Hospital Life

Thank God for the weekend! Nigeria's currently holding a census, and it has been occurring pretty peacefully for five days now, and everything has been slow. As we expected, the travel curfew for the census has been extended for two more days, so everyone is expected to stay home tomorrow and Monday as well. Of course, the hospital continues to work but everything else is pretty much closed. I still hear a lot of traffic and noise outside of the compound, so I’m sure there are many people not obeying the curfew, but I’m not surprised. Who is going to catch these people, anyway?

I myself was counted yesterday. Though the hospital is officially on a “holiday” schedule, still the urgent care and emergency room must be running. So I was taking call with one of the doctors when the census takers came. They were actually quite nice and it only took a few minutes. I was surprised that he wanted to count me but he said they counted everyone who was in Nigeria for longer than a week and was here during the census. I had heard they were asking questions about what languages you speak, how many cars you have, what religion are you, etc, but he didn’t ask me any of those questions. He mostly asked questions about where I lived and education and career, if I was married, how old I was, etc. Then he fingerprinted me and marked my thumb with a permanent marker, almost just like they did in Iraq to show they voted!

Yesterday was also a rough day for Marion, Becca, and I. We had been trading calls Thursday and Friday and had been seeing many interesting things. We see a lot of malaria, typhoid, diarrhea, rashes, work injuries, road accidents, urinary tract infections, and fevers from who knows what. It’s different from the US in that when you come to the ER, few tests are done here. Most people can’t afford many tests and there are few facilities to have them done anyway, so usually we just do a physical exam and treat based on the history and our findings. Sometimes we do lab work, but only if we really think we need it. Plus, the lab wasn’t working yesterday! In addition, everything must be paid first by the patient before it will be done, even lab work, so sometimes they have to find the money first and this can take a while.

Anyway, yesterday was slow but we did have a little girl come in who was very ill. Blessing (not her real name) was 1 year old and was severely malnourished. She was painfully thin, dehydrated, lethargic, and breathing in very fast, noisy little gasps. Her mother explained that four days ago, Blessing started having diarrhea and vomiting. They took her to the doctor and she was given an antibiotic. The antibiotic didn’t help, and last night Blessing began to breathe in those little gasps. The father said Blessing didn’t sleep all night. I was very puzzled, because the parents looked rather healthy and well fed and was very concerned about her, so I couldn’t understand why Blessing looked so underfed and why they had waited till the morning to bring her in. However, there are so many factors that could account for it. One thing is that they were first time parents and might not have realized Blessing was quite sick last night and should have brought her in as soon as she started breathing strangely. After all, everyone gets vomiting and diarrhea here and usually antibiotics make it better. Another thing is that some tribes here don’t believe in giving children high protein food because they think it might bring something bad to the child; for instance, children might not get poultry products because the tribe thinks they’ll then have a tendency to become a thief. So even though the child is fed, he/she might be lacking the right sort of nutrients. Finally, I wondered if the child might have HIV. The family had never been tested. She was admitted to try to hydrate her and give her IV antibiotics.

This never happened. She was taken away to pediatrics, and because she was so little, no one could get an IV in her, though everyone tried for a long time. When they finally did get one in, it was into a small vein, and it is hard to get more than a trickle of fluid into a small vein. When the chief resident tried to inject some fluid into the IV, the fluid couldn’t go in and instead splashed over Marion’s and Becca’s faces. The mother was quite worried; no one had told her what was going on but she knew something wasn’t going well. Becca was able to talk to her and pray with her. Unfortunately, the child died soon after. The mother was hysterical and ran outside, and no one could find her.

To make matters worse, the lab soon reported that Blessing had been HIV positive. This means she most likely had gotten infected from her mother, and the father was therefore probably infected too. This whole young family probably had HIV but no one knew, until now. And, since the fluid that got splashed on Marion and Becca contained some of Blessing’s blood, they now had the tough decision of deciding if they wanted to take anti-HIV medications or not, which is a big decision; the medications are expensive, have lots of side effects, and you have to take them for a long time. Based on their individual exposures, Marion decided to, and Becca did not, but both were quite shaken.

And where was I? I wasn’t even there. I had gone home to get lunch. Usually, we try to keep it to two of us at a time, as three medical students in one situation can be a bit excessive. But I felt bad about everything. I felt bad I wasn’t there. I felt bad that I hadn’t thought to stop and see Blessing before I went to lunch. There is a certain blasé attitude about death and pain here. In the US, we spend lots of money trying to save people in everyway, and if someone dies, it’s almost like it’s a failure. Here, it’s the opposite. If someone is very ill, it’s almost like they feel, why bother? We don’t have the resources to really try to save them and they’re probably going to die anyway, so no rush. I don’t know how to deal with this attitude, I feel we should probably have something between the US’s and Nigerian’s attitudes. I find that I’ve very easily fallen into an attitude of, “I know this is not the way it should be, but I don’t know how I, a lowly medical student, can do anything to change it, or how to be different, so I’ll just follow their lead.” I think I need to learn to fight this, to learn that I can love these people no matter what goes on around me. I can take the time to pray with them, and talk to them, and counsel them, even if it’s hard to communicate due to language and cultural issues.

I also wonder if my own attitude towards death is right. I have been volunteering with HospiceCare for 3 years now, and all of my patients die. Yet, though it is sad, it is not terrible to me. I see death as a natural part of life, and everyone is meant to die. It is sad that some people die in pain, or die when they’re young, or die a “preventable” death. Yet, we can’t save them. We aren’t meant to save anyone, only God does that. And if He chooses to take someone, it is not our mistake, or our failure, it is His way. So though Blessing’s death was very sad to me, it wasn’t depressing. It makes me feel heartless, though, to be so prosaic about it. What did keep me up all night was wondering if anyone told Blessing’s parents that she had HIV, and if anyone counseled them on what it meant, that they had to get tested and the implications for the family. I kept waking up, wondering how I could have loved them more, and wishing I had been able to pray with them and be with them as Becca had. So please pray for Becca and Marion, for Blessing’s family, for the doctors, and for me, most especially that we might let the Lord work in us through this situation and the next crisis we encounter be handled with more grace and love.