One Glad Morning When This Life Is O'er...

I started writing this post a few days ago, the same day Jamie posted about this experience, but it was hard to put it all down into words in such a short amount of time. But here it is. Spoiler alert: might want to grab your tissues first.

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We’ve had many great days in Rwanda, even when we’ve been working hard. Today wasn’t one of those…

I lost my first patient.

It began like any typical day for Team Pediatrics. NICU, newborn, wards… During the middle of our first wards room, Dr. Peevy received a call from Julie that a mother of a term pregnancy was about to undergo emergent C-section for a prolapsed cord. Dr. Peevy sent Jamie (our NICU nurse) and Katy up to standby during the C-section in case the baby needed resuscitating. Within minutes, Dr. Peevy receives another call – this time, Katy, explaining to Dr. Peevy that this one baby with a prolapsed cord was actually three very small preterm babies – two girls and a boy. So up the hill we ran.

From there it was a whirlwind. The resuscitation room was chaotic. Three tiny babies and many adult hands trying to revive them. Making room for all three in the already packed NICU (as you might remember from my previous post is quite small). Trying to find enough plugs for all the monitors, oxygen concentrators, incubators, CPAP machines, and other various equipment. After moving them all to the NICU and evaluating them, it was clear that the little boy I had helped Dr. Peevy resuscitate was in bad shape.

This is Rwanda. They don’t have surfactant. The only mechanical ventilation they have is our team making a schedule and taking turns hand-bagging. Our experienced NICU nurse Jamie and Dr. Peevy both agreed – palliative care was the only option.

Julie wrapped him in a blanket, put on a yellow hat, and handed him to me. I immediately put my steth in my ears and listened for a heartbeat. But Jamie said, “Don’t even worry about that right now. Just hold him. And talk to him. And love on him.” 

So I did.

And I cried. And I rocked him. And I prayed. My first prayer, I admit, was an incredibly selfish one. I prayed and asked begged God to please never put me in this situation with any child of mine. Then I prayed that God would take him quickly and painlessly, and help me to let him feel love for his short time on the Earth.

 Jamie told him to go play with all her little babies who were already happy in Heaven with God. I told him that, too. I told him that Heaven was a wonderful place where he could breathe so easy, and God would take such good care of him. I even told him to find my grandmother so she could hold him, since she never got to hold MY baby here on earth. Then I sang to him. First I sang a song I used to sing (and still do occasionally) to Angel called, “If I Were A Butterfly”. But I kept tearing up at the line “…and you gave me a smile…” because I knew this little guy would never get to smile. So many things he would never get to experience. Then I sang a few verses of “Amazing Grace” to him. It seemed fitting. It always is.

Then I thought about one of my favorite hymns and how fitting it was for the situation – “I’ll Fly Away”. I’d been telling him how wonderful Heaven would be, but I was crying. Seemed like a mixed message. So I sang it over and over, at least 5 times in a row. The first couple times were for him. The others were to convince myself that this was what was best for this sweet child. Even though he wouldn’t know the wonders of the Earth, Heaven was infinitely better than any of it. And God’s love is so unfathomably great that it makes even a mother’s love seem like less than a casual acquaintanceship. This is something that I feel is easy for Christians to say, but incredibly hard to feel while waiting for the inevitable death of a loved one.  Afterward – much easier. But before – almost impossible. But I knew it was the truth. If he did survive, he would have had significant impairment, considering it was HIS cord that was prolapsed, and that it was quite some time after delivery that he’d started attempting to breathe on his own. He would be free of those burdens in Heaven. There wouldn’t be a struggle to breathe. And his little tiny body would be perfect.

Sometime during all this, it became inevitable that his sister would also not make it. Micki wrapped her up and held her, too. So we held them together. Talked to them. Rocked them. And loved them.

To understand the next part of the story, I need to explain something. The Rwandan culture is historically a very stoic culture. They never show outward signs of emotion, and are discouraged from childhood from doing so. Most of the mothers in the pediatric wards will tell their children to stop crying if they even make a peep. This has been especially true since that dark part of Rwandan history a couple of decades ago, that I feel very uncomfortable mentioning while still here. The NICU nurse Euphrasine explained that the country did so much crying during that time that they had finished all their crying. They shed so many tears that they had no more to shed. So they don’t cry, with the exception of the memorial week for said dark times. Only during that week is it acceptable to show emotion publicly. That week begins April 7^th.  Also, here mothers do not name their children until they are two months old. If the children die in the hospital, generally they don’t even want to see them. Most of this stems from the high infant mortality rate in this country. Most mothers have lost a baby or two here.  It’s a coping mechanism so they don’t get attached before they know they are going to survive.

The first unexpected event that happened was that Euphrasine actually cried for these babies. In the NICU. In front of the mothers of all the babies. The last set of triplets that had been born nearby had gone somewhere else and didn’t survive. They were excited for the chance to try to make a difference in these babies and keep them alive. And we just couldn’t.   

The second unexpected thing came after Julie and Euphrasine told the mother that she was losing two of her children. The mother actually wanted to see them and hold them. Julie and Euphrasine took them to her. She prayed over them and told them to go forth to Heaven.

Micki and I had been standing by and considering if we would continue to hold them until they passed. Once I found out what would happen to them if we didn’t, I decided I was absolutely holding him. So we sat in a private room and each held and rocked a baby while sitting on a bed, talking with Julie and Euphrasine.  I checked his little heart again. This time, I didn’t hear it beating. I asked Jamie for confirmation. She concurred. And, I think in that moment, I felt a release. I felt comforted by the fact that he was with Jesus and he would get to play with his tiny sister very soon.

And we still had our tiny Sunshine. This is the name we gave to the last remaining triplet. The tiny, feisty one. The one who looked as if she had the best chance of surviving. She was our sunshine on such a  cloudy day. Micki even made her a yellow hat. We prayed that the Mama would have at least one baby to take home with her. And she held her own for a little while…

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-- Mary Margaret