04 March 2008

Death becomes no one

I hate the fact that the last few posts haven't been all that hopeful or full of healing. Maybe I should change the title of this blog to, as one friend has said, Hope, Healing, and Helping Little Boys Slip Quietly Away.

Two children died on the ship this weekend. Forgive me for waiting a few days to post this...it's taken a while to process it all. Death becomes no one. And most especially not little kids.

Sadie was a four-year-old boy who was brought on-board by his father on Tuesday. For two weeks, Sadie's jaw had been swelling. Rapidly. It had gotten to the point that he couldn't lie back without beginning to close off his airway, without difficulty breathing. He either had a bad dental infection, or a tumor, and likely the latter. We took him to the operating room for a biopsy.

Sometimes the simple things aren't. For reasons that have still eluded us, he arrested on the table. For other reasons that have still eluded me, he survived the arrest (don't get me wrong—of the myriad arrests I've been to in my time, this one had the distinction of being the most calm, the most ordered, the most well-run arrest I have ever seen. There's something about hearing, as your entire world stops and the thunderous funnel of emergency envelopes your thinking, the anaesthesiologist's involuntary prayer. "Lord, help us with this kid.")

Still intubated, Sadie was brought into the ICU. The biopsy confirmed Burkitt's lymphoma, and, through some amazingly heroic efforts in a city you're not supposed to venture into at night, cyclophosphamide was obtained. In 48 hours, his tumor was gone. His jaw was frankly normal.

And that's why, when we finally withdrew care, the blow was that much harder. He simply never came back from the arrest.

A day after Sadie's arrival, Benjamin came in. Fourteen years old and sick for a week with what started out as simple sinusitis, Benjamin had developed abscesses in all the wrong places. His forehead, his eye, and, ultimately, his brain. Collections of evil humors bent on ending his short childhood. They, too, won.

When Benjamin first arrived on the dock, he was barely responsive to his name. He had to be carried onto the ship. And by the time he had made it to the operating room, he'd even lost that ability to respond. We dutifully drained his abscesses, knowing that it was all we could offer. It wasn't enough. The day before we withdrew care on Sadie, we withdrew care on Benjamin.

And two boys slipped quietly away.

I realize that in writing this post, I do a disservice. I do a disservice to the couple of hundred patients who have received surgery in the last two weeks alone, who have gone home complication-free and, more importantly, with an ability to walk back into society.

I do a disservice to the other three patients who have come in on the verge of death but haven't gone down that road. I do a disservice to the healing and the hope that the four hundred people on this ship offer.

But death... she's never easy.

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