Tuesday, June 19, 2012


Don’t ask me to play God. 

It’s raining – I didn’t send the rain. 

You are suffering.  Why do I have to be the one to fix it? 

Why did I put myself in this position?  Do I have any business being here?  Did I learn enough to be here?  Did I study enough to be here?  Did I take myself seriously enough to be here?

You are breathing 120 times a minute.  Since I got here.  Six hours later – you are still breathing 120 times a minute. 

I’m sitting there on the bed beside you.  For ten minutes.  Just looking at you.  I’m sitting on the edge of the bed – where the filthy black mattress ends and the solid, concrete, chipped blue painted bed begins.   There is mold and ants and crumbs beneath me.

I look at you.  you are breathing so fast. 

I asked Olen last night – should we be doing more CPR?  I am really doing enough for these patients?  And the real answer is torturous. 

No.  I am not doing enough.

I may walk the extra mile.  I may walk the second one.  I may give you my cloak – but I have another.  I rarely walk the 3rd – and never the fourth.  And even if I did walk the fourth – there is a fifth, and sixth…and a seventh…..how far do I journey with you? 

All the way?  What does that even mean for me?  For my life?  For my sanity?  For yours? 

But what is sanity – and is it really that important. 

I’m sitting here thinking about respiratory acidosis – wishing I had Wikipedia – wishing I remembered….respiratory acidosis.  Respiratory alkalosis.  Metabolic acidosis.  Metabolic alkalosis.  Partially compensated respiratory acidosis.  Partially compensated respiratory alkalosis.

And to be honest – I am mixing them up.  To be honest – the definitions are not clear to me…..breathing fast….blowing off Co2…..trying to compensate……but for what, and how, and the intricacies escape me

My brain feels fuzzy.  I am not qualified to be here.  I am not qualified to sit in front of you.  I am not qualified to be the one that makes the judgment call – what if anything else will I do for you? 

I can’t get your 02 sat.  And even if I could – it would just be another number I don’t have a treatment for.  There isn’t any oxygen. 

There isn’t a ventilator

You can’t sustain this kind of breathing. 

But who knows…. Maybe you’ll be better in the morning.  Yesterday there was a girl who was exhausted, also with rapid resp. rate, tachycardia, fatigue, that old eyes-rolled back in the head look that is all too familar to me – the look before you leave this world – and so – I decided to take the risk – look stupid in front of Olen – have him come look at you anyways – explain I just didn’t like the way you looked – even though you already had 3 days of IV quinine and 4 days of IV ceftriaxone – and he came and looked – he was gracious.  And in the morning – you were better.  You were perkier.  You went home. 

But other times, I see that same look.  I feel that same discomfort.  And you are gone.  You die in the night. 

So many things here are an exercise in futility.

CPR is one of those things.  If you have a kid drowning to death with pulmonary edema from severe malaria – CPR that includes no oxygen and no sustainable life support is just not going to save you

But do you do it anyway?  Just to make yourself feel better?

I don’t do it.  But will it haunt me that I don’t? 

Is there one kid in a 100 that might have made it if we gave CPR???

But back to the baby.  The one year old.  Still breathing 120 times a minute.  You lips look blue.  I wonder what your 02 sat is.  I remember it doesn’t matter.

Well, fever causes tachypnea – take your temperature.  It is lower.  We have already decreased it from 39 C by splashing you with tepid water and fanning – even with no fever – you are still breathing so fast

I walk to the wall – check out the pediatric VS parameters.  1-3.  20-30 BPM.  Awesome. 

So, I’m not over-reacting.

I look at your conjunctiva.  You look pale.  More so than before.  I open your mouth.  Tongue and lips bluish, or is it my imagination?  At any rate…only faintly pink. 

Well, maybe anemia.  You are tachycardic – you are too pale.  Maybe you are anemic….maye that is triggering this rapid resp. rate

So, I call in the lab.  He is more gracious and less grumpy than usual.  We can finally get hemoglobins again – have been transfusing the last several months on clinical presentation of anemia only – but yours is 6.6.  right above the line.  If it was below 6, I would transfuse you.

