, or have waited too long to seek treatment.

This afternoon, I was preparing a salad for lunch when my phone rang. The voice on the other side was one of our national nurses at the hospital. She said, “We need you at the hospital right away.” Normally, I would have thought C-section, but I wasn’t on-call today, so I knew it had to be a special case. Flying into the hospital on my moto, I tried to imagine—between prayers that the Lord wouldn’t let me wreck—what scene I would find upon arrival. I remembered having those same thoughts and that same rush of adrenaline as an ICU Code nurse, running to a different part of the hospital to a code. (Only, that was just a few flights of stairs, not a 10-minute moto drive through town.)

I arrived to find S and the team working on a 17-year-old pregnant girl. She had arrived with high blood pressure (she was eclamptic) and a loss of consciousness. Somewhere in the mad rush to get her ready for a C-section, she had stopped breathing. They had begun resuscitation efforts. I jumped in and took over CPR while S and B (the pediatrician) discussed possibilities. We had just called it quits when her heartbeat came back. We decided to get the baby out. The baby came out with a very weak heart rate. Brett and his team resuscitated the baby, but despite having a good heart-rate, the baby never took a breath, so we had to let it go. It soon became apparent that the mother was not breathing on her own and would likely die after the case. (During the case we were breathing for her using our anesthesia machine, but we don’t have a ventilator that can do that after the case. She had probably had a stroke from the high blood pressure and so wouldn’t be able to breathe for herself.)

I stroked her forehead and said a little prayer. From around the corner in the delivery room, a woman delivering screamed in pain. It made me think of Genesis, right after sin enters the world—of a world that cut itself off from God and so lives under a curse of sin and death. And so here we are, wading through the fall-out from the rebellion that started then and has continued in all of us.

Then I began to replay the past couple weeks. We had lost the young woman to cerebral malaria. The next morning we lost the woman we had done major bowel surgery on. These losses were not caused by our own negligence, but because we simply run out of resources and higher levels of care. And not too long before that we had the whole day where not a single baby born at the hospital lived (until midnight, when we did a C-section). Again, this is caused by the poor access to healthcare for women. Some women stop feeling their babies move days before coming in, by which time the baby has long since died. These loses are poignant, and you wish you could do more.

I’m reminded, however, that the Lord hears and is responding to this hurting world of ours. The past several days I have had to help take care of a little girl with major burns. This is truly a traumatic thing for all involved. It is definitely painful for the little girl, but it isn’t fun watching someone so little have to deal with that pain, or worse yet, be the one inflicting it by changing the dressing. But it has to be done. So every day, we head into the OR to change the dressings. She starts crying when she sees the OR doors. Her dad is such a champ. He always brings her in and stays right by her, talking to her the whole time while she hugs his neck.

Through her tears she asks him questions, occasionally tries to bargain with us, and often repeats things her dad says. Some of the things she says are down-right cute. For instance, the other day she told her dad that she wanted the Tubabus (whites) to leave, but he told her that the Tubabs are good people. So for the rest of the time, when the pain got bad, she would scream, “The Tubabus are good people, the Tubabus are good people.” Or she’ll tell us, “Ok, you’ve done enough, the other part is better.” (Her leg and back are burned, so we start with the leg and then go to the back.) Today, she stopped crying abruptly, and said in a strong, clear, almost sarcastic voice, if you can imagine that, “Are they using a knife to put on the medication?”

But it is her father’s actions that most impress me. He is attentive to her cries. He holds her and comforts her. And yet, he insists that she get the dressings changed, knowing that it is for her good. I am reminded that God is our good, patient, and healing Father—that He interacts with us in our best and worst moments and is always guiding us (and this whole world of ours) toward what is best. And our Heavenly Father calls us to join Him; to work alongside Him in counteracting evil, disease, and death wherever they are found. And sometimes, like this little girl’s father, all we can do is walk alongside people in their personal darkness, holding onto our Hope—His Soon Coming.

As the case ended and it became clear that the 17-year old wouldn’t make it, I prepared to let her go. My mind drifted once again to the night we did three emergency surgeries in a row (which was the same day we hadn’t had a single live birth…) We started at 10pm with a case of bleeding. We had just finished that case when an emergency C-section popped up. At 2:30, we were just closing the second case, when S was called out to the delivery room.

Moments later, I heard her yelling my name. I rushed out to find her pushing on the baby’s head. The cord had slipped down and if the baby advanced any further it would cut itself off from its source of oxygen and circulation. We rushed to finish the second case while S held pressure. Switching the room over as quickly as possible, we rushed this third patient into the OR. After giving the first dose of anesthetics, I took over for S, holding pressure on the baby’s head till my fingers went numb. They covered me with the surgery drapes and I had to tuck my head down, my face precariously close to the patient’s butt. The case started, and I had to bark out orders to another nurse about which medications to push. And it was just too much. I started to laugh so hard tears formed in my eyes. And I laughed until they pulled the baby out through the incision and I was free to come up from under the drapes.

After the case, I went into the delivery room where the baby was laying under the warmer, doing just fine. I stroked his cheek just hard enough to elicit his reflexes. His eyes opened, and slipping my little finger into his grasping hand, I said, “You owe me one, kid.”

We aren’t an endless source of miracles here in Coco. We can’t save every case. But in working alongside our Lord in working out His redemption of this world, we do save many. For countless babies and moms, we are making huge differences—giving them hope and pointing them to our Hope.