Life and death. I never seen so many births and deaths in my whole life. And it so happened my grandpa passed away during this period too, though i wasn't there. 31st of July. A few days short of his 92nd birthday. It's a comfort to know that he left us really peacefully while being cared for lovingly by my uncles and aunty, and I'm sure that God led him back home safely. To a land without anymore pain or suffering. Where breathing ain't a chore. Rest in peace grandpa, or shall i say, see you celebrating there in heaven?
1st of August. We were brought to the Kamar Operasi Besar, or what they called KOB (pronounced KA-OH-BAY, the indonesian way), or what we call Operating Theatre. A lady was scheduled for C-section, or what they call Seksio C, or Seksio for short. Ah, the joys of learning their medical terminology. And there we were, surrounding the table as the surgeon and doctors and nurses worked quickly. They struggled to grap hold of his head, but succeeded in the end. With a firm grip, the surgeon gripped that tiny little thing out of his mother's womb, as we waited anxiously for the first cry. The other doctor quickly sucked fluid out of his mouth and nose. And the silence of the theatre was broken by that first cry. The relief felt at that moment was overwhelmed by that feeling of awe, of how at that second that baby is alive in this world. Despite being so fragile, so small, he is alive.
2nd of August. After my first Indonesian church service, we went to the hospital. (We are just such rajin 'attachers', we attach like leeches to the doctors there.) Shortly after being there, Dr Paul splitted us up into 2s and Sue. And shortly after that, 2 of us ended up with an invitation to see a kelahiran secara spontan, or natural birth. My respect for mothers shot up through the roof after that. It is just not easy to push someone out through that small hole through your pelvis. The atmosphere in that room was really not unlike a pit stop. The mother being the car and a whole team involve to make sure all parts of the car were ready for that rush of the baby out of the pit stop. The dad was in charge of wiping away the sweat and feeding the mom with sweetened ice tea (no it's not sterile conditions, but it's not horribly dirty either). One doctor came in as a supporter, to motivate the mom to push. "Semangat ya, bu!" "Sedikit lagi!" "Hampir! Sambungkan sambungkan!" "Lihat sini, lihat sini!" "Sekali lagi!" "Kumpulkan tenaga, bu!" The nurse checked the drips and fetal heartbeat every 10 minutes. The other doctors watched patiently at the end of the bed, with gloves, a pail, scissors, clamps and a separate small little table ready for the baby. After about an hour, the baby's head finally got past his mother, and he was crying and alive!
3rd of August. We girls decided to follow Dr AGS as doktor jaga, or what we call on-call. Dr LA the surgeon, was also at the doctor's room that night, and we were talking quite a lot. There were hourly visits to the ICU as a dengue patient was really unstable that night. She was only 7 years old. She was in the critical period - the 7th day after suffering from dengue. Recovering from a shock, she was given IV fluids, but fluid balance is just a really hard thing to acheive. Her BP improved but she then had fluid overload, fluid rushing into her pleural cavity, pressing against her lungs, making it hard for her to breathe. Every breath seems like such a chore. It required every muscle on her just to breathe. Though there were only one on-call doctor for that day and one on-call surgeon, there were 2 other doctors present. Late into the night. All discussing whether intubation or inserting a chest tube would be better. Or even not doing anything. The parents refused a chest tube, which parent would not hesistate to insert a tube the size of a finger inserted into the tiny chest of a 7 year old child? But it was risky anyway, a chest tube or intubation might cause the child to bleed, and bleeding in dengue cases is just bad because dengue patients have low platelet counts which means slower clotting. In the end, they decided on neither, but a nasogastric tube. A tube down her nose to her stomach, to release the air there and hopefully help the lungs expands a bit more.
That fateful night. Just as we were commenting on how the BP was stabilising, O2 Sats getting better, and talking about dengue to the surgeon sitting on a chair, he leaped out of his chair and rushed to the bed. 2 other doctors were already performing CPR. The child laid there, unconscious as the parents just stood there, helpless. We too, stood there, helpless. Her sister just visited her a few hours ago, and she was conscious. But there she was, laying without a breath, the monitors running wild, as the doctors took turns pouncing on her bed and giving CPR. Half an hour later, which really felt like a whole day later, the surgeon left the room, and mumbled to me with a tear in his eyes, 'We lost'. I felt as if the whole world was crashing down on me. I never felt so defeated, even though it wasn't my battle. I really didn't think she would go. I really thought that she would manage to pull through that night. The other doctors were not giving up yet, but this surgeon - he has worked long enough, perhaps, to know. Her legs were getting paler as every second past. Tears were flooding the room. The mum already left the room, not bearing that horrid sight. The dad rubbed her legs that entire time, probably in denial that her legs were getting ice cold. Grappling on to that fine line of hope as tightly as he could. No, he wouldn't give up before the doctors. The doctors too, had tears in their eyes, as they struggled to keep up the 100 times/min pace. They took turns to check her light reflexes and heart beat, or the absence of one.
