Heartbreak at Tenwek

Greetings friends,

Our time here is again coming to a close, and it is always bittersweet to review the joys and sorrows of our time at Tenwek.  One particularly heartbreaking case this year involved a young mother who was on the medical service most of the month.  Her name was Jacqueline R., and she was 23 years old.  She had given birth to a son at the end of 2020, and was about 2 months post-partum.  After delivery, she had developed a post-partum cardiomyopathy and congestive heart failure (a weak heart muscle and inability to generate a normal cardiac output, which usually resolves over time).  She also had developed a deep vein thrombosis in her leg (blood clot), and was on our service receiving treatment for these two problems.  When I would make rounds to check on her, she always had her infant son with her and was often breast feeding when we would arrive.  Additionally, her husband or mother was often present to help her with her needs while she cared for her son.  Her young son would always be wrapped in his shuka (a traditional Maasai blanket with its bright red/yellow/blue plaid pattern unique to each tribe) and always looked so peaceful and content.  His mother always expressed her gratitude to us for caring for her and on several occasions asked us to pray for her and her son (which we did – sometimes in Swahili, sometimes in English).  She was making steady progress and I was expecting that she would be ready for discharge in 1-2 days (after adjustments to her anticoagulation regimen).  On the last day of her expected hospital stay, we went in to visit her and noted that she had developed a peculiar affect and seemed to be having some confusion and anxiety.  Her vital signs, examination, and oxygen levels were all unchanged, and we thought that she might be developing a post-partum depression with anxiety, or perhaps some post-partum psychosis?  Her discharge was delayed while we attempted to address these issues.   In her confusion, she was again oriented enough to ask for prayer – which I provided for her.  I recall asking that God would comfort her, give her peace, and heal her body.  I also asked for wisdom and discernment in making medical decisions for her care.  We started her on some anti-depressants and returned to see her the next day.  At that time, she was more clearly psychotic, but still stable- appearing.  We changed her medications to include some low dose anti-psychotics, and my intern briefly prayed over her again in Swahili.  During this time of her mental decline, her mother had started to come in daily to provide childcare, since the Kenyan culture does not permit husbands to physically care for their children (feeding, diaper changes, etc.).  On Thursday morning of this past week, her mother had come into the room and found her daughter unresponsive and not breathing.  The nurses were notified, a code was called, and CPR efforts were begun.  I just happened to be walking up to the ward to begin rounds, when I saw the activity outside her room and went in to find her in the middle of resuscitative efforts.  Jacqueline was lifeless, not breathing and CPR was in progress.  She received 12 vials of epinephrine, 10 vials of bicarbonate, and was being bagged with 100% oxygen.  She had a cardiac rhythm on the monitor, but only had a pulse with chest compressions.  While these resuscitative efforts were in progress, my eyes were continually drawn to the small bundle, wrapped in his shuka, and sleeping peacefully in the bed adjacent to his mother’s bed.  While her life was ebbing away, he was warm, snug, and blissfully unaware.  The resuscitative efforts were continued for about an hour, and as we were getting ready to stop efforts, we noted that she was making some gasping respiratory efforts, and had visible chest movements corresponding to her heart rhythm.  Despite this, she had no palpable pulse or discernible blood pressure.  At this point, we were in a quandary…we had already called for the chaplain to help notify the family of the patient’s demise, and yet she had not technically “died”.  While discussing whether or not to make additional, seemingly futile efforts on her behalf, my eyes were again drawn to her infant son.  “Let’s make every possible effort…for her sake, and for his…” was the final decision.  We bolused her with IV fluids, and her pulse became faintly palpable.  She was intubated and arrangements were made to transfer her to the ICU where she was placed on an epinephrine drip and a bicarbonate drip.  Despite escalating doses of fluids and epinephrine, she was never able to generate a measurable blood pressure and continued to remain very hypoxemic (low oxygen levels in her blood).  It appeared that she had probably had a massive pulmonary embolus (blood clot in the lung), despite being adequately anticoagulated.  She survived for another 4-5 hours during which time we were able to counsel the mother about her prognosis and the likelihood that she would die sometime later that day.  We were told that the patient’s husband had fled the hospital when it appeared that his wife was dying, and the mother was not sure if he would return.  She informed us that she was a poor woman, but would find family to care for her daughter’s son if need be.  Her only request to us was that we again pray for her daughter, her grandson, and her family…which we did with great sorrow and heartbreak.  Too often, such is the case here at Tenwek…great poverty, great hardship, and great sorrow…. but also great faith and trust in a loving God.  I have continued to silently grieve these past few days for Jacqueline and her infant son and family.  Please join me in praying for protection, comfort, and provision in their time of need.

Psalm 34:18   “The Lord is near to the brokenhearted and saves the crushed in spirit.”

2 Corinthians 1: 3-5   “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God.”