At the Bedside

For those who are curious, here are a few of my recent nursing journals:

Wednesday 

There she was, all 8 kilograms of her.  The body size of a small infant, the age of my toddler.  Three years old but sunk in so deep that her eyes looked cartoonish.  Except this was no cartoon.  Malnourished, dehydrated, a slip of a girl, slipping away.  I tried not to stare, tried to make myself useful amidst the chaos of this pediatric trauma unit.  Some of the sickest children I’ve ever seen, in the sweaty heat of an overcrowded ward with 3-6 children per bed.  Mothers laying beside their young, cooling them off with cloths, gripping one another when another precious one drifts away.  So much to do, so few to do it.  Which one should live today, I guess we decide?  I must pretend like the periphery doesn’t exist, I must focus in on only one or else my despair will rise like the din of the noise around me.  It’s all too much and too little.  Too little supplies, too much need, too much loss, too little comfort.  So I focus in on the infant-child.  I try to imagine the face of my own energetic Naomi, instead of the bony bird in front of me and get on with it.  One spoonful of oral rehydration at a time.  Every 5 minutes.  I can do this every 5 minutes. 

Thursday

I picked up her chart, 12 years old.  I barely saw the girl behind her thin blanket.  Her mother, nursing an infant sister, sat beside the bed, staring off into space.  Scattered though the papers of her chart were, front and center were the dreaded words: confirmed biopsy result of osteosarcoma (cancer).  We breezed past this family, “she needs a referral to the cancer team” was all that was said.  Another patient in the lineup of 85 waiting to be seen.  We walked on, but I couldn’t shake this feeling that more needed to be heard, more needed to be said.  Looking back, I took a deep breath and in my broken Chichewa asked the mother how she was.  As she rocked her nursing infant and gazed past her 12-year-old daughter, tears started streaming down her face.  The battering ram of her words hit me like bullets, “she has cancer, she is going to die, what am I going to do?” and on she went.  All she had been told was that it was cancer.  Nothing more.  She wasn’t told that there are some treatments available in Malawi now.  She wasn’t told that there are some doctors who might be able to help.  She wasn’t told anything other than the dreaded word that carried with it certain agony, hopelessness, and fear.  What could I say?  As floods poured out her eyes, her daughter, the recipient of the diagnosis starting crying alongside her mother.  I held their hands, and sat with them in silence: beholding the word that carries so much devastating meaning.  Empty platitudes are meaningless and hollow-sounding in the rushing noise of grief and fear.  What could I say to this mother?  This young girl?  I sat in silence with them and cried alongside.  Knowing things might be able to be done, but as often it is here in Malawi, it might be too late.

Friday

Tragically innumerous neonates crowded into heated beds. Streams of mothers in the hallway waiting to come in to feed when it is time. Babies with their intestines strung up above their bodies in plastic bags: a new study to provide some kind of hope for these babies who cannot be operated on because of their age. Some might live, most will not. The cries haunting me, their need to be held: unmet. Empty IV syringes, temperatures not checked, how can this be? The most precious and the most innocent, but so few to attend to them. The most dependent, and somehow the most neglected. Lack is not the right word. Nurses are trying, doctors are trying, everyone is trying but we are failing because the work is impossible. At one point do the babies just become nameless and faceless? How does one work and not feel her heart break under the enormity of the unmet needs? Like fish out of water, they purse their lips, hungry and in need of suckling and soothing but no one can possibly notice to answer. Yet every hair on their heads is counted. Every number of their days, known. Though some go unseen and unknown, they are fully known and knit together. The only comfort to the loss is knowing that He knows, but still I am raw with the reality of it all. When will this change?