It must have been at least 1 hour, at 1 plus in the morning of the 4th of August, she was gone. It was a hard sight to watch. On one hand, deep down inside, we know that God is with the child, and she'd be in no more pain or suffering. But on the other hand, all of us were struggling to accept reality. The tears, the effort proved that. Why would God rob us of this child? Why would He rob the parents of this child at this tender age? Was He not there when they were all crying out to Him as they did CPR? Was He not listening? Why this child and not an old man? Why a 7 year old child who has a younger sister? Questions. Questions. None audible. Nobody was talking audibly. The tears did all the talking. The doctor-in-charge of the patient had a hard time writing the report, and completing all the paperwork with her swollen, red eyes. The nurses too, shed tears as they cleaned her, removed all the hospital materials, and changed her into her favourite clothes, with bright coloured cartoons. The parents helped, speechlessly. Her mom paced between her bed and the toilet, entering the toilet a few times. Everyone just manage a short pat on each others' shoulders, and that spoke volumes too, without words.
And there I stood, feeling humanly small. We in the medical field do so much, learn so much, just to try to cure, try to make patients comfortable, try to change the outcome in our favour. But sometimes, our favour, or what we think is best isn't the best way, and isn't God's will. But we battle it out anyway, trying to help anyone we can. Just sometimes, maybe, sometimes, we really take it as our sole responsiblity to see people cured fully, their parents happy, when it really isn't. At the end of the day, all we human doctors can do is try to help those who can be helped medically, comfort those who can't and their family, trying our best to show love in the darkest hours. Indeed, many, we can help, but life and death, are all in the hands of God alone, and who are we, mere humans to question Him. He has it all planned out, all in His hands, and there are times we just got to say, 'You know best, Your ways is higher than my ways, your thoughts are higher than my thoughts'. There are some lives destined for us to save medically, by His grace, but not all. All we can do is try, and after all is done, move on because we who are living have to keep on living, and living lives that count.
During the next week, I saw another C-section, (and assisted suturing). It was an emergency C-section. The mom's water has broke 2 days before the surgery, but was not having enough contractions. The dukun kampung told her to push and push, and all she pushed out was more amniotic fluid. If she stayed at her village for a few more days, all the amniotic fluid would have been gone and the baby crushed, succumbing to the forces of his mother's womb's contractions. That would have been an ugly sight. A deformed baby at best, a miscarriage as the worst case scenario. Thankfully, the surgery went smoothly. And the baby, despite the challenges he had, even in his mom's womb, was brought to life in this world. A new life. A new day. The Lord gives and takes away. Blessed be the name of the Lord. And thanks to the doctors there, by God's grace, they have save this child's life. Fragile as he is, he is still a precious gift, a mother's first child.
Earlier that morning, another baby was born, also an emergency C-section. Except that it was more delayed that the case mentioned earlier. The baby was already swimming in his own faeces, toxifying himself if there's such a word. I wasn't there, but those who were there said it was a sea of green. The mother was only 19. I remembered clearly because that's my age, and I can't bear the thought of having a child right now, though I often fantasize having one in the future. It was really too late, but the child was still alive, barely alive. Oxygen saturation was low, and he wasn't crying. He had normal reflexes, or so I was told. APGAR score was very low. He was placed in an incubator and brought to the ICU, where this little but strong baby battled it out for a few days. Left alone in a box, apart from his mother, unnamed, he still battled it out. The doctors and nurses called him the ICU baby for convenience sake. And everyone really looked out for this little one. One night, the ventilator was facing some problems and a senior doctor stood by him and manually ventilated him for quite a while. A few people took over for a few hours before the ventilator was fixed, and he still battled it out. There were no signs of improvement, but his heart went on. It wasn't till we left, he finally succumbed. The story of the ICU baby, though now ended, will live on in our hearts. The tale of the little strong one. The way he looked at us, teared, held our hands when he still could.
While we were there, there were 4 more deaths. One was another dengue case. She too was a fighter, but God had better plans. Dengue. I can't help but think, if dengue affected some other developed country with lots of resources in R&D, dengue could have already be rid off this earth. It is one cruel, unpredictable disease, preying on the weak, the young, the defenceless. Another death was result of a road traffic accident, and another due to post-surgery septic shock. The last one was an old man who died the moment he was wheeled in after being transferred from a hospital in Pontianak. I can't help but question again, why God decided to take him then. Why let them travel that arduous trip from Pontianak, 5 hours on a bumpy winding road, why not let him go peacefully? Why give the relatives a tinge of hope just to crush it the moment they arrive? Why? Why let there be so many deaths in one day? Why dampen our spirits? The wailing, the pain, the tears, the broken hearts - why? I thought after I've witness my first patient death, the subsequent would be easier. But it still hurts. It still does. As deep as it does the first time. Losing someone is not human instinct. Dying is against our instinct to survive. Dying in a struggle is hard to see. Struggling to keep the dying is also hard to see. But, as the indonesian song "Tuhan punya Cara - Edward Chen" goes
Sebab Tuhan punya cara,Yang tak terpikirkan olehkuTuhan punya jalanYang tak terpahami akalkuKu yakin pasti rencanaMulahTerbaik bagikuHatiku s'lalu percaya kepadaMu.
No comments:
Post a Comment