Why bother?

Sometimes I wonder why I even bother. I stand in the semidarkness of the early evening with my hand over the heart of an 11 year old girl feeling the life ebb out of her. I've detached the ambu-bag from the tracheostomy tube in her neck and she's not breathing. Her pupils are fixed and dilated and I'm now getting to experience for the first time in a raw way the process of life leaving a broken body.

She came in four days ago. She was by the side of the road drawing water from the lake that has now all but flooded the road in between Bere and Kelo. A truck was trying to plow and rev it's way through the water logged mud and slid over towards the girl. She was knocked over and the truck turned on it's side crushing her legs beneath. The passengers frantically unloaded the barrels off the truck and were able to lift the truck up enough to pull her mangled body out from under it.

She arrived at the hospital conscious with her right leg twisted out at an impossible angle and her left leg wrapped in a bloody, mud-splotched t-shirt. She had no apparent head, chest or abdominal injuries, just her two legs.

I unwrap the shirt.

Her left lower leg is sliced open from just below the knee to just above the ankle as with a butcher knife. There is another 6 inch long cut on the side, a 2 inch long cut on the back of the calf and an inch long wound over her outside ankle.

The large lower leg bone is broken and the pieces sticking out at weird angles with much of the rest of the bone exposed.

Her right femur is also fractured, but not open.

We start an IV, give antibiotics and put her under anesthesia. We scrub out the wounds and rinse with liters and liters of antimicrobial fluids. I set the bones which have cracked in a V-shape making the reduction fairly stable. Liz holds the reduction at the foot and I suture the wounds closed.

I put casts around her ankle and knee with a broken broom stick on each side to act as an external fixator. The fracture is stabilized and we have room to clean and dress the wounds.

I then drill a pin through the bone on her other leg and we move her to her hospital bed where I attache a sand-filled shirt to the pin with a rope to act as traction for the femur fracture.

She is breathing well and is otherwise stable.

A few hours later I go to check on her and she is in respiratory distress. She has what is every anesthesiologist's worst nightmare: micrognathia. In other words, her lower jaw never developed well and is so tiny that her mouth won't really open, her tongue is too big for her throat and her airway is small.

She has too many secretions and now her neck has started to swell. She probably had head trauma as well. She is struggling to breath sucking desperately with her chest. I run and get the pulse oximeter and her oxygen is already going down. I yell for the family members to grab her bed and bring her to the OR (it has no wheels so has to be carried...with the traction it'll be impossible to move her quickly otherwise).

I run ahead to open up and go back to find they haven't really moved. I notice she has stopped breathing. I yell again and this time they come running. We somehow manage to get the bed out of the ward, across the courtyard and into the OR.

No breathing, no pulse.

I grab a scalpel and slice her throat. I poke aside the muscles with a clamp and expose her trachea. I cut into it with a scalpel and widen the hole with the clamp and grasp each side with clamps. I insert an endotracheal tube into the hole and attach an ambu bag while Anatole starts chest compressions.

Miraculously, she comes back to life. After a few minutes she is breathing on her own through the tube in her neck and after waiting a while to make sure she's stable we take her back to the ward.

She stays in a coma, however, and we realize she has brain swelling from the accident. For two days we keep the swelling down enough with medicines that she breathes on her own. Her pupils still react normally. On the third day, we have to start breathing for her. The family members take turns "bagging" her to force air into her lungs.

The fourth day, today, the pupils are fixed and dilated.

I'm amazed at how long it can take to try and save a life and how quickly one can remove those life saving devices. Surgery took two hours. The tracheostomy and resuscitation took another hour. Not to mention all the other time spent adjusting meds, explaining to family members, suctioning her tracheostomy tube, etc.

Now in 10 minutes her IV is out, the urinary catheter has been removed, the tracheostomie was pulled, the traction pin drilled out, and the cast cut off. Nothing remains but the sutures and the slightly twisted, un-stabilized legs.

As I sit to write this, I'm sobbing deep down with no tears. How much have I prayed for this girl over the last four days? How much of my own time, strength and energy have I put into her despite having Malaria myself? Why do I bother?

Why does God seem to never intervene? Why does it seem I'm on my own in this?

I need to make sense of it or I'll lose my faith.

Maybe it's not God's fault at all...maybe it's ours. Maybe if this girl had a clean well or running water she wouldn't have been forced to draw from the side of the road. Maybe if the road had been paved with appropriate bridges and drainage systems the truck wouldn't have slid into her. Maybe if the hospital had better lab facilities we could've intervened to prevent any of the number of things that could be unknown contributing factors to her death.

Maybe we in the West can't go out to buy the latest Energy drink or expensive gourmet coffee without using up the resources that could have gone to furnishing clean water sources in the Third World.

Maybe we can't buy bigger and fancier gas-guzzling SUVs without wasting the money that could've gone to provide simple improved infrastructure in developing nations.

Maybe we can't spend millions of dollars on boob jobs and face lifts and lipo suction without depriving bush hospitals of basic laboratory and x-ray equipment.

Maybe we can't live our comfortable lives and sit back and expect God to do the work that he has given us adequate resources, abilities, talents and time to do ourselves. Maybe God's saying, I haven't refused to save that girl's life...

You have.