A Good Death

February 9, 2012 Amy ChildrenResidency

Nights in the NICU anywhere is to stand in the strange gap between heaven and earth.  Everyone is coming and going somewhere.

In Africa, we would run our list prior to call and come across a name of a baby who was struggling or had an infection we could not beat, there were no ventilators or was just too small, too early for us to give it a fighting chance with what we had.  We would say, Baby so and so is going home tonight. It doesn’t meant we won’t try, it doesn’t mean we haven’t racked our brains of what we can do with with what we have. But we know our limitations and we also know that us beating on the chest of a premature new born who needs a ventilator we don’t have is not going to help anyone.

Home is an evangelical phrase that is a reference to a verse in Paul’s letters that talks about being citizens of heaven and not of earth.

But I like it because it implies that death is not just about leaving, its also about going.  Babies don’t have the need for our theology and politics but  they remember where they came from.

In America, when a baby is dying in the NICU, we stand around running through every physiological rotation, we throw every drug we can think of, we call in the surgeons, who join the circle around the bedside, we try experiments, we give blood, fluids like we have unlimited resources,  we switch around ventilators left and right, we talk about the baby in the circle as some academic enigma whose body is just not doing what we tell it to do. The parents hover just inside the circle. Most are stoic, looking at the baby back to our circle, trying to decipher our academic whispers.  We tell them the truth, we tell them the baby is going to die.

In Africa, the mothers visit every two hours to breast feed or pump to feed through a feeding tube. They are devoted beyond belief.  We don’t mess around when a baby is dying, Mom will sit by the bedside in vigil, holding the baby, loving the baby. Other than making the baby comfortable we don’t interfere. In some ways, its the worse feeling in the world as a physician and in other ways its liberating to be able to give the baby and their family that moment.

Last night, we had a baby that had had every thing we had to offer who was dying, this went on for about 7-8 hours.  The mother was alone, young, she didn’t seem to understand what we were saying when we told her, her daughter was dying. She went home to sleep 20 mins afterwards. Perhaps it was the crowd of onlookers, the 25 people standing around still intervening. It didn’t look like the end, it looked like the middle of the battle. I called the chaplain and we called her back.  It took no less than 45 minutes to change the tubes around enough so that Mom could hold the baby.  I am watching the monitor the whole time and watching the baby heart rate drop alarmingly fast.  By the time Mom got to hold the baby the baby was purple and no longer had detectable pulses, we were breathing for the baby.   But the baby was gone.

Why did we wait I cried out internally?  What in the name of all that is good were we doing??????  WHY is she still on the dam monitor?  If we hadn’t waited till past the 11th hour, we could have found a private room for this Mom, we could have let her hold her, sing to her, cry, call her family. She never held her child alive or if she did it was for seconds to minutes. What really mattered here? We knew 8 hours ago that we were pulling for straws.  What were the extraordinary measures here?

Instead, she held a dead baby for about 45 minutes in the middle of a NICU pod with the sickest patients so with people constantly in and out. Even with screens….it was hellish.   And the moment heaven meets earth should haven’t to be.  It doesn’t have to be like this.

I am not saying the agony of what I don’t have in Africa is better but the agony of having everything except for the one thing that really matters in America is  haunting.   Its haunting because we have lost a grip on life in our attempts to foil death.

Either way the baby dies, its about how they die.

 

 


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