Monday, 25 October 2010

A new name

Names in the Bible are so full of meaning.  Someone's name might be a description of their character or prophesy about the future.  In Genesis Chapter 15, God changed Abram's name to Abraham.  "Exalted father" became "father of many."  Isaac's name means "he laughs" because his mother found it amusing that she would bear a child in her old age.  Esau was a hairy man, and so he was called.  Jacob was born grasping the heal of his brother.  Any guess on what his name means?  Naomi suffered much in her life and changed her name from "pleasant" to Mara, which means "bitter."  Skip ahead a few generations to the birth of Jesus.  His name means "the Lord saves."

I started caring for Dai about a month ago.  There were two sort of foreboding things about her case from the beginning.   The first was her list of medical problems, which was quite impressive and only got more so as time went along.  I will get to that in a minute.  The second was her name.  "Dai" means either "to faint" or "to die" in Pidgin.  I'm wondering if her name had another meaning in her local language?  I sure hope so.

Dai came from the Southern Highlands, one of our neighboring provinces.  The doctors at the hospital there referred her because she was pregnant and had a low blood count.  One of her family members works at the local tea plantation, so she ended up at Kudjip.  I saw her in clinic and started her problem list:  23 weeks pregnant with twins, anemia (Hgb 9), enormous spleen, asthma, and hepatitis B.  As tiny as she was, I was amazed that two babies and the big spleen could all fit inside her short little abdomen.  And she still had 17 weeks to go!

A couple of weeks later, Dai returned to clinic with nose bleeds and jaundice.  Dr. Bill saw her and ordered a complete blood count.  Sure enough, her anemia had worsened and platelets were so low that her blood was not clotting well.  She was admitted to the hospital where I took care of her on D-ward.  I ordered all the lab tests I could think of and came up with a working diagnosis of "hypersplenism."  Big spleens are common in some parts of PNG, usually from multiple infections with malaria.  A big spleen can become overactive, collecting platelets and breaking down blood cells.  I gave her a couple of units of blood and her blood count stabilized.  She was discharged after several days in the hospital.

Another week passed by and Dai returned to clinic with yet another problem to add to her list.  Now her blood pressure was high, she had a head ache and quite a bit of swelling in her legs.  Multiple blood pressure checks and a few more lab results confirmed the dreaded diagnosis of severe pre-eclampsia.  This is a sickness of pregnancy that is only cured by delivering the baby.  Dai's condition continued to worsen.  If we didn't deliver the babies and soon, she was going to die.  Even so the decision was not an easy one... at 27 weeks gestation, the twins were not likely to survive in PNG.

Dai was re-admitted and started on medicine to control her blood pressure and magnesium to prevent seizures of eclampsia.  I think it was during this second admission that I decided to call her "Hope."  Anyways, the induction was quite a process.  It took three days to get her into labor!  She finally delivered her babies early Friday morning.  As I feared, the babies were too small.  The first was a boy who died shortly after birth.  The second was a girl.  She weighed only 875 grams.  This one lived through the day but died Friday evening.

Dai herself was quite ill by the time she delivered, starting to show signs of pulmonary edema.  Dr. Susan was on call and stayed with her through the early hours of the morning.  Dai received a couple of units of blood to keep her from bleeding to death and a medication to clear the fluid from her lungs.  I saw her later in the afternoon and she was already starting to look better.  By rounds on Saturday morning, Dai was doing amazingly well.

On Monday morning, Dai looked like a new woman!  What an improvement from how sick she was, and a dramatic example of how delivery cures pre-eclampsia.  It seemed as though we had made it through the most critical period.  I decided to keep her one more day to tune up her asthma and re-check a blood count.

Tuesday morning I walked into D-ward and found the crash cart at the foot of Dai's bed.  Not a good sign.  Dr. Susan who was on call again.  She and a crowd of nurses were hovering over the patient.  Apparently Dai had gone outside and had fallen down.  By the time she was found, she was unconscious.  Somehow the nurses got her back to D-ward and they called Dr. Susan.  Dai was going in and out of consciousness, her blood pressure was low, pulse weak, and her abdomen was starting to swell.  Dr. Susan did an ultrasound and discovered free fluid in the abdomen that looked suspiciously like blood.  Dr. Bill, Dr. Rosie, and I all arrived and listened to the story.  We concluded that the fall had probably ruptured the Dai's enlarged spleen and she was hemorrhaging into her abdomen.  The surgeon was called.  Drs. Susan and Rosie went to give blood.  The nurses started a second IV.  The first unit of blood had just started to go in when Dai became unresponsive and stopped breathing.  Our team worked hard at CPR, but we were unable to save her.  Tears brimmed in my eyes and flowed freely down the cheeks of others.

Sorry for the heaviness of this story.  We don't lose many mothers at Kudjip Hospital, and it is always a tragedy when we do.  But I want to leave you with the happy ending to this story.  Dai was a Christian.  She believed in Jesus and tonight she is with Him in heaven!  I would imagine that she has already received her new name... "Life."

Zion's new name

"The nations will see your righteousness,
and all kings your glory;
you will be called by a new name
that the mouth of the Lord will bestow.
You will be a crown of splendor in the Lord's hand,
a royal diadem in the hand of your God.
No longer will they call you Deserted
or name your land Desolate.
But you will be called [My Delight is in Her],
and your land [Married];
for the Lord will take delight in you,
and your land will be married.
They will be called the Holy People,
the Redeemed of the Lord;
and you will be called Sought After,
the City No Longer Deserted."

~ excerpts from Isaiah 62

1 comment:

  1. Oh, Steph, you wrote this so beautifully. I know reading this that it is God's strength that keeps you going and doing what you do. Love you!