A Paradox

I am now nearing the end of a weekend of rest after what has definitely been the hardest week I have had here in Kapsowar. I had a wonderful time this morning worshiping with my new church family here and marveling in the sounds of about 200 Kenyan children as they praised the Lord with their voices. And now, as I type this, there's a beautiful rainbow over the valley outside my window - a reminder of the Lord's promise that He loves us and is faithful.
So, this was a very full week. Every day seemed to bring many surprises and emergencies. There were emergency C-sections, retained 2nd twins after a traditional birth attendant allowed a woman to labor at home knowing she had twins, too many D&C's to count including a couple that were in shock. On top of all of that, Ben and Cathy Sawer, who I have written about before, left to return to Canada. They left a hole here on station and we were all very sad to see them go.
The most consuming patient of the week was a 19 year old girl - we'll call her V - who was transferred from a health centre where she had delivered her baby prematurely and then developed postpartum hemorrhage. When she arrived at Kapsowar, she was hypotensive and had a hemoglobin of 6 (should be at least 12). She was given blood and seemed to improve a bit. Then, her blood pressure became high (probably what it was before delivery) and she complained of a severe headache - she had severe pre-eclampsia (toxemia). Who knows how long she had had it. So, I started her on appropriate therapy and she seemed to improve. Then, on Thursday, I noticed that her abdomen was becoming distended. Her exam was consistent with ascites, which can come from the liver being affected by pre-eclampsia. On Friday, it was markedly distended and an ultrasound confirmed that she had massive ascites. We decided to drain some of the ascites to make her more comfortable. As I was coming to do that procedure, I noticed that she all of a sudden was not very responsive, responding only to pain but not able to communicate. This was a definite change from how she had looked just an hour before. We quickly did what we could, but decided she needed to be transferred to Eldoret - a 2 hour drive and the closest ICU. One problem - our only functional ambulance was currently in Eldoret. So, we had to wait for it to get back in order to transfer her. We prayed over her and reassured her scared husband that we were transferring her where she could get better care. As we saw her off, I had a bad feeling. Why had she suddenly worsened? Was there something else I could have done? Should we have transferred her sooner? Only God knows the answers. All night that night, I couldn't sleep. I just felt like something wasn't right. I said so many prayers for V - that she would recover, that her newborn child (her first) would do well, that her family would have strength through this difficult time, that they would come to know the Lord.
I found out the next morning when I went in for rounds that V had died at 3 am. My first maternal death. She was only 19. The unfairness of it all was overwhelming. Why couldn't I have done anything else? Why couldn't I do the labs I needed to do to determine why she had become nearly comatose? Why would a 19 year old be taken away from her newborn child? As I sat and cried, I was comforted by one of the labor nurses and one of the cleaning ladies. They reassured me that this happens here in Kenya and it would be okay. But it's not okay I told them. It's so unfair.
While I will continue to mourn V, I think that the Lord had a lesson to teach me through all of this. First, He is in control and He does have a plan. Second, I am not in control and no matter how much I think I know, ultimately, my patients' lives are in His hands. Third, I have to just trust God that what I am doing for the patients is the right thing and leave the rest to Him.
So, despite the fact that it was an exhausting, overwhelming, and challenging week, I think it will be one that I will look back on as a turning point, perhaps. I now know, more than ever, that He is in control. And I praise Him that after we have come through the flood, He provides a rainbow of hope to remind us that He is there - yesterday, today, and forever.