Thursday, December 9, 2010

Why I shouldn't have become a nurse

I met Christopher after the earthquake when he was transferred off the USNS Comfort. The doctors had sent him home "to be comfortable" but we had other doctors examine him and tell us that it would be possible to operate on his hydrocephalus (a condition that causes an excess of cerebrospinal fluid around the brain and therefore disproportionate head growth and brain damage).

It took us about 3 months to get Christopher's paperwork together for a medical visa. During that time, he and his mother Christine and sometimes oldest sister Christina, were frequent visitors at the clinic at Delmas 24 and my office at Delmas 91. I fell in love with them. Christine is a spitfire, full of the toughness that makes life possible as an unemployed single mom of 5 in Haiti, but also full of the love that makes those 5 children think that they have it made! She calls me "Maman" and is always ready with a story to make us laugh. She's never missed an appointment with me and never complained about her son's condition or the choke-hold that having him puts on her family by forcing her to stay home with him instead of being able to find work.

Her 11 year old daughter, Christina, often makes the 2 hour trip of multiple taptaps with her mom, to help carry the diaper bag while Christine hefts Christopher. At home, when Christine is worn out from a long day, Christina makes Christopher's bottle and feeds him. When Christine was going through a rough week and seriously considering abandonning Christopher at a Port-au-Prince hospital, it was Christina who talked her out of it.

Christopher spent 3 months in the US over the summer, undergoing an operation that enlarged the natural drainage opening between the 3rd and 4th ventricles of his brain, allowing his cerebrospinal fluid to drain better. Back in Haiti in July, we watched him improve somewhat, showing more personality especially in his ability to respond to voices of the people he knew and to track with his eyes. However, we were also concerned because his head seemed to be getting bigger.

Two weeks ago, Christine brought Christopher to clinic. He had a large fluid-filled lump on his head that presented just like an abcess - red, tender, swollen, warm, painful and causing fever. I have treated over a dozen such abcesses on Haitian infants and I went after this one the same way. But it wasn't an abcess. I cut it open and instead of pus, cerebrospinal fluid came squirting out. I had my staff rush Christopher to the hospital, but they wouldn't take him. The tiny incision had closed itself off so I kept them overnight to make sure he was OK and then let them go home in the morning with warnings to contact me immediately if he got a fever.

The call came last Monday: Christopher was running a fever. I wanted them to come to the city, but it was only one day after elections and the roads were full of angry crowds. They couldn't get here until Wednesday. I immediately started Christopher on antibiotic injections, but his fever kept climbing. In the middle of the night on Thursday, he started shivering and vomiting so early Friday morning, I was able to get him admitted to Bernard Mevs, a Haitian hospital where teams from Miami University Hospital have been working.

On Saturday night, Christopher had a seizure and lost consciousness. He never woke back up. At 5:00am on Monday, he died. I made it to the hospital and cried with Christine and with Lucson, my loyal volunteer clinic manager who had been taking shifts staying with Christopher. It was a long and awful morning, making arrangements at the morgue and the cemetary. I'll probably never forget how casually the morgue attendant grabbed Christopher's body wrapped in a white sheet and held it away from him, as if the baby was a bag of trash, not a beloved son.

We drove Christine home to Archaiae, almost 2 hours outside PAP. There, we had to break the news to her other children. Christina, who had been a little mother to her baby brother, grabbed Lucson and cried in his arms.

Beyond the simple grief of losing a patient and the pain at seeing a friend of mine suffer, Christopher's death brings a burden of guilt. It was my wrong diagnosis and my scalpel that opened him up to the meningitis that killed him. It was my decision to let him go home and to keep him under my care for a few days that allowed to disease to progress. He was my patient and I failed him. It doesn't matter how long the list of saved children is, it's the list of the ones that did not survive that is printed in bold in my mind.

The one spot of joy during that sorrowful day was meeting Ferlens, now the youngest in Christine's family. He is 5 years old, and looks precisely how I imagine Christopher would have looked if he'd not had hydrocephalus. I believe in heaven, and as I sat beside Christine, holding little Ferlens, I could almost see my patient toddling along holding Jesus' hand, fully healthy, looking as bright-eyed and cheery as the little one on my lap. No more suffering, no more illness. Christopher is whole now.


'Gina' Hoai-nam said...

Kez, it is not your fault that Christopher died. Yes, you were holding the scalpel, but you saw that there was something wrong. You saw what looked like an abscess. How do you know the infection wasn't already brewing before you ever cut him? So cutting it didn't help, but you did everything you could do to try to save this kid. Don't blame yourself for his death.

Leslie said...

Should you NOT have become a nurse imagine who you could not have helped. You did help this little one. You loved him, got him help, allowed his family to see him happier and for this they will never forget you. You have loved them because you love their child. He is, as you said, in a better place but I am so sorry for your and the family's loss. Thanks for sharing.

Matthew said...

Everyone in medicine makes wrong decisions sometimes; you made the best clinical judgment you could with the information that you had. I'm no pediatric neurosurgeon but I would imagine that if he had a red, swollen lump on his forehead that oozed CSF, his CNS was probably already infected. Furthermore, the hospital's refusal to take him also puts any further fault on their shoulders. It is a good thing that you are a nurse, and God is using you right where you are. Take heart, and know that you are in our prayers. We love you, Kez!

John & Jan said...

I've tried to think of some clever words that would make sense of Christopher's story and of course, I really have none, except the world is out of order until Christ comes. We wait for his coming and in the meanwhile are his picture of who he is as we touch lepers and seek to draw alongside the suffering and commend them ultimately to the Father's care.

Anonymous said...

Oh, Kez, I'm so sorry for your loss. Love, Beth

Tom Landon said...

Beautifully written Kez. Of course you know that no doctor or nurse is 100% right, but it doesn't make it any easier, I'm sure. Thank you for this blog.

Lauren said...

oh sweet kez. i am sorry, both for the loss of christopher (who i remember at the clinic) and for the pain it has caused you. there is no easy answer or explanation to the constant 'why' you must be asking yourself. in part, we are only human. you have done miraculous things, things i could never have done. god is with you, and now christopher is with him. you were born to be a nurse, and you are the most incredible one there is.

Anonymous said...

Thank you for all you do Kez! You are a valiant soldier for Christ and we love you for it... I'm sorry for your and the family's loss :(

Andrea Cramer said...

My dear Kez, you are the most extraordinary nurse I have ever met. I would not hesitate to put the care of any child in your hands. God had a plan for Christopher--to touch our lives, allow us to love him and then call him home. He is at peace now. He is healed. We will forever miss him