Not good – but you can support it. 

So I sit there some more.  I watch the fat caramel colored night ants scurry on the floor and in and out of the boxes of medicine, sticking to the gooey spilled sirups and the residue in the dirty cups of tea.  Old powdered globbed tylenol is stuck to the side of your medicine cup.

Cracked boule bowls and a covered chipped ceramic basin of half eaten rice.  Your father is old – he has gray peppering his beard – he is surprisingly mild and willing to pay for your blood test – your mother is just holding you.  looking tired.  I can’t read her face.  I woke her up. 

I wish I knew more.  I wish I had the will power and the dedication and the gumption to have researched more, studied more, taught myself more, put in the time to be a better nurse, a better person

But since I did none of those things, I just sit there.

Ceftriaxone?  No. 

Your eyes are wide open.  Unblinking.  Cerebral Malaria – pupils reactive

I listen to your lungs.  They sound a little tight.  I decide to follow the example of the tchadians and give Dexamathasone.  It doesn’t work for pulmonary edema really – but its harmless  and a slim chance maybe it might help.  At least I’m willing it to anyways.


I didn’t used to give it.  I thought it was a waste of money.  Not treating the real respiratory problem.  But I’ve been getting desperate lately. Throwing everything at a problem and hoping something will stick.

A not so shining example of this is B complex.  B vitamins.  There is a kid that I had another vague feeling about – well, no, it really comes from the fact that one time when I was leaving, maybe a week ago – I noticed a kid I had previously thought was doing well.  He looked more fatigued than usual.  His eyes were half closed – you could see only the whites – and I didn’t even really register the fact that I noticed that until I came in the next morning and found he was dead – and it jarred me and I flashed back to that face and then I couldn’t get it out of my mind – then one glance when I realized that he wasn’t doing well – and then exhausted and un-connecting walked out the door –

So It was haunting me.  So, when I saw the same look in bed 21’s eye, I got a little irrational.  I texted  Olen.  The one thing us nurses can do to at least partially salvage our souls from complete damnation is that we can collect data and pass it off on the Doctors – make it their call – so that’s what I did. 

Well, I pretty much described to him oh I don’t know – what EVERY kid looks like with malaria – and he texted back and said to give B vitamins.

So I immediately wrote for them.  And made the dad buy them.  And gave them.  And wondered what kind of magical healing properties were in B vitamins that could save the kid –

And then I when I tell him seriously that I gave them – and what else could we do – only then did I realize he was kidding.

If he had said to rub the sole of the kid’s foot with a mixture of half sand, half salt and repeat a dozen hail marys at the same time – I probably would have done that too – I get a little crazy sometimes


I felt foolish. 

But I’m okay with that.  Most of the time.

I’m digressing.

120 breaths per minute

I want to call respiratory.  Pass him off to the PICU – call a rapid – get some grey shirts up here, maybe the trauma nurse – page the resident – get my charge nurse to give a second opinion – hash it over with Jessi, or Lauren, or Tessie, or Melissa……..catch the pulmonologist at the computer at the back of the nurse’s station …..

I just want to do something for this kid.  But what?  There was nothing I could think of.  Nothing that I felt like I “knew” that I had to do – nothing I thought I could feasibly throw at the problem.  Nothing I thought would stick.

So I sat there.  And I counted.  And I listened.  And then my shift was over. 

Am I a bad nurse?  Do I have any business being here?  I had the audacity to come here and not even really study up on tropical diseases.

There is so much reading I could do that I just don’t do

Is that morally wrong?  Will I answer for that one day? 

If someone else who was better informed, smarter, more prepared, would that person have had a different answer that perhaps would have made the difference? 

Am I really helping anyone?  I don’t even speak the local dialect or Arab – the people I rope into translating can usually barely speak French themselves – I think I do a better job than the Tchadian nurses – but how can I think that when I can’t even communicate with people?  When I’m fumbling along in a culture I haven’t been here long enough to wisely navigate?

I couldn’t think of anything to do. 

And so I didn’t do anything

And that is what is bothering me. 

And yeah, I would have asked Olen if I thought that maybe he would give me some enlightenment. 

