September 7, 2006 – “Little ones to Him belong”

     I met Sarah on the evening of September 5 when was brought into the emergency room of the Kijabe Hospital.  She was unresponsive, had a high fever, was breathing very rapidly and had a pulse rate of over 160 beats per minute (for reference, yours pulse is probably about 60 now).  Her grandmother, whom she had been living with since her parents divorced, brought her in.  When they separated, the father took the 5 older children and the mother had taken the remaining 6.  When the mother couldn’t raise enough support to feed her children, she left for the city to work, and was to send back money.  She hadn’t been heard from in some time.  The grandmother wasn’t sure how long Sarah had been sick – but recalled she had been given some TB medication a few months ago, and that “this one” coughed a lot.

     Sarah weighed about 10 kilograms, which is on the low side for a 2 year old.  Sarah was 4½.  Her upper arms were the same circumference as my index finger, her thighs – about the size of my thumbs.  She was quickly diagnosed with congestive heart failure as her primary problem – this added to the list of TB, liver failure, severe dehydration and starvation.  You don’t see a lot of congestive heart failure in 4½ year old children, at least in the U.S., I can’t even imagine that diagnosis coming to mind - but one of the doctors administered a medication to relieve some of the pressure on her heart, and within minutes her condition began to improve.   The fragility of her blood vessels made starting an I.V. nearly impossible.  After several failed attempts in her tiny arms and legs a line was finally established in her neck.  Her jugular vein was the only one large enough for the smallest of I.V. catheters. 

     As her condition improved, she slowly regained consciousness and started to become aware of what was happening around her.  I was holding her while we rearranged tubing, bedding and monitor wires.  She looked up and saw who had her.  Her eyes got huge – and she said something in Kikuri (her “mother tongue).  One of the attending doctors laughed and said, “She says she is afraid this mzungu will ‘inherit’ her”.  She did not speak any English or Swahili – but had the sweetest voice you have ever heard.   That’s how our relationship began – she could not get out of my arms fast enough.  

     Over the next several hours x-ray and lab tests began to reveal the severity of her condition.  Her chest x-ray showed extensive damage to her lungs as a result of the TB.  She had been left with lung capacity roughly equal to a walnut.  This explained her rapid breathing and heart rate – her heart had to work that hard to get oxygen to her brain.  Had she been brought in 6 months earlier, the prognosis would have been much more promising, but at this stage, there was very little hope of recovery.  The medical staff was nothing short of amazing.  Although her chances of survival were slim, and chances of payment were even less – nothing was spared in trying to save this child’s life. 

     Several other patients came and went that night – as a matter of fact it was the busiest the emergency department has been since I’ve been here – but I don’t remember any of the other patients.  I went and helped where I was needed, and always ended up back with Sarah.  For whatever reason, it was so important to me that she knew I was there, and that I loved her – just like she was.  I stroked her head and held her hand.  At first she would pull away – she didn’t know what I was doing – but over time started to figure it out.  The whole time I spent with her – I prayed.  I prayed that God would spare this one, pull her from the fire, restore her.   As the 6 hours in the ER passed, my prayers changed to “please don’t let her suffer” and “what can I do to bring this little one to you.”  Her last set of lab results came, and any optimism that remained was now squelched.  Regardless of how many times you’ve been through it, this part never gets any better.  I hate it when they die.  I was still holding her, and the thought occurred to me that I should baptize her.  There was no water nearby, but before I could give thought to it, I could see my tears landing on her forehead.   The Lord provides. 

     I made a very special request of God, which I rarely do – really.  It was after midnight, and officially my birthday – and for my birthday, I asked for one day with Sarah. 

     She was transferred to an intensive care room and I stayed with her until about 4am.  While I was walking back I realized that although the grandmother had been there the whole time, and had talked to Sarah, she never touched her.  Never held her hand or hugged her.  I guess it’s a cultural thing, but certainly explained how foreign touch was to her.  I was back at the hospital by 6:30 so I could check in on her before 7am case reviews.  I brought her Rosie’s “little light” (a battery operated candle) and placed it on a table at the foot of her bed so she would have something to look at.  During breaks in the day I went to the pediatrics ward, and the local store but could not come up with a toy or a book or anything else to entertain her.  I spent every free minute with her.  We colored (I did most of the coloring), sang, I brought her juice, which I thought would be a huge treat – she wanted chai (tea) – she got chai.  I kept stopping in all day.  The grandmother thought it was strange, the nurses thought it was strange – the hospital is full of patients  - why was this mzungu spending so much time on this one little girl?  I just wanted her to feel loved – I didn’t know if she had ever felt that.  I don’t think anyone ever spent a great deal of time or attention on her. 

     I had dinner at Dr. and Karin Swanson’s house that evening – news of the birthday had leaked.  I told them about Sarah, and after dinner, one of Dr. Swanson’s daughters volunteered a stuffed rabbit to bring to her.  The dinner and company were wonderful, and I returned to the hospital.  When I got back to ICU they had put Sarah on respirator to force oxygen into her lungs.  This was to hopefully improve the amount of oxygen she was getting.  The mask had a 4-point strap that held it tightly to her face to form a seal.  Her arms were restrained to keep her from pulling the mask off.  As I got closer I noticed big puddles of tears on top of the mask.  With all this little angel had been through, these were first tears I saw her shed.  I looked at her oxygenation level – and the ventilator wasn’t helping.  The nurses couldn’t remove it without a Dr.’s order, so I found one who agreed that although it was a noble effort, at this point probably doing more harm than good.  When I motioned to Sarah “mask – off” her eyes lit up – I think I even saw a hint of a smile under the mask.  The ventilator came off and she went back on a regular oxygen mask.  She had some more chai and water.  I gave her the rabbit; she took it hesitantly and tolerated it.  It wasn’t long and the rabbit was tucked under her arm.  It was getting late and I was about to leave.  I got up a started to pack my things up.  I heard her say something and when I looked, her hand was reached out.  I asked her what she wanted – tea, water, juice?  The grandmother said “wewe” (she wants you).  I gave her my finger and she held on.  This is the same little girl that was doing everything she could to get away from me 24 hours ago.

     At 10pm Sarah let go of my hand and took Jesus’ hand.  She will never be hungry or thirsty again.  There is no more poverty, pain or disease.  She has no wants or needs.  I can only guess by her condition what the last 4½ years of her life were like, but I know that she left this world loved.  Sarah, and so many like her give me so much more than I could ever give them.  That’s why I’m here.

    I can’t speak highly enough of the staff at Kijabe Hospital and the level of care and compassion they showed Sarah, as well as every other patient that crosses their threshold.  They continue to be an oasis of hope in a dessert of disease and poverty. 

     I met the grandmother in the hallway today.  I didn’t understand what she said to me, but when she finished, she hugged me.

Shine!