Via dolorosa (4/9/11)
I had 3 deaths in 12 hours this week on call.
11pm it was a 6 year old who suddenly died 2 hours after having his arm amputated. By the time I got there, there was nothing to be done – make sure we were giving him oxygen, trying to jump start his heart with adrenaline – but nothing. His dad yelling at no-one in particular when he realised we had stopped doing anything, the orthopedic doctor agreeing to talk to him and try to figure out what on earth had gone wrong – while I ran to ICU to check on another baby.
10am, after much of the night spent with another patient in ICU, it was a 3 day old baby who had been born almost dead, but had been resuscitated. Sometimes the brain is elastic, and the resuscitation changes the story from death to life. But sometimes the damage has been done – and for this baby it became clear over 2 days that this brain had been hurt. Convulsions, then kidneys not working, acid building up in the body… and then, enough. Nothing more that can be done because the newborn ventilator is being used by another baby and this baby can’t breathe without one.
Death has become an inevitable part of work here. And over 4 months, I have become used to the conversations with the mothers, the post-death analysis – Could we have done more? What can we learn? What was inevitable? And I have made a tentative peace with mortality, with the uncertainty of this journey, with this never-predictable-length-of-a-piece-of-string that is the walk of my patients, of their parents, of all of us.
And then at 11am I was called to another resus on the peds ward. The automaticity of my role takes over – a staccato rendition of “What is the story? What has been done? Right – I need a laryngoscope, a 3.5 ET tube….”
And then a double take. Someone had said this was bed 43.
Bed 43. Naomi.
Under the mask on her face, I see baby Naomi, 3 months old. Born in our nursery, a delicate tiny doll with some syndrome we hadn’t been able to definitively diagnose. With us for a few weeks until she tenuously gained weight, despite the hole in her heart,but home with mum. Readmitted 45 days ago because she couldn’t gain weight at home and then had fever after fever after fever. Her patient, gracious and ever-smiling mum stoically tolerating our testing, our uncertainty, the improvements followed by relapses, her tiny daughter gaining weight, losing weight…
And then today, she was ready to go home. Finally off oxygen, finally gaining weight. Mum’s bags packed and waiting for family to collect her to go home. Home.
In a resus, I have been around long enough for most of it to be automatic. A – B – C.
But now, tears well in my eyes. This is Naomi, she should be going home.
Push the tears back down. Push the needle into the shin, dilute the adrenaline, continue the chest compressions. Secure the airway. Listen for a heartbeat, look at the pupils.
But she is gone. There is no question. We have lost.
So out I go to talk to mum.
As I walk down the hallway, tears just start to fall down my face. And mum is there at the end of the hallway, about to walk back in. She sees my face, and I put my arm around her, and I don’t need to say anything because she knows. Together we cry, and my mother’s heart breaks for this woman.
Jennifer and I both had come to the conclusion that Naomi would not have had a long life. We had hoped to get her stable enough to go home and have some time with her family, for a few months, a few years – we didn’t know. But it felt like a kick in the stomach for her to die here, now.
Jennifer called me to after I sent her a message that we’d lost Naomi. I so appreciate her wisdom, her experience, and her friendship – a debrief, a chance to reflect. We all knew Naomi better than any of her family did, because she’d spent her life with us, and we, the nurses and the other mums in the pediatric ward loved her in a way her community had not had a chance to. That Naomi’s battle was a tough one, and it had to come to an end.
I don’t think there’s any way around a shift like that. I don’t want to not love these babies – I don’t want to grieve the loss of every child like they are my own, but I want to get to know some of them enough that death never feels easy. I want to walk in this tension of the “already-but-not-yet” life – heaven being the other side of the veil, but being a part of bringing heaven to earth, here and now. Feeling the certainty that I am not in control, but at the same time knowing that I can be a part of fighting this timeless battle of injustice, oppression, sin.
So I’ll keep meeting and treating these babies and children, these sons and daughters. Some of them a fleeting visit, some of them catching a hold of my heart. All of them precious.