In the balance – part 2

Important note:  This post, as with all on this blog, are my observations and experiences only. I do not write or speak on behalf of Rotaplast, any member of this mission medical or otherwise, or others on site. This is my unofficial blog only. The name of the patient has been changed out of respect for those involved. I'll add that while tragic, what you are about to read should not overshadow the tremendous work being done in Cebu.

He’s gone. Little boy “Ronny” (not his real name) didn’t make it. This is a first for Rotaplast and a first for me. The medical team members have lost patients before in their jobs back home – it’s part of the risk they accept to make a difference and one they live in fear of. And yet, the pain is obvious in their tear-filled eyes. After two hours of working, he slipped away. They understand the risk with surgery – there’s always a chance that someone may not come through. I didn’t understand. And I still don’t. It never occurred to me in joining this mission that this was a remote possibility. My own naïveté, I suppose.

Only an hour after I watched "Ronny" walk on his own into his surgery room, the events leading to his passing unfolded. I watched the whole scene start to finish, feeling my only job was to sit by and pray, pray, pray. My heart breaks for the medical staff. The pediatrician who pumped little Ronny’s heart by hand for nearly two hours, trying to keep a pulse and brain function. The anesthesiologist who worked with three others to mix and introduce the right combination of drugs (we discovered later that our mission was the only equipped with the right drugs in the entire city and the very best equipment of any local hospital) that gave him the only chance to survive this rare condition all the while monitoring the screens for any signs of improvement. The head nurse in full ER mode documenting every move made. All of this effort was not rewarded today. And that’s hard for me to process. It seems so unfair.

The medical director, Frank, comes over to my desk, leans over, and tells me it’s over. My eyes spill over and I hear a sob coming out but try to maintain control. So many people are hurting and I’m the last thing anyone needs to see or hear. I had to hold it together and stay put, awaiting my next instructions in case I was needed. People milled around in disbelief and then slowly started to filter out of the OR. I felt like a statue. This couldn’t be real.

The surgical team stayed with little "Ronny’s" body and cleaned him up as best they could. All I could do was stare at the top of his spiky black hair and unmoving chest. I’ve never seen death, so close, so personal. This was the little boy who quietly selected the largest dinosaur sticker off of a sheet I offered him a few days earlier as I completed his paperwork at the pre-op clinic. His mother was beaming, excited for her son and I told her how handsome he was and that everything was going to be great. Now, I feel like somehow I didn’t hold up my end although I know this loss isn’t anyone’s fault. It is a possibility in 1 out of 50,000 anesthesia cases. Of any case, he had the best chance of any -- being young and having the most experienced medical team that Rotaplast has ever assembled. This was the dream team of medical staff if there ever was one.

Next, his mother is brought in. She glances in my direction almost like she’s not sure of what she’s about to see. I hear her scream and the door closes behind her. I still hear her in my head. It goes on for what seems like 10 minutes and it’s at this point I push to the back of the room behind some cases and hole up on the floor in the corner needing to release my own pent-up emotions. No where really to go. About 30 minutes later, Yvonne brings me a cold bottle of water and rubs my shoulder. It’s a sweet gesture, but I want to be alone. The noise dies down and I’m asked to move into the next room over where the entire team is assembling for a briefing. I find another corner spot on the floor in a daze and focus on an ant trailing the same circle over and over. It’s kind of how I feel. My mind playing in circles of images: heart compressions, the determined expressions on each person’s face as they work, the mother’s uncertain face, the scene as she walks into the room where her dead son lay on the table. I don’t belong here and I know it. I’m a strong person, and I know that too. But I don’t feel strong enough for this. A child has died only feet away.

Frank, the medical director, and Michael, the lead anesthesiologist, say a few words to explain what happened to the rest of the team – many who were out in other areas of the hospital while this all happened. We’re encouraged to support each other and talk about it as needed, but to not share beyond our team until further notice. I’m completely numb and feel better in my corner.

Then Carolyn, my mission mother and head nurse, comes to me. She’s been a model of professionalism and composure despite the obvious pain in her eyes. She grabs me into a big hug and fresh tears come again. I tell her I don’t think I belong here in this kind of an environment. She pushes me back, hands holding both of my shoulders and shakes me firmly while looking directly my eyes says “You are meant to be here. You belong here. You have the heart for it.” I mustered a nod as she continued to tell me that she needs me. We have patients waiting for surgery today that must be rescheduled, and even more arriving for tomorrow. We can’t let them down, and together, she and I will revamp the schedule before we can leave today.

I situate again at my desk and fumble with some charts. I curse my own organization wishing I had something real to do, but I’m actually ahead in my work. Then the OR door opens again and the mother emerges as a nurse carries the body past my desk and into the recovery room where a larger bed awaits, and so the surgery team can clean up the room and prepare for tomorrow's surgeries. She looks like she’s sleep walking; completely in shock.

Minutes later someone puts a chart on my desk. It’s "Ronny’s". I open it up to again see his picture and information I became so familiar with. Fresh tears. I’m not sure what to do with the chart, but pretty sure I need to keep it close by. There will be endless more paperwork to do on this one. Every so often I peak again at his picture in the chart and send a silent prayer heavenward.

Carolyn comes back after what seems like an eternity and we settle in to rework the schedule so that the day’s remaining patients can get the services they’ve been waiting for. It’s tough though because no matter what we do, the remaining days ahead will be long and hard for each of the surgeons with extra cases that are more complicated. It’s not ideal, but they are professionals, we are well equipped, and so they agree to tackle it.

As I close up my desk preparing to leave, I step across from my desk to the rest room for a quick break. I peer into the mirror; I look like a goldfish – bulging swollen eyes. As I step from the restroom, I bump into a man walking into the recovery room and suddenly he lets out a scream I’ll never forget as he lunged forward to the bed and flung himself on the body of the little boy. The father, a taxi driver who they had been trying to locate for the past few hours, has finally arrived. It starts all over. More pictures in my mind of human grief I could never have imagined. These poor people. I run from the OR and fall into the arms of one of the pediatricians, Sheila, who hugs me tightly and says how sorry she is that I’ve had to witness so much my first time on a mission. Kind, gentle, and clearly sad herself, she finds the right words to excuse my emotions as appropriate. I’m so grateful. So many loving people around me who in their own grief find ways to support one another.

I quickly change out of my scrubs and somehow make it outside to the front of the hospital to another awaiting air-conditioned van. A little boy is gone. I can’t compute it. I’m sad. I’m angry. I’m in disbelief. Six years old. "Ronny" – the little boy with the big dinosaur sticker and questioning eyes is gone.