I Grieve For The Living

On Monday morning, my Haitian colleagues expressed the belief that I was in shock. They said that I had invested too much into caring for Sophie, to be coping as well as I seemed to be in the days following her death. I told the ladies I was ok, because I knew we had done everything that we could for Sophie, and I told them that I was rejoicing for her, because I was absolutely convinced that she had gone to a place where there was no more pain, and no more suffering.

Today, I am in shock, but I greve for the living and not the dead. On Thursday evening, 3 critically ill babies were admitted to GLA from an Orphanage in a nearby town, located high in the mountains. The missionary who brought them told us that an outbreak of gastroenteritis at that orphanage, had all ready claimed the lives of two infants, earlier that day.

Frandline was the last to arrive, deathly pale, gasping for breath, and so cold that her temperature would not register on a thermometer. The medical team who has been with her had been unable to get an IV line in. Frandline had a large, distended abdomen and she was comatose. While Dixie worked for almost two hours to try to find a vein, I started Frandline on oxygen, and pushed large volumes of fluid through a needle that a Dr had placed into her thigh bone. After boluses of saline and dextrose to bring her blood pressure and blood sugar up, we were relieved to see Frandline regain consciousness.

Was she out of the woods, one of the missionaries who brought her asked? I was sorry to have to tell the lady that Frandline's condition was still critical. Her pulse oxygen levels were low despite receiving large volumes of supplemental oxygen, her blood pressure had not stabilised, and she was vomiting altered blood and faeces. We had to place an NG tube down, and aspirate Frandline's stomach contents to prevent her from aspirating. We suspected that the baby had a perforated intestine, or an intestinal obstruction. She needed a surgeon but there was rioting in Port-au-Prince and in Petion-ville, so it was not safe to travel. We poured ice water down the NG tube. It was the only thing that might stop the bleeding. I was struggling to replace the fluid she was losing. The baby was profoundly anaemic and needed a blood transfusion. She couldn't have one tonight.....

Dixie eventually got a working IV line into Frandline's scalp. It was close to midnight when I left the nursery. Frandline's  body was still in shock. Her temperature was in the normal range and she was awake, but glassy eyed. Her oxygen levels were fair, and her breathing was only slightly laboured.

At 7:30 the next morning, Frandline stopped breathing, and her heart stopped beating. We were unable to resuscitate her.

In the next room, 9 month old Geraldine, who had also been admitted the previous night, was lying listlessly in her crib. The emaciated baby was lethargic and her body temperature was dropping. She needed to eat but was unable to tolerate even small volumes of oral medications. I was very concerned about this little one. Hypothermia is a very worrying sign in a severely malnourished child. Hypothermia can be a sign of severe infection. and organ failure. It can also cause organs to shut down. I dressed Geraldine in extra layers of clothing. I drew blood, and changed her IV fluids, based on the results of the tests I ran, using our portable blood gas analyser. I gave her IV antibiotics, medications for vomiting and vitamins. I put ointment in her eyes, which, were swollen and oozing puss.

I held a bony hand in mine. The baby was so cold. I looked over at Woodly, a 9 month old boy, from the same orphanage. His body was swollen from malnutrition, and his eyes were gummy. He had profuse, watery diarrhoea but his condition was not critical, so we were rehydrating him orally. He had a searching gaze. He whimpered and extended his arms towards me. I couldn't help thinking, that maybe Frandline was the lucky one. Hers was a horrible death, but it was over.

When these children are well enough, they will go back to an underfunded, and under-resourced orphanage, where the water is contaminated, where there isn't enough food to go around, where there are few medicines, and even oral rehydration solution is in short supply. Their suffering is not over.

It is the living I grieve for, not the dead.