the terrible, horrible, no good, very bad day (x2)…

12 Jul

to sum up our day, all we could talk about on our walk away from the peds ward at the end of today was how badly we wanted a pizza, a tub of blue bell ice cream, and a bottle of wine.  we keep thinking we might have one day while we’re here that could inspire a happy, up beat blog post… but unfortunately, we have yet another tear-jerker for you tonight.  however, even as we tell these sad stories, god has been faithful to remind us of his grace and power.  this morning, we went to devotional (held at 7 a.m. every morning at the front of the hospital and led by one of the chaplains) and the choir from first baptist church of nalerigu was singing.  they sang a few ghanian songs, and then began singing “because he lives.”

because he lives, i can face tomorrow

because he lives, all fear is gone

and i know, oh yes i know, he holds the future

and life is worth the living just because he lives

the words of this song, and the hope we have in god’s power to overcome death is so much more obvious and relevant to us here.  in the midst of suffering and hard times, it is so much easier to understand songs like this and to actually look forward to the day when he returns.

in the last two days, we have signed a total of 8 death certificates.  while each was difficult in its own way, we will tell the story of only one tonight.

he was an 18 month old boy who came in with malaria and seizures yesterday afternoon from clinic.  he continued to have seizures last night and so received valium and phenobarb (both seizure medications) and was then very sleepy.  rachel saw him and wrote in her orders not to give any more seizure medications overnight, as both could cause him to get sleepier and possibly stop breathing.  however, by the time we made it to the wards this morning, he had received two more doses of valium and a large dose of phenobarbital despite our orders.  he was difficult to wake up during courtney’s exam, but was breathing ok.  unfortunately, a few minutes later, one of the student volunteers noticed his breathing had changed.  courtney checked his oxygen saturations and found them to be decreasing quickly as he stopped breathing altogether.  he then lost a pulse.  courtney started compressions and called rachel over to start bagging (providing breaths with a bag-mask).  his pulse returned quickly and we got his saturations up to 95%.  but then we were in a bit of a pickle… he clearly had no respiratory drive due to the seizure medications, and we didn’t expect a speedy improvement, but yet we have no ventilator here to support him as we waited for the medicine to wear off.  so we kept bagging.  for 4 hours, taking shifts with the nursing staff and the student volunteers.  at that point, we enlisted the help of one of the anesthesiologists to find an intubation tube and blade to make the work a little easier for everyone, as the number of nurses had dropped to 2 after shift change and the ward was filling with new admissions already.  intubation was successful and we continued bagging via the tube for another 4 hours, again taking shifts.  all we had to monitor our patient was a pulse ox.  around 5:30 p.m., we checked his pupils and found them to be fixed and dilated, indicating a very poor prognosis and an unlikely recovery no matter how long we continued to bag.  we called the chaplain and made the decision to withdraw respiratory support.  the only request the mother had was to take a picture of her son, but unfortunately, there was no way to get it to her (no printer, no email address, etc).  it was heart breaking and defeating.

we were struck today by the fact that despite our ability to intervene here, there is no way of monitoring the intervention like we do at home.  in other words, there are no monitors, labs, blood gases, etc to help us adjust our interventions and ensure the patient remains safe.  it’s frustrating when we can’t do what we know needs to be done – we knew the patient needed to be intubated and ventilated this morning.  but there is no ventilator available (not even for patients under general anesthesia in the operating room), and even if there was, there are no blood gases to guide ventilator settings.  and truth be told, the patient would have been considered in “critical condition” even at home.  so it’s hard to know where to draw the line of what is helpful and what is only prolonging the suffering.

we were so thankful, though, for one of the peds nurses, who told us that we had done “such good work” today.  she said that even though we had lost a life, we had worked hard and that was appreciated.  it made us feel some peace knowing that even with a language barrier, the nurses and parents can see that we care.  and we can continue loving because he loves us and asked us to serve him in this way.

because he lives, i can face tomorrow.

