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So said the freshly written death note on this 8 month old patient. I was on call with Luci, one of the excellent British GP's, on Sunday 10/6/13, and we were just finishing rounding on the last "sick" pediatric patient (malnutrition to the point of skin desquamation) when I noticed one of the Ghanaian nurses bulb-suctioning one of the "not sick" patients. He was fumbling a bit, and I went over to take a look. As soon as I realized the child was taking only occasional gasps through an airway full of secretions/reflux/who knows what, I called Luci over and we started resuscitation. She took over suctioning and I started to look through the chart. At this point the child’s pulse became lost, so I started compressions interspersed with intermittent suctioning and weak, ineffective breaths given by the nurses with the bag mask. These were the first compressions I had ever given, and I was fully expecting to hear/feel ribs breaking, but soon realized that his underdeveloped ribcage was still quite soft and pliable. There was no O2, intubation or trach support, or epi available, so we continued our poor man's resuscitation for 5-10 more minutes before accepting the tragic futility. We pulled our hands away from the boy, thanked the nurses, and turned to the mother with a sad look that told her what no words can really express well in any language.
Such is the disease of cerebral malaria, which often leaves children dying of seizures.
We could not save this child, despite our best efforts. Unfortunately, full resuscitative efforts are often a rarity here. I have only been here a few days, but according to the other volunteers, with situations like this which would be "Code Blues" or at least "Rapid Responses" in the States resulting in Herculean efforts at saving or restoring life, we are generally called by the nurses 30 minutes later to report a "condition change." Changed to dead.
Hopefully if nothing else, our efforts at saving this child’s life caused the mother to see that the white doctors were genuinely concerned about what happened, that we tried our best, that my hugs for her were as genuine as my tears (which were only the prequel for tears later that night).
Maybe other changes will happen as well as a result... Maybe Hudu Inusah dying will be the spark that sends me to Africa long term. Maybe...
Interestingly, I knew Luci to be a self-described atheist from a previous conversation we had. She had mentioned how her views on God had been changing in Africa. I asked her about it after rounds on our walk back home. It turns out that like many others, she has been unable to reconcile the idea of a loving God with the suffering and difficulties of life here on earth. I have lived a relatively charmed life and until now I could only give intellectual assent to that understandable argument. However, this night hit me like a ton of bricks. I could be forgetting, but I'm pretty sure this was the first patient I've directly cared for who passed away (even if I only cared for him for 10 minutes). It was my first time doing chest compressions. And the fact that these firsts were on a child only heightened their potency. I had even prayed during the "code" that he would not pass such that Luci might be more easily reached by God. It would seem He chose to pursue her heart in other ways.
I had already cried briefly on the ward and when I got to my room I slumped to the floor, crying more than I had in years. I was so hurt, bitter, and angry that I called to God- cussing more than I had in the last 8 years. How could He make such a seemingly-God-forsaken continent as this inhospitable, resource-poor, and grossly tragic one? How can He allow so many people to live in such squalid conditions, so close to the line between this world and the next? How could He have created such misery-causing organisms as the mosquito and the malaria parasite?
And then it hit me- I was operating from the wrong frame of mind. I was thinking that a person's experiences (or lack thereof for Hudu) in this world are what matters and validates a person's existence. If they are largely negative, filled with abuse, poverty, etc., then such a person (or any observer) would have the right to question the existence of an all-powerful, good God who could tolerate such wrong. However, if I start with a different premise, that we are inherently spiritual beings only temporarily on this Earth, then an alternative conclusion is not only possible but necessary. God started speaking to me of the beauty I have already seen here- the closeness and lack of disconnect seen between people and their community that is so present in the Western world, the appreciation of each day due to acceptance of life's fragility, and a necessary reliance on God. Further, if I honestly believe in the goodness and desirability of an eternity with God, how can I not be jealous of Hudu rather than pitying him? Sure, I hope to have a long life here filled with as much fun, meaning, and other good things as possible. But with the abundance of sorrow and difficulties (even assuming the best life possible), is Hudu not in a better place than I am right now?
I accept that this life is full of sorrow, tragedy, emptiness, and inequality, of which I have not had my fair share. I certainly disclose the fact that I think about this topic from a Christian worldview, but I’m not attempting to fully explore this issue theologically in all its intricacies; there are innumerable people who could do that better than I can. I merely want to share an experience and give insight into how God is already helping me process it. I hope when you are faced with suffering that you are able to hear from God and be similarly comforted.
About the Author:
Tom Boone is a 4th year at UCCOM going into Family Medicine. Despite seeing lots of kids die in Africa, he still wants to do medical mission work and is looking forward to sharing God’s love with those hurting in the third world. He gets pretty excited about skiing, backpacking, and just about anything outdoorsy.
About the artwork:
"Jules" is an acrylic and colored pencil piece on paper by 2nd year med student Connie Fu.
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