And yeah, I would have bought the kid some meds myself if I had thought that maybe it would help.

But I am not that smart.

Or that stupid.

I am not God.

It is still raining- I didn’t send the rain.

Yet I deal in life and death. 

Without any of the tools he supposedly has at his disposal.

Without knowing the end from the beginning. 

If that is how I feel, how must a doctor feel?

It gnaws at you – knowing you can do more, knowing you should do more, yet feeling a strange inept paralysis creeping over you

I need to change but how.

In many ways, I’m doing the very best I can.

In other ways, I am not

And in many cases, my best is simply not good enough. 

I should have made my best better.

But I have the opportunity to change.  To do better.  To be able to sleep peacefully.

 I need to work harder for the kids - only quit when I know beyond a shadow of a doubt that there is nothing else that I can do. 

That’s the core of it.  Living with myself.

 Living a life that at its core and deepest level and most secret thing that I CAN BE PROUND OF.  THAT I CAN STAND ON.  THAT I CAN STAKE MY LIFE ON.

 Nothing else matters.   What matters is that child that was breathing 120 times a minute. 

Or the one whose heart  rate kept increasing, slowing,  increasing, slowing – the erratic breathing, another one I thought might only have minutes – but was still hanging on when I walked out the door

That’s what matters.  THAT IS WHY I AM HERE.

 That is my commitment that I make to myself.  Right here, right now.  That I will walk those extra miles.  That I will take that extra time.  That I will care about those children – force myself to- force myself to try and try and try and try and do EVERYTHING in my power.

 Everything.  Starting tomorrow – I will do it.  I will try.  Because I have to live a life I can stand on.  I have given up everything to be here.  But that is a mockery if my existence and motivations and actions here are half-baked and distorted.

  I have to live a life that will weather every storm.

  I have to live a life that I can be proud of.

 That is all that matters.

  And all that matters is those children. 

That is why I am in Tchad.

 not to play humanitarian but to be humanitarian.

 and it is harder than I can describe, and it is exhausting, and it scrapes your soul with its chaos and seeming futility – but I’m getting back on that train, back in that saddle.  I have worked through it – and I’m going to follow my path – and no one said it would be easy.  But that means I have to follow it all the more.

 And am not here for the jargon, for the rhetoric, so I can think myself a good person, so I can point out to myself all my merits – so others can think I’m amazing and cool and doing something special.  In truth – I don’t deserve to be here.  In truth – my heart is often black as night.  But I am here.  And so I might fight harder, do better, strive to be worthy of it.

I am not here for appearances. No.  I am here to SAVE A LIFE. I am here TO HELP/MAKE SOMEONE LIVE THAT OTHERWISE WOULDN’T.

 I am here to RELIEVE suffering.  As far as I can in my capacity and with my skill set.  And I am not worthy of that grave and awesome opportunity and responsibility.  But at this time and in this place and in this small way this is my responsibility.  I’m not saying I should have it.  I’m not saying I should have come here.  But I am here. 

 To do my best for my patients.  To not stop until I have tried everything, exhausted every possibility, given everything I have, walked every mile until I crumble and can literally walk no more.

  And I need to do it in such a way and with such intensity that it brings peace to my soul.  That is gives me a true settled bedrock of inner satisfaction.

 So that I can stand on my own two feet and look MYSELF in the eye and say, YOU DID YOUR BEST.  That is all that matters.  THAT IS ALL THAT MATTERS. 

That is the CRUX the HEART the CORE of what MATTERS most in this ENTIRE world. 

that is why I am here -  for the actions.  Not for the words.  Not for the looks.  Not for anything except these people that are starving, these children that are dying, these lives that are breaking.

every decision I make has terrible gravity.  But I will step up to the challenge, I will stand on my feet, I will look square in the mirror and square at the child.  I will TAKE ON THIS CHALLENGE.

 Because it’s the only thing in my life and in the world that actually matters.

To relieve suffering. 

Right here.  Right now.  In this world.  in this life. 

To ease suffering.

Right here.  Right now.  In this world.  In this life.

Because that is the ONLY thing that ACTUALLY MATTERS.    

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