The First Call

The baby was full term, but exceptionally small, and struggling to breath when I met him. His mother had just delivered, and was still bleeding as she looked longingly at her new son. There was no joy on her face that most mother’s experience after delivering a new baby. There was only concern and ambiguity.

This was my first call. I have been well pampered by Tansen Hospital during my orientation and last month of language training, so even though I had been at the hospital for about 2 months, they hadn’t put me on the call schedule. Call was something that I was dreading. I am trained in internal medicine, or as a grown-up doctor, and find it easiest to explain to people what I do by what I don’t do. “I don’t do surgery, I don’t deliver babies, and I don’t play with kids.” Well, these lines are now blurring for me, and while this is still my mantra for my day to day work, when I’m on call the best I can say is “I don’t do surgery… or at least they haven’t asked me to yet.”

There is a network of people at the hospital that, for the most part, keep the head medical physician sleeping soundly during the night. There are excellent nurses, including superb mid-wives who manage all of the normal vaginal deliveries. There is a resident and intern, who address all issues initially and can handle most admissions. It is only when there is an issue that is too perplexing or so critical that the head medical doctor will be bothered.

My first night on call I made sure that all of the patients in emergency were sorted, grabbed some dinner, and then came back in to check on things. The resident on that night, a good one, told me to stay home and he would call me if there were any issues, but I thought I would sleep better if I saw things were going well before I headed to bed. I walked around with the intern checking in on all of the wards, making plans for some patients with stroke and alcohol withdrawal who had recently arrived in the emergency room, reassured a mother who’s baby had diarrhea on the pediatric ward, and then made way up to the maternity ward, the place I feared the most.

On arriving, we found there was a mother with failure to progress in labor, and required a cesarean section. Thankfully there are a team of surgeons who are on call to take care of this. Tonight it was an orthopedic surgeon who would be operating. This would be the first cesarean section that I would be watching since the operation that brought my 5 year old son into the world. Everything went very well and a plump baby came out screaming and kicking. Those cries were music to my ears. I even teared up a bit, as I often had done in medical school when I watched deliveries, and took pictures as if I were the proud father.

C-section delivery

After leaving the operating room, the resident and I wandered down to the emergency room again to make sure there were no issues before I headed home. Things were just about wrapped up when an emergency call came from maternity. There was a “flat” baby. The resident ran ahead while I quickly walked behind. We found this baby not crying, and laying limp on the examination table using all of it’s effort to try to move air into it’s lungs, accompanied by grunts. There was little to do. We put oxygen on the baby and moved him to an incubator to keep him warm. There was no sense in intubating the baby, since there was no ventilator to breath for him if we did. We found the father and explained things to him. His face was blank, and he didn’t make any eye contact as we delivered the grim prognosis. The baby certainly was not going to make it through the night.

I found my eyes welling with tears for the second time that night, at this second delivery, but for the opposite reason. One healthy delivery with promises of a long life. One who would live only hours. I remembered why I had chosen not to go into OB or pediatrics. When an adult dies, it is often because of something they did to themselves. They smoked. They drank too much alcohol. They let themselves get overweight. They slept around. And even if they hadn’t done anything to “deserve” their sickness, at least they had lived some good life.

This justification is nowhere to be found with babies. They are completely helpless and are victims of the fallen world they are being born into, full of sin and sickness. My sadness turned into anger. Why was it this baby had been born here without any of the technology to offer it a chance at life, as my son had had? My son came into the world smaller than this one, but had a full fledged ICU to nurture him into the world. This child was stuck with an internal medicine doctor who could only put on some oxygen and place him in a warm box! Then my anger turned to helplessness. There was nothing more to do. Nothing but to pray for this small child. Pray that God would gently welcome him into the next life, after such a brief life here in this World.

These feelings were made only more acute as I was recently reading through my emails. One of our fellow families in Samaritan’s Purse’s Post Residency Program who are working in Kenya had sent out a message. Their daughter Hannah had fallen gravely ill. She had been crying and vomiting for the last week, and not responding to antibiotics. She required a feeding tube as she was losing so much weight from her illness. Then things turned nightmarish yesterday. In the middle of the night she stopped moving as she slept on her mother’s chest, and was found to have no pulse. Her father (an emergency room physician) had to resuscitate her multiple times as they made their way from their house to the emergency room of the hospital he worked at. She was then intubated by her own father needing a machine  to breath for her, and placed on medications to support her blood pressure. Through the night her heart stopped several more times, requiring CPR each time, and had seizures. Eventually she was stable enough that a CT scan could be done which revealed the next chapter in the nightmare- a brain tumor. By God’s grace, at a hospital several hours away in Kijabe Kenya, there was a world renowned pediatric brain surgeon from America. They made the drive over, and soon after arrival she was in surgery to remove the tumor.   Even with this excellent care I was shocked and saddened to read the e-mail that Hannah, is now with her Savior. “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts… and my word will not return void.”

It is easy to smile at God and say he is good when life around us is easy, and things are going well. But the ambiguity of all of this wrenches my heart. The question “why” is so easy to ask, but there are no easy answers. I think of Job, after God had allowed Satan to destroy all that he had, including his wealth, health, and family. He asked God “why,” and the response he received did not remove any of the ambiguity of the question, but did offer some perspective. Twice God, in no concise terms, laid out how foolish Job was to question His ways. In Isaiah 55 it says “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts. As the rain and the snow come down from heaven, and do not return to it without watering the earth and making it bud and flourish, so that it yields seed for the sower and bread for the eater, so is my word that goes out from my mouth: It will not return to my empty, but will accomplish what I desire and achieve the purpose for which I sent it.” So what is God’s purpose? Is it always my happiness and comfort? Is it His own glory? How do dead babies glorify God?

The rest of my night of call was eventless. I slept shallowly waiting for my phone to ring with the next emergency, but it never did.

I was still wrestling with my feelings as I walked into the hospital the next morning a bit early just to check to make sure nothing had been missed. “Why?” I continued to ask, knowing full well the answer was beyond me. His ways are far above my ways, and from where I was standing, nothing was clear. The slogan of the hospital rang through my head… “We treat, Jesus heals.” I had done all I could for that “flat” baby. It was completely insufficient to save him, but I had done all I could. The rest was in Jesus hands.

Knowing this, I shouldn’t have been surprised when I found that the baby was still alive. I shouldn’t have been surprised the baby was doing so well the pediatricians were even considering sending him home that day. It shouldn’t have surprised me that God took a nearly lifeless body and breathed life into him, completely in spite of my lack of experience, and the lack of resources. But I was surprised, and was reminded that our God is a God who can do miracles and answers prayers.

Please pray for Aaron and Stephanie, Hannah’s parents, as well as her 3 brothers.