If there’s one overarching feeling since moving to Kenya, it’s one of inadequacy. There are just so many people who are so sick, so in need of so much more than I can provide. Impossible choices, weighing what this man, woman or child needs, compared to what I can provide for them. Kijabe hospital is an unbelievable oasis of love and competency, but is incessantly overwhelmed by unending demands on its limited resources.
I haven’t always been a Christian. I know that label makes some peoples’ skin crawl, and I don’t like some of the connotations myself, maybe “follower of Christ” is better. Whatever you call it, I’ve arrived there by a number of different roads. Some have been direct experiences of the mystical, others more practical. The sustaining structure of my faith, however, is that it helps me make sense of the world that I see, taste, breathe. If I look at the world without blinking, with the insulation removed, my mind has trouble making sense of the paradox. How can so much evil, so much suffering, exist alongside such sublime beauty and structure. How can a God who loves infinitely allow so much suffering in his creation?
For me, the question contains the answer. A God who loves so much He would release control, allow free will, allow betrayal. A God who loves so much He would love anyway, knowing the cost. A God who loves so much he would suffer and die so his children could live. Love involves risk. Risk of loss, risk of rejection. Maybe ultimate love involves ultimate risk. So I’ve turned it all over to a God who I believe risked it all to be in relationship with us, with me.
This all helps me make sense of a child like Jonah.
Jonah was scheduled for his big spine surgery today. Weeks of anticipation, discussion, tests, consultations. Weeks of TB medications, good nutrition, surrogate mom’s and dad’s scooping him up and taking him on “walks” in his wheelchair. We got Jonah to the OR early, before he could sneak some rice or milk from another child on the ward. With Jonah on the OR table but not yet asleep, I got a call from our anesthesiologist: ” Don’t put him to sleep, we may not have an ICU bed and ventilator for him after surgery, a neurosurgery patient just had to be put on a ventilator.” We can only have five patients at a time on a breathing machine here.
Jonah was taken back to the waiting area, and we went ahead with another surgery, then later in the day got the go-ahead to proceed.
Finally, Dr. Muchiri (the gifted head spine surgeon here), myself, and the anesthesia team were all set to go.
Jonah’s a bright little boy. In his region, they don’t really keep track of birthdays, but he’s about eight years old, same as my son Michael. He’s been in the hospital about three weeks, so he knows my face, and he likes it when I take his picture with my phone and show it to him. He doesn’t speak English or Swahili, only his native tongue Samburu, so we can’t talk much. Lying on the OR table, hundreds of miles away from his parents and unable to speak to anyone in the room, he was scared. I grabbed his hand, just the same size as Michael’s, and he squeezed hard. If I even looked away to get some piece of equipment organized, he squeezed harder and used his other hand to pat my arm. I played “spider” walking my fingers up his arm to tickle him, and his little body was wracked with giggling. We kept this up until the intravenous propafol put him off to sleep.
Finally, Jonah was under anesthesia, and we then rolled him prone (onto his stomach) for the surgery. We all paused and watched the monitors. Smooth sailing! Unlike the previous attempt, Jonah’s blood pressure and heart rate remained stable. We proceeded with the surgery.
Surgery for TB of the spine involves two general stages. First, the spine is opened, and the tissue compressing the spinal cord is “debrided”, or removed. The second stage involves stabilizing the segments of the spine destroyed by the infection. The first stage went very well: the spine was opened, and the pus, dissolved bone and soft tissue fragments were removed. We were gratified to see the sac around the spinal cord begin gently pulsing, indicating the paralyzing pressure on the spinal cord had been relieved.
There exists an unspoken communication between surgeon and anesthesiologist. The surgeon’s job is to complete the surgery. The anesthesiologist’s is to care for the patient during the surgery. A thin sheet of sterile cloth separates us. But both surgery and anesthesia have a certain tone, pace, and rhythm. And when that rhythm is disrupted on either side of that sheet, you just know. As we finished the first stage of Jonah’s surgery, we could sense a change in the tone of the anesthesiologist. A quick glance at the monitors showed the reason: Jonah’s blood pressure and heart rate had plummeted.
We quickly called for suture to quickly close the foot long spine incision. Rather than the usual meticulous layer by layer closure, skin, muscle and connective tissue are swept up in deep sweeps of a large needle, closing the incision in seconds. Sterile drapes torn off, and we flipped Jonah onto his back. Monitors flat line. No pulse. No blood pressure. For the moment, Jonah is not alive.
In this rare situation, the surgeons are perfectly positioned to provide chest compressions (CPR), while the anesthesiologist administers fluids and epinephrine, or adrenaline. We compressed his little heart to provide blood flow to his precious brain, and to allow the life saving epinephrine to circulate through his body. As we did CPR, we also prayed out loud for his life. Twice we paused the chest compressions, only to see that he still had no heart rate or blood pressure. I was starting to think about what I would tell his parents. Miraculously, on our third and perhaps final pause, Jonah’s heart took over! His heart rate and blood pressure, while not normal, were remarkably good.
We got Jonah to the ICU and connected him to a ventilator to breathe for him.
Thankfully, his pupils were reactive, some indication that he did not suffer brain damage from the stoppage of his heart. His blood pressure and heart rate normalized. And I just received a text from the anesthesiologist in the ICU: “Jonah awake and off the ventilator”! He survived.
Jonah’s still got a rough road ahead. Once he’s stabilized, we have to go back to surgery to stabilize the segments of the spine destroyed by infection. After that, he’s got a long recovery ahead of him
The only way I can make sense of all this is by surrendering to a God who loves Jonah, who loves me, and who understands suffering. To believe that there’s a bigger picture than pus and paralysis and a scared little boy. And to believe that there’s a God who loves each one of us so much he allows us to be a part of His plan. Thanks for praying for all of us.