In Septemeber 2008, I traveled 6000 miles to Haiti's Kenscoff mountains. My mission: to care for some of the orphaned and abandoned, the sick, malnourished and premature infants of this beautiful but beleagured Caribbean nation.

Sunday, 21 August 2011

A Thousand Times Over

For most of the week, the nurses and nannies that work in the nurseries have reflected on Kervens life and his death.

We have experienced the ebb and flow of guilt and grief, anger, doubt and despair. Sandia. Edna Kervens. Three precious lives so hard fought for, and lost. It is hard to bear. Our latest loss is a painful lesson, we all agreed. We wished we had kept Kervens here longer.....

Days before Kervens died, a colleague directed me to be alert for the presence of God. I am going to be completely honest with with you: there were days last week, that I did not feel God's presence. I wondered what we had achieved upstairs in the nurseries. We had nothing to show for our efforts, it seemed, and no hope to offer these babies.

Mid-week, the despair receded and a wave of thanksgiving washed over me. Our God did not doubt the product of our work here, and the hope he whispered, was without question.

[Love] always protects, always trusts, always hopes, always perseveres (1 Corinthians 13:7).

He knew from the outset that Kervens would die. He wanted him to know before he left this world, that he was worth fighting for. And loved.

As Edna's life faded away, I communicated to her the best way I could, that she was going home. I couldn't do that for Kervens. I hope it isn't too naive or sentimental of me to believe that as he made his last earthly journey up the mountain to GLA on the morning of the day that he died, he knew that he was returning to us and that everything was going to be ok.

God knew the outcome at the outset. I am glad I did not, but if he calls us to love a thousand babies into his arms, I will do it a thousand times over.

Sunday, 14 August 2011

Deep Calls to Deep

A lament rises from the depths of my soul.

Just after mid-day, the NICU staff called me to come urgently. I ran. Dixie reached the infant just ahead of me. I didn't know the shrunken frame of the baby on the table, I was sure. And then....... Oh God, oh no! It can't be! Kervens was still warm, but he was not breathing, and he had no pulse. We tried to resucitate him. It was too late. Only just. But too late.

Why, Lord? Why! Our miracle baby, the one we pulled back from the clutches of death twice was lifeless in front of us. We had discharged him on Wednesday, fat and beautiful and healthy, with formula and bottles and diapers. Now, the whites of his eyes were blue and his eyes were dark and sunken. The skin covering his stomach and his thighs was wrinkled, and his mother couldn't explain any of it. As I heard how Kervens writhed in pain all night last night, I struggled to see the goodness of God. This just looked like cruelty from where I was standing.

Our God, the one with a plan for each life; a plan to prosper us and not to harm us. Our God , the God of mercy and love had has allowed Kervens life to be saved not once, but twice, only to end like this? Where is the hope in that?

I am not in the mood for plattitudes today. I don't really want to hear that Kervens is at peace, and that his suffering is over. I want justice for him in this world. And I I don't want God to promise to make something good out of this tragedy, I want him to stop any further tragedies from happening.

The answers to the whys, the bible instructs, are too high for me now. I will have to wait for eternity for those. God sees through the darkness that envelops us tonight but we don't.

'My soul is cast down within me;
therefore I remember you
from the land of Jordan and of Hermon,
from Mount Mizar.
Deep calls to deep
at the roar of your waterfalls;
all your breakers and your waves
have gone over me.
By day the LORD commands his steadfast love,
and at night his song is with me.'

(Psalm 42: 6-8).

We are always told to encourage one another in the hope that is in Jesus, but I think we need to be honest too, that the demands of faith, lived by blind sight, are tremendous. The cosolation in this, the only one I can find, lies in that deep calls to deep connection to a God that knows that this is very hard for us, who knows that it hurts, who feels it, and who cries a deluge of tears, roaring at the pain and the injutice of it all. Deep calls to deep.

