I believe we just saw a situation in which God let us know that an event which we would call tragic was actually according to His will.
Casualty (our Emergency Room) was quiet in the cool of the morning. The three beds were empty and the staff were chatting socially. Our Family Medicine Resident, Yulu, and our PA, Derek, and I decided to hold a resuscitation drill. We invited the Casualty staff, and two nursing students were interested in participating. I went to the storage area on the far side of the hospital compound and brought out our old CPR manikin and the ventilation bag and mask which we had stored with it. We moved our “crash cart” and its defibrillator next to the bed and started to attach leads to the manikin “patient.” I was disappointed to see that all of the defibrillator pads had been used but not replaced from storage, so made the journey back across the compound to retrieve a new supply while Yulu taught the students some of the operations of the defibrillator. After I returned, we showed the nursing students how to attach the cables and leads properly and we proceeded with our teaching case drill.
Abruptly, one of the clinical officers stuck her head in the door and said, “We need you.” A lady had been brought by her family, unresponsive. The lady was young, about 40 years old, and did not appear to be chronically ill. But she was entirely unresponsive. We all joined in her care. She was breathing rapidly and her heart rate was a little fast, but she had a normal blood pressure. Her blood sugar was normal. Why couldn’t the monitor read her oxygenation level? We tried another device with no success and gave her 100% oxygen. Her heart sounds and lung sounds were normal. Her eyes were open but pupils weren’t reacting very well. The family said nothing unusual had happened and there had been no trauma. She had taken her usual medications. Her daughter, a young adult, was distraught. What was going on?
Yulu said, “She has stopped breathing and has no pulse. Start CPR.” We brought the “crash cart.” We needed to attach defibrillator leads. Glad for our opportunity earlier, I handed the pads to the student nurse and said, “Attach these. You know how.” And she did. I was also glad we had discovered earlier that we needed to resupply the pads. We didn’t need to shock our patient, but we kept the defibrillator in case the situation changed. We used our suction device (glad we had that out for the drill). We asked for a bag and mask, and I was again disappointed that all had been used and not replaced. But we had the one that we had been using for training with the manikin, and brought it out. There had been no delay.
Our patient had normal electrical heart rhythm on the monitor, but no pulse. We gave adrenaline and started chest compressions which produced an excellent pulse. Then she regained her own pulse so we stopped compressions. Still no oxygenation level on the monitor. We tried to intubate but the situation made it technically difficult. So we used one of the only LMA devices in the hospital to be able to breathe for her. It worked well.
Someone had called for the chaplains, and our Evangelist, Nancy, came. I explained the situation to her and that we had tried everything but we were not being successful. We prayed and she went to the family to update them.
Then our patient's pulse stopped again, and we started chest compressions again and called for the ultrasound machine and looked at everything but we couldn’t find a reason for the dysfunction. Normal hydration, normal lungs, anatomically normal heart but now with slow beats, no unusual fluid anywhere. The blood count returned with near-normal values. No clues. We tried fluids, drugs, maneuvers, and more, to no avail. Her own heart rate had slowed to about 20. She was dying.
The pulse would sometimes return and we would stop compressions, then the pulse would go and we would resume compressions. We rechecked the history with the family and reexamined her and asked for ideas. The Medicine team came and helped with ideas, compressions, and tries.
Yulu said, “Shall we continue?” I was surprised that I had lost track of the time. I asked how long we had been doing CPR. “About 40 minutes, Daktari.” We looked again with the ultrasound machine. The heart movement was minimal. Any further action was futile.
Nancy was there. I told her that we had done everything possible in our hospital and that she had died. We needed to speak with the family. She said we should wait and that she would prepare them.
We stopped the resuscitation attempt at 11:55. We reviewed the events of the attempt, asked for questions and asked if anyone had concerns or reservations or burdens. We should have prayed collectively, but several did individually. No one knew where Nancy had gone with the family, so I called her. “Dr. Jim, come to the Chapel.” There were sounds of singing in the background of her call.
Yulu and I went to the Chapel, which is in the heart of our hospital compound. There were over twenty people – family, neighbors, friends; they had come as soon as they heard something was wrong. The daughter was sitting and crying just inside the door, being hugged by two ladies on either side. Our Chaplain was speaking to them, mainly in the Kimeru language. It became obvious that some in the group only spoke Kimeru, though some also responded in English and Swahili. Yulu and I sat among them.
After the Chaplain finished his words, he asked us if we had something to say. Yulu stood and gave a very compassionate account of what had been done, speaking mainly in Swahili with some English. Well said.
Then a mature lady stood and gave one of the finest speeches I ever hope to hear. She spoke directly to the daughter, who was still in school and had lost her mom and still had younger siblings. And she spoke indirectly to the rest of us. The lady introduced herself as a neighbor. She gave testimony to the life of the fine and generous lady who had died. The mature lady explained that when she was a girl, she had three younger sisters. Her mother died giving birth to the only son. The death occurred at our hospital long ago. And despite heroic efforts, the boy died, two days later. And the lady gave testimony as to how God had raised her, and had seen to it that she had what she needed. She was not allowed to leave her education, and the community had joined with her in raising the family. All of her siblings had finished their education and were well.
She said to the daughter, “You will finish your education. God will be your parent. And you will find Him faithful, as I did. We will see to you and your younger ones.” She challenged all of us to do this. It was a beautiful act of the Body of Christ in the midst of a very difficult time.
I needed to say something, too, and the Chaplain gave me the time. So I spoke to the family and told them some of the remarkable things that had happened that morning. I can’t remember the words, but the sentiment went something like this:
Lord, God of the Universe, who made our souls and gave us life, you say in your Word in Psalm 116, “Precious in the eyes of the Lord is the death of His saints.” You also have said , “'See now that I, I am He, And there is no god besides Me; It is I who put to death and give life. I have wounded and it is I who heal, And there is no one who can deliver from My hand.” We surely did not ask for this event today and we do not know its purpose. But it is clear from these people gathered that this was a loved woman who was very important in the lives of many. And believing the testimony presented here that she was one of your children, we know she is rejoicing with You right now.
Lord, it is remarkable to me that as we were trying to keep this lady alive, we had everything available to us right away. Even the things we found missing in the morning, we had replaced. Even the training we did this morning helped us be prepared to help her. We had all of our tools, even the uncommon ones, immediately available. We had lots of help. Even now gathered here, this excellent lady was here to give us a very fine word and encourage us all with her testimony of your goodness. I believe you have arranged all these events to show that you brought this about in Your perfect will and for Your perfect purpose. We are not so foolish as to think we know better than You. We bow to Your wisdom and Your timing. We are grieved at this loss, and we ask for Your blessing. You have said, “Blessed are those who mourn, for they shall be comforted.” Let it be so.
It was difficult to leave this gathered group. God was doing something.
Three days later, I met with our Chaplains for our weekly combined training session. They spoke of the death and what happened after. They said the family were so appreciative. The family were grieved, to be sure. They were mourning, but not as those who have no hope. They were mourning as those who have confidence in a sovereign, good God who had seen to it that all human effort had been tried. There was no reason to despair that the medical care had been poor or uncaring. It was the best available, with many good doctors and nurses and clinicians trying their best for a very long time. This was something that God had done. What a kindness!
I am convinced that God’s highest plan was for this lady to be “permanently healed,” as Nancy calls it, and go to Heaven. And in His kindness, He arranged for there to be no “what ifs” regarding the medical care. What must that mean to the daughter? What does that mean to those of us who tried and “failed?”
There are times in the service of the Good King when I have to kneel down, put my sword down, and just worship because of something He has done.