Death

 

I was rather shaken up today when one of my patients died.

Now, this sounds silly at first glance. I’m a doctor, people die, inevitably some of my patients will be among those who die. But this death felt different.

The man who died was my own age, a secondary school teacher with a wife and a young family. He’d been suffering from headaches for a few months, that no-one had been able to figure out a cause for. Eventually he was referred from an outlying district to our hospital to try and sort things out.

When I first saw him mid last week, I was worried. He had nasty sounding headaches vomiting, and some subtle problems with double vision. We don’t have a CT scanner in Butare, so we arranged for him to go Kigali ASAP (within 1-2days) for a scan of his head, looking for a problem in his brain.

The scan I saw last Friday. It showed advanced neurocysticercosis; a disease caused by the pork tapeworm larvae (from eating tapeworm eggs) migrating into his brain and dying there. This had blocked the outflow of fluid (CSF) from inside his head and the pressure had built up, causing headaches. The question was what to do. The only neurosurgeon was in Kigali, and a transfer required a letter which would take days to organise. I decided to treat him with antiworm medication, steroids to reduce inflammation and mannitol to get the pressure inside his head down while we waited.

It was a long weekend, so nothing moved on the letter front until this morning. Unfortunately this morning, the pressure inside his head became too great and he died. The first I knew of it was his wife wailing as she ran through the ward corridor grieving her husband’s death as I started my ward round nearby. The memory of that cry still sickens me.

I liked this man. I really wanted to save his life. I feel tremendously sorry for his wife and family, now deprived of their husband and father, as well as their breadwinner. I wonder what else could have been done. Should I have ignored the letter and tried to get him urgent neurosurgery? Truthfully I doubt the surgeon would have operated without the correct paperwork, and even if he had, it would probably not have been done on the weekend, in time to save his life.

The barriers to emergency care are often just too great here. The transfer systems, as with so much of the other bureaucracy are so Byzantine. The capacity to pay for treatment is often so low. Many cases find their way here so late that sometimes little can be done.

But my job here, as i see it, is to both to try to help these patients and to model this helping for my colleagues and junior staff. Sometimes I’m not sure what I’m trying to model. I know my Christian faith is a big part of it, but even then I don’t have all the the answers, especially to the medical, culturo-political, and health system issues. This too is part of the equation: vulnerability, seeking advice, not taking one’s power or position as a right but as a trust and privilege. But modelling fallibility is one thing; feeling it and experiencing its consequences is quite another. A fallen world is a painful place to live, even when much of the worst pain is experienced second-hand.

Maybe then, my conclusion is that there is no conclusion, at least not this side of heaven. I can model hope, but never be it. I can point and cajole, but never command or direct. I can teach, but only brokenly and imperfectly, I am only a signpost to the Great healer of this world. And my care will fail, but His love and care never will.

I am praying for this man’s family tonight.