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.
