Tuesday, April 26, 2011

Death Before Dawn

This morning a baby girl died in my arms. Her last breath was abrupt and unsatisfying, the way an incomplete sentence hangs on the page: taunting, defiant, unnecessary.

We picked up Boikano on one of my first outreach trips. It was a memorable outing that involved driving well beyond the end of what should be considered a road, working with a village chief to assign a man on horseback to continue the journey, and then somehow intercepting a petite grandmother traversing a rocky mountain while carrying the malnourished and dehydrated three month old baby who we’d soon nurse back towards health at the safehome.

Once she arrived at TTL, Boikano gained weight quickly. She struggled with chronic sinus and respiratory infections, though she’d been relatively asymptomatic in the past couple weeks. She was also recently confirmed as HIV positive and was started on ARVs about 10 days ago. Her health was actually on the upswing. Until, of course, it wasn’t.

Yesterday afternoon she started looking listless, and by 5pm was running a high fever and had vomited once. We gave her medication to help bring down her temperature and tried to replenish her fluids, just as we’ve done dozens of time when similar scenarios arose with other babies. When I went to bed around 1am, the bo’me hadn’t come looking for me or Eric, indicating that Boikano was perhaps not better but likely not worse.

A few hours later, I awoke to a man’s voice, speaking softly in the dark outside my rondavel door. The words were English--otherwise I think my brain would have dismissed the voice as a passing shepherd guiding his herd down the road past TTL.

It had to be Eric, my co-fellow, in conversation with one of the bo’me from the safehome. After a minute of fumbling around to find a hoodie, I opened my door to the cold autumn darkness to see what was going on.

(Fall has just arrived in Mokhotlong--crisp, fragrant, and blustery-- and it is rapidly ushering away the the vibrant green foiliage and previously ubiquitous purple flowers, gradually polarizing the colors of the daytime landscape into two distinct camps: the assertive bright blue of the sky or the soft golden brown of the mountains).

I’d been the last to check on Boikano and since I often gravitate towards the medical side of our work anyway, I encouraged Eric to go back to bed while I went down to the safehome. Being awoken by the bo’me didn’t necessarily mean something critical was happening, but perhaps more importantly both of us knew there was little we could do in a crisis other than take her to the hospital where there would likely be no responsive medical staff and certainly no doctor on duty for hours.

Boikano was on the bedroom floor next to one of the bo’me, wrapped in a plastic sheet and a plush blue blanket. Even without a medical degree, I was pretty sure that she wouldn’t be long for this world and would in fact probably be dead within minutes. Her eyes were open but not tracking; in addition to being unconscious, her breathing was significantly more rapid and shallow than when I’d observed her respirations the previous evening, her hands and feet were icy, and there was moisture beading on her upper lip. I sat for a minute, trying to remember how to treat a a baby for shock or ARV-related toxicity or any other possible cause of her condition, knowing there wasn’t really anything I could do but not yet wanting to admit it.

I don’t have any experience with how death is supposed to be handled here but I have enough experience as a human to know that a baby deserves to die with as much comfort and love as possible in its last moments. I lifted her limp body and cradled her tiny body tightly, whispering things to her that I don’t even remember, watching life drain out of her until the last exhale.

The morgue is essentially within sight of TTL so it doesn’t take long to get there. And thanks to one of my predecessor’s blog posts about a similar experience, I was somewhat prepared. Not that getting down on hands and knees and leaning into a dark coffin-like chamber containing a dead adult male whose rigid cheek was only separated from my own by a thin sheet while I positioned Boikano on his chest was any more pleasant with the memory of Kevin’s blog post in my mind, but it helped to know certain practicalities like that it is standard to jam multiple bodies into one small, cold space and that I needed to leave a handwritten note on the door with the name, gender, time, and contact info before leaving.

When I returned to TTL the sun was still just a suggestion from beyond the horizon. I cried for the second time since being here (the first was last week, when Neo and Molefi left TTL for an orphanage--perhaps not an ideal outcome but at least their departure confirmed their health and the success of TTL’s initial intervention). Eric--who despite worshipping his sleep was not actually in bed when I returned--came over and managed to make me laugh, and the miracle of Skype meant that I could share the events with my boyfriend back in Seattle, all before dawn. Experienced, processed, released and done. Or something like that.

Now as I sit in my office next to the playroom, back to work as usual, I hope the rest of my day continues to be filled by the happy chortling of the babies and the comings and goings of the bo’me. And I also hope it’s a very long time before another early wake up call from the safehome.