– courtney & rachel

9 Responses to “the terrible, horrible, no good, very bad day (x2)…”

  1. Karen Tucker July 12, 2011 at 4:55 pm #

    Rachel & Court – Your blog today made me cry – for the family who lost a precious life, for the inability to take a picture for a Mother’s future memory, for your frustrations at having knowledge that can’t be put into action. I was not surprised that the nurse would notice your hard work – I know the hearts of the two of you and know that your love and compassion show in the way you treat and care for your patients. The comfort for days like this, as you both know and shared in your blog, is the absolute knowledge that God is in control of our days and our nights – no matter how short or long life might be – because he lives. Stand strong in that belief, my Chicas and know that there are many praying mightily for you to have strength, wisdom, and joy as you serve Him.

    Love to all of you – pizza, blue bell and guacamole are waiting for you at home.
    Mamasita

  2. Tommy Tucker July 13, 2011 at 7:42 am #

    Hey daughters of mine – it was hard to read your blog. It is so sad when a child goes home not having a chance to make a difference in our world. It makes me realize how precious our time is here on earth and how our priorities need to be on our Lord. The song is right on though “Because of Him, I can face tomorrow’. Keep this in your thoughts and rely on your faith in Jesus and He will give you the strength to carry on. Hope the days ahead bring you joy instead of sadness. All of you guys will continue to be in our prayers.
    Love you girls! Dad

  3. Doug Whitmore July 13, 2011 at 8:43 am #

    Thanks for your blog, ladies. We are amazed that you find the strength at the end of each day to keep us informed.

    The sufferings of Christ come in many ways. Consider Him who was faithful, obedient to go to the cross because of God’s great love for us. Your love for others and faithfulness to Him are apparent…keep serving with all your heart. We will continue to pray for you all (almost Texan, I know!).

    We love you,

    Mom & Dad

  4. Denise July 13, 2011 at 9:19 am #

    We love you guys and are so proud of everything you are doing every day. We are praying for strength, energy, and peace for y’all today. We are also praying for the kids and their families.

    “Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows.”
    2 Cor 3-5

  5. Jane Vorce July 13, 2011 at 11:34 am #

    Reading your latest entry through tears, this Franciscan Benediction came to mind…I hope it will comfort and encourage you in the midst of difficult times…

    “May God bless you with discomfort
    At easy answers, half truths, and superficial relationships,
    So that you may live deep within your heart.

    May God bless you with anger
    At injustice, oppression, and exploitation of people,
    So that you may work for justice, freedom, and peace.

    May God bless you with tears
    To shed for those who suffer pain, rejection, hunger, and war,
    So that you may reach out your hand to comfort them and to turn
    their pain to joy.

    And may God bless you with enough foolishness
    To believe that you can make a difference in the world,
    So that you can do what others claim cannot be done,
    To bring justice and kindness to all our children and the poor.
    Amen

    God bless you both as you serve him by loving and caring for others…
    Jane

  6. Jen Pape July 14, 2011 at 11:00 am #

    Praying that your time in Ghana, with all it’s tears, difficulties, and frustrations will continue to strengthen and make more real your desire to see our Lord return… hoping that He plants an eternal perspective in your hearts that will carry over when you return home. He is good, He is faithful, and He lives!

  7. carl & Elaine Baldridge July 15, 2011 at 7:54 am #

    “Because He lives” we can face today, after yesterday’s heartbreak, but we cry with you. As you continue to work hard to give each little one and their families a better chance at life and wellness, our prayers and love are with you there. Your blog will inspire us all to try to think of ways for the hospitals there to have what they need to give children that better chance. We love you all, Mom and Dad B.

  8. Doug Whitmore July 16, 2011 at 12:14 am #

    What good, achievable resources could be channeled to this hospital that would help? (Hope that’s understood. Answer when/if you can.)

    Still praying for you.

    Mom & Dad W.

  9. Caleb July 24, 2011 at 11:18 am #

    Ladies, you are heroines of mine. We are praying for you every day. I’m in my ICU month now, and I definitely can see how you crave having those resources. I can also understand that feeling of, “I wish I knew a little bit more,” or things turning for the worst despite your best efforts. But God has put you where you are for that specific moment, all the way in Ghana. And you are making a difference even when things go wrong. It may be to the child’s mother or a nurse or the other patients in the unit or just yourselves (for a later time). God will use it; He wastes nothing. And knowing you the way we do, we know that you have already picked yourselves up and moved to the next patient that needs your help, but while you do, God will store your tears and give comfort. We cannot wait to see you again, and like you, we cannot wait for the time when there will be no more suffering. We love you.

    Caleb

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