Final journey

I happened to be walking by the ICU and saw Sarah, one of the Alabama medical students, sitting by one of the patients looking profoundly worried. I went up to her and when I got closer, realized that the patient she was sitting next to was all wrapped up like a modern-day mummy.

“What happened,” I asked Sarah. She told me that the patient had come in overnight. A 10-year-old girl with epilepsy. She had had a seizure and fell into the cooking fire, suffering full-thickness burns to 40% on her body surface area, including most of her face and upper torso. She would definitely lose both of her hands, with the possible exception of her left thumb. Her eyes were swollen shut, and so they had no idea how badly her eyes were damaged, or if she would ever be able to see again. That is, if she survived.

“When we got here this morning, she had gotten almost no attention from the night staff. No IV fluids were hanging. And guess what she was on for pain?” I ventured some guesses. Pethidine? Morphine? “Ibuprofen,” she spat out in anger. “So I’m sitting here making sure she gets caught up on IV fluids, making sure she gets morphine. She’s only ten years’ old and she is suffering from intolerable pain. Why doesn’t anyone seem to care?” “You’re here. You care. She’s lucky to have you to advocate for her,” I told Sarah.

Just then, a young woman walked into the ICU and headed straight for the patient. She looked into the little girl’s unrecognizable face, and started crying silent tears. She gently touched the gauze wrapped circumferentially around the little girl’s face, whispered a few words that nobody else could hear, and turned away. We both watched the little girl for a few more moments, and then I slipped away, unable to bear the heavy atmosphere any longer.

The next morning, when I walked into the hospital, there was a huge commotion in the hospital compounds. As it turned out, the girl had had a tracheostomy overnight, and had stabilized. The Alabama students had all taken shifts overnight to watch over her and make sure she received continuous IV fluids and morphine for pain. The night staff was so over-stretched that with all the other emergencies going on, she would’ve surely been neglected without the additional attention afforded by these amazingly caring medical students.

The decision had been made early that morning to transfer the patient to Kigali, for the ability to sedate her and keep her comfortable, for the availability of ventilators. Everyone and their mother had come to see the little burn victim get loaded into the ambulance. The patient’s family had resisted the idea of transferring her. None of them could go with her. They did not have the money or means to return from Kigali. So if she were to die, she would die alone, without her loved ones by her side, and there would be no way for her family to transport her body back to Kibogora. She would likely be buried somewhere in Kigali, far from friends and family. But once her family understood that there was not enough morphine here in Kibogora to keep the patient comfortable, that at the very least, she would be sedated and pain-free in Kigali, and her chances of survival would be marginally improved with the transfer, they relented and allowed her to go, solo, on what will likely be the furthest and final journey of her life.

Death of a baby

Julie, the American nurse who has been working longterm at the Neonatal Intensive Care Unit here in Kibogora District Hospital, sat down in front of the distraught mother. The woman’s husband sat beside hher. One of the nurses stood by, ready to translate. Julie launched into a not-altogether unfamiliar speech. After all, there had been 4 neonatal deaths this month, and it was only mid-February. Julie told the mother that her baby was dying. His breathing had slowed down significantly, the heart rate was very low, the baby was turning blue. “There’s nothing more we can do.”

At first, the mother had no expression on her face. Just a blank look. Julie proceeded to explain to her that her first baby, who had died less than a year ago, had died of a different cause. That baby had died because of extreme prematurity, and this one has some sort of genetic defect. This baby looked syndromic – an odd shape of the cranium, non-symmetric chest, rocker-bottom feet, etc. Hopefully, because the 2 babies died of different causes, history will not repeat itself, and her next baby will be born at term, alive, healthy, thriving.

The mother suddenly burst into tears. The news had finally travelled from her ears and reached her heart. She sobbed uncontrollably. This was the second baby she had lost within the same year. Her husband sat by her, expressionless. He didn’t say a word.

“Would either of you like to hold the baby?” They both said no. Neither of them would even look at the baby. Julie asked if she could pray for the baby. The couple gave their assent. We all took great comfort in her words, words that described happiness, and heaven, and innocence, and hope for the future. Right after the prayer, the couple left the NICU, without even a backward glance, a final embrace, a kiss goodbye, for their dying child.

“That’s the culture here,” Julie told me. “They don’t even look at their child if they know the child is dying. To them, baby is already dead.” One of the American medical students picked up the baby and gently held him. “It’s so sad, someone should hold this baby and comfort him until he passes.” So she held and caressed the baby until he took his last breath.