Sunday, 7 August 2011

Dashed Dreams

Two months ago, I had a series of dreams. In these dreams, newborn twins or triplets were admitted to GLA, and all of the babies needed CPAP. I knew that it would be a challenge for our NICU, if a set of multiples did arrive. I decided that I would not be caught out. I made CPAP hats, and got the circuits ready, and I made plans and contingencies for caring for these babies. I was prepared

So when, at 8am on Monday morning, news reached me that a set of tiny twin girls were downstairs, I was ready. The girls weighed in at 2lb 1.7oz and 2lb 0.3oz. They had been born 9 hours before, five miles away at the Baptist Mission Hospital in the mountain village of Fermathe. They were icy cold and they were not breathing well

The rest of the day went by in a blur, as we warmed the babies, and struggled to get them stable. I remember I started working on Sandia, the smallest twin, first. She was showing more signs of respiratory distress. I got her on CPAP, and directed Mme Bernard to start her sister on oxygen.

I remember that we could not keep Edna's CPAP working. Two oxygen concentrators were down. Two incubators malfunctioned. I was glad for my contingencies! I remember being caught between the urgency of Edna's breathing problems, and her twin sister's low blood sugar. I remember getting an umbilical line into Sandia, then Edna.

Starting them on intravenous fluids, giving vitamin K to prevent blood clotting problems and brain bleeds, antibiotics, medications to stimulate them to breathe.... It was difficult to get the girls warm. When their temperatures did rise, the consequences of prolonged cold stress caught up with them. Oxygen levels falling, heart rates fluctuating, me running between the girls at shift change over, both of them apnoeic...

As the days passed, we lurched from one crisis to another. Sandia's temperature would not stay in the normal range, and whenever her CPAP became disconnected, her airway would collapse. She needed a high flow of oxygen through her CPAP and once or twice a day, we would have to hyperventilate her with an ambu bag, to blow of excess carbon dioxide build-up.

Edna's immature digestive system could not process sugar. Her blood sugars were dangerously high and her tiny body was forced to burn fat for energy. There were two problems here: Edna had very little fat to burn, so as the days wore on, she became emaciated. And as the days wore on acids that were produced from the break-down of body fat, accumulated in her blood. She needed regular doses of sodium bicarbonate through her umbilical line, to neutralize the acids.

I worked double shifts with the girls, starting at 5:30 in the morning. The extreme heat in the NICU, and being on my feet all day made my feet and ankles swell, I was dehydrated, having muscle cramps, and my whole body hurt. I was exhausted: I was woken in the night more than once to help get a struggling baby out of crisis. By Thursday, Sandia and Edna were stable, kicking their legs and waving their arms in their incubators.

Sandia had became anemic and needed a blood transfusion, but she improved significantly when she received it. Edna was on room air CPAP. There were reasons to be hopeful, Soon, the girls would be well enough to tolerate milk feeds. They would stop burning body fat for energy. I was running on adrenaline and I was elated. We were winning, I was sure. Finally, we were winning!

I wish that I could tell you today, that everything we did, paid off, that all the knowledge we gained from working with babies like Jonathon and Sophie Dora had saved two twin girls lives.

Instead, I have to tell you, that Sandia died at 11 am on Friday morning, from a collapsed lung, or an airway, obstruction, we don't know.

As we were working on Sandia, her sister, Edna, began having breathing problems. Less than an hour after her sister died. Edna stopped breathing all together. Blood tests showed extremely high acid levels in her blood. Dixie and I worked until late into the night. Edna legs were stiff, and she wasn't moving the right side of her body. Her pupils were dilated and we were afraid that she had had a brain bleed. We made a call to a neonatal nurse practitioner in Pennsylvania. Eventually, after 6 hours of ambu-bagging, and lots of drugs, Sandia responded to treatment. She opened her eyes, she began moving, and eventually she was breathing on her own.

The next morning, her exhausted body gave up the fight. I held her on my chest. There was a flicker of recognition across her face as Edna relaxed to the rhythm of my heart beat under her head. She remembered her mother's womb, I'm sure. A safe, warm, watery place, where she floated, and where there was no struggle. Where her mother's heart beat consistently and reassuringly above her head. I hope she knew in those moments that I held her, that she was loved dearly, and I hope I communicated to her in a way she understood, that everything was going to be OK.

At 9:53 yesterday morning, Edna was pronounced dead.

My dream came true, and then it was dashed. But oh, that is a small thing, compared to the dreams of Edna and Sandia's parents.