Monday, September 5, 2011

#56 The Will of God

When we got back, I learned that my pharmacist was sick. She had been sick with severe malaria. She was hospitalized, given IV quinine, then taken home and given a second week of quinine. Just for good measure, she was given a course of Ceftriaxone too.

My opinion was asked for. ‘Bring her to the hospital.’

Finally, several days later, she was brought in. She was so tired. Barely had the energy to answer my questions. And usually, she was quick to smile and chat. In fact, talk about energetic, because we only have two pharmacists, and we’re a 24-hour pharmacy, she slept at the hospital every other night. And I never heard her complain about it.

She wasn’t without problems, though. Her husband was estranged and up in the capital, N’Djamena, a six-hour drive away.

Looking at her then, I knew something wasn’t adding up. I asked her a lengthy review of symptoms. Seemed like she was experiencing more respiratory problems than would be expected with malaria; dry cough, shortness of breath, difficulty exerting herself, etc. But she was running a fever and she was exhausted and had vomiting and diarrhea, which all go with classic malaria.

I hospitalized her, put her back on IV quinine, treated all the parasites I could think of with mebendazole, praziquantel, ivermectin and diethylcarbamazepine and gave her some IV fluids. I also gave her a slip for the lab to get tested for HIV the next day.

That night she had a fever, which would become a recurring theme. Despite treating her with Tylenol, Motrin and Aspirin, the fever persisted. As did all the other symptoms.

The next day I got her results back. Positive for HIV. Confirmatory test also positive.

The hospital ambulance took her to Kelo the following day for a CD4 count. 24. She must have had HIV for some time now. We couldn’t check her viral load, but I’m sure it was astronomical. Her HIV was a bullet train an inch from the cliff. Nothing short of a miracle could save her now. This was full-blown AIDS.

When she got back the next day from a trip to Moundou with her x-ray, it was pretty clear that she had PCP pneumonia, an AIDS-defining illness. All her symptoms fit.

By now she was on quinine, doxycycline (actually erythromycin, since doxy made her puke), Ceftriaxone and a veterinarian’s dose of Bactrim. She was still spiking fevers daily, despite all her antibiotics and all her antipyretics.

A week later, she had a nasogastric tube in her nose so we could crush up her pills, dissolve them and get them into her stomach, a Foley so she wouldn’t be incontinent all over the floor, an IV in her arm for steroid injections, family and friends surrounding her around the clock and a vacant look in her eyes. She was working much too hard to breathe. Her blood pressure wasn’t enough. Her pulse was weak. And from the oxygen sensor I put on her finger, I knew she wasn’t getting enough oxygen to her brain to think. She was gone. Her heart was still beating, barely, but the Dina I had known a week before was gone.

For days, everywhere I’d been, I’d heard the staff talking about Dina. About how we were just waiting for the will of God to take its course, whether it be healing her or letting her die. The will of God. That’s what our chaplain tells mothers and fathers when their two-year-old dies. It was the will of God. Really? How is it the will of God that a beautiful young person, with so much kindness and goodness left to give, should die?

We’re in a region where Islam has rubbed off considerably on animist and Christian alike, for better or for worse. The passive mentality, the Calvinistic bent, that all things are controlled by God and furthermore, that all things have already been divinely dictated and must occur as such, leads to a sense of, ‘Why do anything? We can’t change the outcome. God will either save or not, regardless of what I do.’ God already has created the final result, which we cannot alter. This leads to a lackadaisical workforce. Why bother to give the medicine? It won’t change what God wants to happen. Why rush to operate? God already has decided if the patient will live or die, no matter how soon we take out his appendix.

I kneel over her body as she lay on the floor. I pick up her cold and sweaty hand in both of mine. And I pray silently for her. And for her family. And for her friends. And for the community. And for my other patients. And for my own children. How easy would it be for something to happen to my own children? Dear God, why have I brought my family here? Why is there so much suffering here? How is this fair? How is this right? I can’t improve anything here.

At this point, I’m not really sure how to finish this private prayer of mine. I’m pretty sure God gets the gist of it, so a simple ‘Amen’ will suffice. I open my eyes. I’m looking at Dina’s dress. It says on it, ‘Eli, eli. Lama Sabbachthani?’ ‘My God, my God. Why have You forsaken Me?’ Uttered by Christ on the cross and now poetically imprinted on a dying AIDS patient’s garment. God, what are You trying to tell me?

Then I see the other side of her dress. ‘Father, into Thine hands I commend my Spirit.’

She died at 5AM. The nurse didn’t come and tell me. The wailing started and I knew.

In the afternoon, we went to her house. Following the sound of the drums, we arrived to find her open casket under the mango tree. While the drums beat rhythmically, the women wailed and mourned and danced, as if giving themselves to a supernatural realm that would make them move and cry in rhythm with the forces of life and death, good and evil.

Father, I don’t want to wait until I’m on death’s door. I commend my spirit into Thine hands today. And tomorrow. And the next day. And the day after that. And...

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