Breathless

The Lord God formed the man of dust from the ground and breathed
into his nostrils the breath of life, and the man became a living creature.
Genesis 2:7

We call it respiratory distress. It means severe shortness of breath, trying desperately to get enough oxygen in, and carbon dioxide out, to stay alive. Untreated, the breathing muscles eventually fatigue, and death soon follows.

The causes are many, and we see many of them at Kijabe. For three of my patients this month, the cause was AIDS.

First there was Monicah, age 37 with two children, and a nearly obliterated immune system. Her initial Xray looked like tuberculosis, but within days she had an overwhelming lung infection, probably with TB or a germ called pneumocystis, or both (we have a limited ability to diagnose these infections accurately, so we determine the likely causes and treat them all as aggressively as we can). Soon Monicah was breathing 40-50 times per minute, in spite of the best mask and the highest oxygen levels our hospital can provide.

Sharon came a few days later, with an identical picture. Age 29 and a mother of one child, Sharon too was soon working very hard to keep breathing at a rapid pace, barely able to keep her oxygen levels up. We kept these two women in our isolation room, beds facing each other. Perhaps these young mothers, watching each other, mustered strength to keep going.

Jecinta is 31, and has the same illness. Unlike the others, Jecinta has severe anemia and seems quite a bit weaker, so she struggles more to keep up.

We have an ICU with a few ventilators, and in Western settings, these women could be on ventilators while their infections subsided. Here though, we must use the limited supply of ventilators for patients most likely to survive and overcome their illness, thus benefiting from the additional risk and expense of ICU care. Sometimes a patient's prognosis is so grim that we have to make the tough decision to pray for them and treat them with all we have, short of placing them on a ventilator. Such was the case with these three young women.

Watching them struggle to breathe, and grimacing at their terrible-looking Xrays, I predicted death for all three women, even while we treated them in every way we could and prayed for them daily. But I'm thrilled that these young mothers are proving me wrong. With more strength than I would have guessed, Monicah and Sharon have kept up breathing 40 times per minute for over 3 weeks while the medicines we provided gradually caused their infections to recede.

Last week Monicah went home to her children, and Sharon will probably go home this week. We thank God for the amazing capacity for healing that He has built into each of our bodies, and for the special touch of His healing hand when that built-in capacity isn't enough.

We're not so sure about Jecinta. We'll keep treating her and praying for her, but her poor frail body may not endure the effects of aggressive germs and the devastation of AIDS. She's in God's hands now.

- Doug