The certainties in life

 

One might argue with Benjamin Franklin's second ‘certainty’, but the first is universally true; death comes to all of us. Here at Chitokoloki Mission Hospital, the certainty of death seems pretty tangible. We are working hard with our hospital colleagues to provide the best possible care with resources available, but the odds are sometimes badly stacked against us.

Over the weekend, we heard that the 20-year-old girl who we sent to one of the big Zambian cities for treatment of her kidney failure died even before she had reached the hospital. A tragic loss of a fun-loving, spirited young girl who should have enjoyed many more years of life. Jess in particular had spent a lot of time with her, getting the diagnosis right and then labouring to carefully optimise her condition over several weeks, making sure that she understood her situation and the options available. Today, we diagnosed another young girl as being in acute renal failure. There is no pleasure in using your skill to make a right diagnosis for a condition where treatment options and prognosis are so poor. The possibility of renal transplantation in Zambia is exactly zero and facilities for dialysis are very limited.

Today, we processed another tragic death – a young girl who lost her life to a devasting combination of HIV/AIDs, Hepatitis B and likely TB. She presented unannounced from a neighbouring hospital at the beginning of our weekend on-call, having failed to make progress elsewhere for the past month. We used all treatment means at our disposal, but our feelings of doom were confirmed as she came close to dying several times over the weekend and finally succumbed this afternoon in liver and kidney failure. In this part of Africa, death is a noisy affair. When it became apparent that she was passing, the grief of her mother and sister was overwhelming, and so loud that after a time, they were escorted out to continue being comforted out of the earshot of the surrounding ICU patients and relatives.

In a mission hospital, in a country which embraces an identity as a Christian nation, there is much more available opportunity to engage with spiritual matters around the threat of death. One of the recent operations we took on was a very high risk endeavour in an elderly gentleman. We had very little lab work available, but knew that he had been bed-bound following devastating consequences from surgery in another hospital, losing large volumes of fluid for the past month. As we weighed together the available information on his condition, we felt the only possible route to survival was a long, difficult abdominal operation with a very uncertain prognosis. There was a real possibility that he might not even survive the operation itself. As would happen in any context, there was a discussion with the patient about the options before him – take the risk of a huge operation with an uncertain outcome, or continue on a path of terminal decline. But the other discussion that happened was focused on more existential issues – was he spiritually prepared for the possibility of death? Or did he have discussions to have with the Almighty before he went under the knife?  Our missionary nurse colleague shared with him what for us also is a life-changing belief – that death need no longer be ‘the final enemy’. That repentance and faith in Jesus Christ brings the certainty of life beyond death… did he have that certainty? Celebrating the triumph of Christ over death, the apostle Paul wrote these words:

"When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: ‘Death has been swallowed up in victory.’
   ‘Where, O death, is your victory?
    Where, O death, is your sting?’" 

(1 Corinthians 15:54-55)