I’d like a do-over

You know those days when you just want to go to bed and start all over again? Today was one of those days for me. The last couple days have been pretty busy and frustrating as we are pushing forward with numerous projects in casualty. We have found ourselves understaffed and my attempts to accomplish administrative work have been thwarted on numerous occasions. Even providing patient care has proven to be a cause of stress. One example from yesterday was a young man who was transferred to us from an outside clinic with a suspected neck fracture. A quick evaluation revealed that he likely did a neck fracture causing paralysis. He also had a broken wrist and a broken femur. While the care he required is relatively straight-forward, getting his workup completed on this occasion was extremely challenging for a number of reasons. It just seemed like we met one roadblock after another. (This isn’t an Kenyan or even an African phenomenon. I have had this occur in the U.S. on numerous occasions as well.) No matter where it occurs, it becomes extremely frustrating and it is difficult to not lose one’s cool. Thankfully, other than a couple stern conversations to ensure that my patient received the care he needed, no cool was lost and the patient was cared for appropriately despite the delays. The day remained busy, administrative work was put on the back burner and a lot of sick patients were cared for. I was really hoping today would be different. And today was different…it was worse.

At first, things looked promising. Casualty wasn’t overloaded and I was getting ready to meet with our head nurse to get some important work done. Then I was made aware of a scheduling issue that would leave us short staffed in casualty again. About that time we began to get a bolus of sick patients. Arrangements were made and I tapped into an amazing resource that I currently have available…another ER doc!! (At this time we actually have two ER trained guys here. I can’t even tell you how great it has been to have them. Although they have had their time split with the medical team, they spend time in casualty and in a crunch I have been able to rely on them to help out. Having two guys here who think and process patients the same way that I do has been awesome! I’ve been told that it takes a “different kind of person” to go into emergency medicine and I really think there is some truth to that…we are a different breed in a lot of ways. My family will without hesitation tell you that I’ve always been a bit different.) Anyway, I was able to pull one of them over to help see a couple patients so I could again attempt to get some admin work done. Just as I was getting ready to walk out of casualty I saw the look on a mama’s face that I never want to see…she looked terrified.

I watched as she carried her young baby to a nurse who immediately called for me. The baby (who we later found out was 9 months old) was limp but still warm, had no pulse and was not breathing. My ER colleague and I immediately began resuscitation efforts. As we worked on her, we found out that she had been suffering from vomiting and diarrhea for the past couple days and then started spiking a fever. She had been better overnight and was even feeding but her condition worsened throughout the morning. Two docs and almost my entire staff worked incredibly hard. We worked through every possibility but in the end, she joined Hannah in her forever home. During and after this event, one of my friends here asked if I was alright. And while pediatric resuscitations have taken on a whole new burden for me, I was still holding it together. But I do have to admit that this case was much more difficult than the last couple I have had (even though I have had several since Hannah’s death). I’m not sure why this was different.  Maybe because the resuscitation occurred in the same bed that Hannah’s did.  Maybe because the yesterday marked the 5 month mark for Hannah’s home going.  Maybe because my heart has been aching as Levi has now started to verbalize that he misses his sissy.  I don’t really know.  But this baby’s mama did not take the news well at all. Pole (pronounced pole-a) sana is the Swahili phrase for being very sorry. (It was one of the first phrases I learned because I wanted to be able to express my sympathies to patient’s families in their own language.) In the past several months, I have said it more times than I would like to admit. And I told this mama and her other relatives over and over and over.

When we finally were able to get her into a room where she had a bit more privacy, I could still hear her wailing and I was told that she was in complete denial about the death of her child. Although I had explained everything to her (she spoke and understood English quite well), I knew that I had to go in and talk with her again. I knelt down and held her hand, I again told her how sorry I was. I pleaded with her to understand that this was not her fault (she felt that she should/could have done more). And I shared with her my experience of losing my princess.

After my dad died (just a few weeks after Noah was born and only months before I graduated medical school), I had a deeper understanding of loss. I was able to identify with my patient’s families as they said their final earthly goodbyes to loved ones. It made me a better physician. Losing Hannah has allowed for an even deeper understanding of what so many of the families I see have to endure…it is a burdensome privilege.  It was in the instant that I told her of Hannah that she looked into my eyes and she knew that I understood what she was feeling in a way that no one else in that room did. I couldn’t (and even didn’t try to) take away her pain. It is hers and will be for the rest of her life. She is in the valley that we are only now beginning to climb out of. Only Christ can truly carry her through it. All I could do was to encourage her that God is bigger than our pain and that He can and will use it for His glory. Each e-mail and message we receive about the impact of Hannah is a personal testament to that fact.

