un--sugarcoated

East Africa, September 2015

When I walked by the nurses station at 3:57pm there were two families sitting on the bench waiting for their children to be admitted to the hospital ward.  One of the children was unconscious, the other had her eyes wide open, a grimace on her face, small arms and legs rigid and jerking in a full scale seizure.  I immediately medicated her with diazepam and then glanced over both children's charts.  And I was horrified.   I had given the child an appropriate dose of diazepam because I was familiar with the dosing, but the dose the doctor had prescribed for her would have been a tenfold overdose, which would have almost certainly killed her.  Many of the nurses in this hospital would have simply followed the order as written.  The child had been correctly diagnosed with malaria, but whoever had seen her had failed to do any differential diagnosis (meningitis, perhaps?) and instead of prescribing artesunate, the first line drug for severe malaria, had prescribed quinine, the third line medication.  Nowhere on the child's chart was there listed the child's temperature (which by that time was 40.7 C or about 105 F) or an order for tylenol, which would help decrease the child's fever and therefore chance of seizures.

The second child was totally limp and unresponsive.  The parents reported she had been seizing until about 10 minutes prior, when she had also been dosed with diazepam.  The dose she was given was, thankfully, close to appropriate.  However, without doing any diagnostic testing the practitioner (a different one than had seen the first child) had diagnosed severe malaria and had also written for quinine instead of artesunate.  He had also failed to listen to her lungs or check her oxygen saturation, which was 85% (normal for a child is greater than 96%), so her main problem had gone completely untreated.

Both children were critically ill.  Both required immediate and appropriate treatment and careful care.  Our total nursing staff at that moment was two: myself and one other.  Caring for two critically ill patients is enough to keep two nurses busy, to say nothing of the 43 other patients on the ward, many of whom were also very sick.  It was physically impossible for the two of us to provide adequate care for even half of the patients.

I could say this was an exception to the quality of medical care here.  I could say it, but I'd be lying.

What do you do with that?  How do you face conditions like this and not totally lose hope?  If you come into this setting with compassion in your heart, desiring to give each patient the best care possible, how do you possibly reconcile that desire with the reality of the situation?  I am only one person, and I can only do so much.  While I can attempt to teach and encourage the other staff, I can't force them.  There is no escaping the fact that even my best efforts will be inadequate to satisfy the convictions of my heart.

This is a recipe for burnout.  It's a recipe for standing in the nurses break room crying because you are trying so hard to help these patients but at times it feels like everyone else in the hospital is actually working against you, intentionally or unintentionally.  It's a recipe for getting angry with other staff when they are sitting while you are running, or at doctors who disappear to who-knows-where when it's their turn to see patients.  It's a recipe for snapping at a patient's family member when they come and ask you to please come and check on their loved one because something seems to be really wrong and nobody has come to check on them at all today.  And then you catch yourself and realize that you came here to love people, and the frustration you feel at not being able to love them the way you want to is actually leading you to be entirely unloving.

Ouch.

So far I've only found one remedy for this problem, and it's to beg God: please, please give me the strength to get through this day in a way that glorifies You.   Work through my hands and my words and sustain me so that at the end of the day they recognize Your heart as one of love and mercy and compassion.  Grant me the humility to remember that it is not my work but Yours that counts here, and grant me the honor of taking part in Your work.  Abba, my Father, don't leave me alone!  My strength alone is simply not sufficient for this work.

I'll be honest, the pain is still there.  It is impossibly heartbreaking to live in the tension between the care I want to give and the care I am able to give.  There is no way around that, but to be honest, I'm not sure there's meant to be one.  The suffering of our fellow humans hurts our Creator far more than it could possibly hurt us.  If my pain over a situation reflects God's pain over the same situation, might He be glorified in it?  I will (sometimes gladly, more often begrudgingly) give of my personal comfort in service of my King.  But only because He daily provides me with the heart to do so.