“Ele enxugará de seus olhos toda lágrima; e não haverá mais
morte, nem haverá mais pranto, nem lamento, nem dor; porque já as primeiras
coisas são passadas.”
~Apocalipse 21:4~
Today I received news that one of my little angels, Aryan
Rahaman, died Wednesday evening. He was
a beautiful 2 ½ month old baby boy who came to Blantyre Adventist Hospital
(BAH) two weeks ago from Mozambique. I
first met Aryan in the Emergency Department after doing my rounds around the
hospital, trying to make myself useful. That particular day that I came on duty
was very slow; 9 patients in the entire hospital, including him. He was hooked up to the portable oxygen tank
at 8 Liters per minute (he was suffering from severe respiratory distress... trachial tugging, substernal retractions, wheezing...); a machine monitoring his oxygen saturation and heart rate,
which beeped like crazy; and an intravenous drip, by gravity... (I fought to get an IVAC machine to accurately regulate the rate of infusion so the poor little guy wouldn't suffer from overload! Folks couldn't spare
1 of the 3 unused and working ones, for fear it would get damaged … I practically
yelled EXPLAINING how we had a critical patient who needed it NOW…So what’s the
problem??? And you’re worried about
your equipment… Uhhh!!!) After being exam pediatrician, the x-ray, blood tests, STAT doses of IV medications and
nebulizations, Aryan was diagnosed with aspiration pneumonia and
cardiomegaly (the cardiac issue was resolved after an ECO, done by Dr.
Priester, showed nothing wrong). We later concluded that the
aspiration pneumonia was due to the fact that he suffered from severe asthma
(his parents are asthmatic) and mostly likely had an acute broncho spasm when
feeding.
Aryan’s regiment included vital signs, taken every 2 hours; a
strict course of antibiotics, nebulizations (nebs), random blood sugar tests (because
he was initially NPO= nothing by mouth), strict I & O’s (measuring/weighing
what went into the patient; including feeds, IV fluids, IV medications, etc.
and all that came out of the patient; includes waste, blood, vomit, drainage…),
chest physio, suctioning, you name it! We even cut out dairy, when he was able
to eat (milk and dairy tend to worsen asthma due to the increased mucus
production). I don’t know how many
times I got up, just to check his alarm! I can say it was a constant
prayer. You worried when he started to
desaturate to the 70’s and 80’s or when his heart rate shot up above 200 (sometimes around 220-235… due to the side effects of the neb treatments and his illness). You worried at night, when the temperature
dropped (the cold air exacerbated the acute broncho spasms… there is no thermal
regulators in the hospital, save blankets or a closed window… but what do you
do when your kid as a fever or 39.1°C and he’s wheezing?). You worried when he
had a sudden spike in temperature. In
the two weeks that he was at BAH, I spent so much time with Aryan and his
family, that I even memorized the hospital admission number! I just knew, each
time I’d report to work, I’d be assigned to them/him. He knew my voice. Aryan was my little boy.
I had a front row seat to the tenderness and genuine love
both the mother and father have for their child. Save for a sister-in-law from
the dad’s side also living in Mozambique, the family had no other relative
living on the African continent.
Everyone else lived in Bangladesh. The kisses, rocking to sleep, doting,
questions, tears, and prayers; they are universal. They barely slept! Though
at times their requests and expectations where sometimes overwhelming (more so
out of fear…at first, they were scared to touch Aryan, because they felt they
might hurt him…), the Rahaman’s and I really bonded. They trusted me and sincerely appreciated
the care and attention I gave their son. All eyes, hopes, and prayers where on precious
baby Aryan.
Sunday, April 21 would be my last time holding Aryan in my
arms. He had improved so much and I could
see the joy and relief that were on his parents’ faces. They were even becoming more comfortable with
his care and help participate. He wasn’t out of the woods, by any means, but he
was no longer on high flowing oxygen and was tolerating blow-by oxygen at 2
liters per minute well. He also had only one daily antibiotic and one neb drug, Salbutamol, every 4
hours (he had 3 and was nebulized almost every 2 hours). After the neb treatment, we’d see how long he
could tolerate being on just room air.
The longest, on my watch, was 7 minutes (his parents claimed as long as
30 minutes, but I beg to differ). He was
now smiling and cooing again.
The problem:
BAH is a private hospital.
About 50 percent of the patients have health insurance; the other half
pay with cash. Aryan’s parents where
cash paying customers and his two week high dependency stay became too much for
them to afford (the bill was an estimated 1.65 million Malawian Kwatcha;
equivalent to purchasing a really nice used car in the US… keep in mind, 80
percent of Malawians live on less than $1 a day… a slightly higher percentage
than Mozambique). Hence, the doctors worked diligently to organize ways in which
we could still manage his dependent condition and help ease the financial drain
it was causing on the family. We thought of everything, from having them
purchase their own oxygen tanks and medications; to hiring a home nurse while
they stayed in at a friends’ house here in Blantyre. Since Aryan just needed oxygen therapy and
neb medications, the final decision was to transfer him to a hospital
in Mozambique, near the border.
Aryan and his family left BAH Monday afternoon around 1 p.m.
I was off duty and didn’t get to see them leave. I arrived at work Tuesday happy to see the
room, where the family once occupied, empty.
Aryan had improved and was stable enough for transfer. However, later
that afternoon, we received a call from Mozambique stating that the parents
were returning because they were not satisfied with the care there and it made
them worry. That day it was extremely
busy. Most of the beds were full and so
was the nursery. I have to admit, I was hoping he would arrive after my shift
was over. Just my “luck”, he didn’t show.
I figured, I’d see him Wednesday morning. No Rahaman’s… “Perhaps the decided to stay in
Mozambique because of the long drive?” were my thoughts. “After all, they won’t
have an ambulance to escort them this time from Mozambique to Malawi.”
The News:
Thursday, the head of pediatrics and the medical council at
BAH, Dr. Varona, pulled me aside and asked, “Did you hear about what happened
to Aryan?” Immediately my heart sank. I didn't want to think about what
she'd say next, though I prayed what I was about to hear wouldn't be true. The news of his death stung and my
thoughts raced back to the parents, especially the mom (she suffers from depression). Apparently, Aryan did arrive in Blantyre... just to the free government hospital, Queen
Elizabeth Central. When he arrived his
oxygen saturation levels were in the 50’s and 60’s. The doctors did an ECO, confirmed that there
was nothing wrong with his heart, and were about to place him on
CPAP(continuous positive airway pressure—used to help treat his severe
respiratory distress), when he had a cardiac arrest. After CRP with rounds of epinephrine for more than 30 minutes, Aryan was pronounced dead.
My heart is heavy and I think of the parents and Aryan’s 5
year-old older brother. I think about
the emptiness and the unexplained answers the parents must have (because of the
language barrier, it took them a while to understand that their son had
died). I think of the fact that they are
so far away from their native country, Bangladesh. They have no blood relative to visit them in
this time of tragedy. I think of You… I think of heaven. One day, I will see
baby Aryan again. He will be healthy and
his parents will no longer have to worry… but at this moment, I pray that You,
oh Lord, will wrap Your loving arms around those that are grieving and give them
hope and peace.
Tu hijita,
Joya
“And God shall wipe away all tears from their eyes; and
there shall be no more death, neither sorrow, nor crying, neither shall there
be any more pain; for the former things are passed away.”
~Revelation 21:4~