Anytime a death occurs in casualty/the ER, it affects staff…we wouldn’t be human if it didn’t. Ask anyone who works in the ER and they will tell you that the mood of a department can change in an instant. When a child dies, this change is even more drastic. It can take the best of work days and make them gloomy and downcast. And on this gloomy day, things were about to darken even more. As I was sitting down to document everything that had occurred in that case I heard “Dr. Kelley, we need you in here!” As I ran into our resuscitation room, I saw a six month old baby. I had noticed her earlier as my clinical officer was evaluating her. At that time, she appeared ill but she seemed to be receiving  appropriate care so I didn’t interfere or investigate further. I wish I had…now she looked far worse.

What I learned was that she had been admitted, treated and released from a nearby hospital. The working diagnosis was pneumonia. Because she still didn’t look well, her mama brought her in to be seen by us. We immediately found out that her blood sugar was too low to be recordable. An IV line was impossible to obtain so we made use (for the second time that day) of one of the best donations a casualty department could receive…an IO drill. Very quickly we had access and gave her the sugar she still did not improve.  In fact, she stopped breathing and we lost pulses. As if we were stuck in a bad recurring dream, we again began chest compressions and bagging of this baby. I intubated her and she was given all appropriate medications. A visiting pediatrician (also a huge blessing to us) came and assisted. Again, despite our best efforts, it was her time to return home. This mama didn’t speak English so all I could do was tell her “pole sana, pole sana” and hope that my hand on her shoulder could relay in some small way the sorrow that I felt for her.

Upon walking out of the room I sat down and almost lost it. Losing one baby was bad enough, but losing two within hours or one another?  The words of the first mama rang in my mind. “I just don’t understand! Why would this happen?” I wanted an answer…even more now than before. This isn’t right…it isn’t fair. Intellectually I still know why these things happen…because we live in a fallen world (Therefore, just as sin entered the world through one man, and death through sin, and in this way death came to all people, because all sinned. Romans 5:12). But it still hurts. It hurts to see another human experience the deepest of all pains. I know that pain and today I relived it with great ferocity.

After replaying this mama’s words, the words of a Steven Curtis Chapman song that I had listened to just this morning as I got dressed for work came into my mind (Much Of You).

“And how can I kneel here
And think of the cross
The thorns and the whip and the nails and the spear
The infinite cost
To purchase my pardon
And bear all my shame
To think I have anything worth boasting in except for Your name
Cause I am a sinner
And You are the Savior

I want to make much of You, Jesus
I want to make much of Your love
I want to live today to give You the praise
That You alone are so worthy of
I want to make much of Your mercy
I want to make much of Your cross
I give You my life
Take it and let it be used”

 

Christ can use all things for His glory.  Steph mentioned in her last post some of the recent messages we watched by Louie Giglio.  This is now the testing part of the faith of these families.  The pain they are feeling will be a megaphone to all of their friends and relatives announcing clearly what they believe.

 

I don’t know what pains, trials, or difficulties you are experiencing right now.  It may be a diagnosis of cancer or another disease, you may have lost a loved one, it could be divorce or the loss of a job or so many other things.  Let me also encourage you…God is bigger than every one of them.  “I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world”  John 16:33.  We have been promised difficulties in this world.  But we have been promised that God would help see us through them and allows us to draw closer to Him through the trials.  He has overcome the world!!  Nothing, and I repeat, NOTHING in this world is bigger than our God.  Please read James 1:1-16 and Psalm 91.  For those who are new to reading the Bible, some parts of these passages may be difficult to fully understand but basically we are told to expect trials.  More importantly, we are promised God’s protection and provision through those trials.  It is a difficult thing to explain but if you talk to those who faithfully follow Jesus Christ, they will tell you that when they have experienced an intense trial, they grew stronger in faith and closer to Him.

 

Pain and suffering can be good things although it seems counterintuitive.  But I experience a form of this every day.  Doctors and nurses cause pain…every day.  We don’t do it because we enjoy causing pain, we do it for the ultimate good of our patients knowing that a little pain now, spares tremendous pain latter.  C.S. Lewis wrote in A Grief Observed,  “But suppose that what you are up against is a surgeon whose intentions are wholly good. The kinder and more conscientious he is, the more inexorably he will go on cutting. If he yielded to your entreaties, if he stopped before the operation was complete, all the pain up to that point would have been useless. … What do people mean when they say “I am not afraid of God because I know He is good”? Have they never even been to a dentist?”  

If we truly want to “make much of you Jesus” then we must understand that suffering very well may be involved.  In John 9:3-5, the disciples are asking the reason why a man was born blind, thinking that the blindness was a punishment for sin.  Instead they are told that it was so God’s work could be displayed.  I love the way The Message Bible expresses Jesus’s response “You’re asking the wrong question.”  And so often we do.  We view events from our finite viewpoint that we have now and miss the big picture that God sees.  Our temporary suffering can reap eternal returns (2 Corinthians 4:17).  None of us can fully understand what this means or what it looks like, but God does. He has promised this to us.   And one thing I know full well is that God keeps His promises…EVERY TIME!!!

For now, we must continue to walk by faith (2 Corinthians 5:7 ), trusting in His promises.  It reminds me of the Jeremy Camp son, Walk by Faith.  No matter your situation, God can and will see you through.  He will provide even when we can’t see how any good could come from your situation.

 

If you have placed your faith, trust, and life in Jesus Christ then strengthen that relationship daily, for you never now when the next trial is coming.  If you don’t know Jesus, who He is and what He has done for you then I would plead with you to read the book of John.  If you aren’t comfortable with reading the Bible or it seems weird, try readying it in The Message as it uses more contemporary language.  Here is the bottom line.  God loves you, right where you are.  There is nothing you can do, nothing you can change to make Him love you more.  His love is perfect beyond our understanding.  But He will never force you to accept Him…true love can’t be forced.  Open acceptance of His love and the sacrifice He made for you, ensures that He will walk with you through every trial.  If that doesn’t make sense or if you have questions, don’t hesitate to ask.  I would be honored to share with you some of the truths I have learned.

If you do know this truth and understand this gift, TELL OTHERS ABOUT IT!  I know how scary it can be in those conversations where you know what you should say but don’t out of fear of rejection or ridicule.  I have failed many times.  The next time an opportunity presents itself, step out in faith and watch what God can do.  Will everything work out great…maybe….maybe not.  But God will honor honest attempts to serve Him, every time.

Thank you again for following our journey.  It has been and will continue to be a bumpy one.  Today bruised me up a bit and only God knows what tomorrow will hold.  It may be better, it may be worse.  But what I told that first mama was that “When we get to Heaven all of this pain will be such a distant memory that we won’t even remember it anymore.  We will have eternity to be with our babies and with Jesus.  We won’t even remember the pain.”  Scars are a reminder of a painful ordeal.  I don’t know if we will bear our own scars in Heaven to remind us of the trials we have faced.  I do know that Jesus’s scars remained (John 20:24-29).  But His are different.  Our scars are the result of pain/suffering inflicted by a fallen world.  His scars came as the means to rectify all of that pain that we have suffered.  While I’m not sure if we will bear the scars of this world, I do know that the overwhelming presence and love of God will overshadow any past hurt or regret we could ever face.  May He always receive the praise and honor that is due to Him and Him alone!

 

Prayer Requests

-Pray for comfort and healing for these mama’s and the rest of the families who will now prepare to bury these babies.  May they shine brightly for Christ and exalt Him even in these dark days.

-Pray for my staff and all of those who witnessed and assisted in the resuscitations.  Pray for their healing as well and strength to continue to carry on with the work that must go on.

-Pray that through these (and other recent tragedies) that megaphones of praise will blare out the hope we have through Jesus!

-Pray for the increasing pursecution that we are witnessing around the world.  What is reported is only a small part of what truly goes on.  May the testing of our brothers and sisters create opportunities to share the truths of the gospel.

-Pray for my family as we are preparing to say our last earthly goodbyes to my maternal grandmother.  This would be the second grandmother I have lost in the past months and we again will miss memorial services with family.

-Pray for Levi (and all the boys) as we continue to process the death of Hannah.  Everyday is different.  And a conversation about superheroes or movies can, on a dime, turn to her.  May we provide the love and support they need.  May we point them to Christ.

-Pray for opportunities in your own life to grow in faith and knowledge of Christ.  Pray for opportunities to share this hope.  Take the leap.  Praise Him regardless of the outcome.  He is sovereign.  He is in control.  He is love.

(I apologize for ranting and if there are errors. It’s been a long day and I really felt like I needed to write this tonight.)