Book excerpt: ‘Oh God. What am I doing here?’

It didn’t take long for the first waves of nausea to wash over me as I faced backward in the makeshift Ghanaian ambulance. It was a frantic and wild drive along a dark, windy, pothole-filled road with this newborn clinging to life. We held on for three hours and prayed that we would make it in time.

Halfway there, Eric tapped me on the shoulder while I was vomiting copiously into my little bag.

“Dr. Jenn, the baby’s breathing tube has become dislodged due to the road conditions. Please – you must re-intubate the baby. And doctor – we have a ‘small-small’ problem – we have run out of oxygen.”

It felt like I was in a horror movie with no escape, professionally vulnerable and personally terrified. I was sweating profusely, buffeted by tidal waves of nausea, vomiting uncontrollably, and we were still hours away from the neonatal ICU. Who was I to be carrying out the highly skilled procedure of intubating a newborn in the back of a so-called “ambulance” that had just run out of oxygen?

I was way out of my comfort zone and my imposter syndrome was screaming in my ear, “You are a small-town family doctor, not a neonatologist!” There is no way this baby will survive.

I instructed the driver to pull over. I steadied myself, prayed for courage and favour, and placed the blade with the light into the baby’s mouth to search for the tiny vocal cords through which I somehow needed to thread the tiniest of breathing tubes. As the blade slid in, my target – two small vocal cords – popped immediately into view, lit up like the Eiffel tower, clear as day. Then, like the parting of the Red Sea, the cords opened as the baby took a gasp, ushering the life-giving tube straight through. Did that just happen? Using only room air instead of oxygen, we were able to continue to support the baby’s breathing.

There is no way this baby will survive.

When Eric finally pointed to the distant lights of the massive regional hospital, the relief I experienced was indescribable.

I’ve felt it in the past, but to a lesser degree. Before we had critical care ORNGE paramedics in Ontario, we as physicians would travel in the ambulance with our sickest patients when transferring to other hospitals. Pulling up to the Hospital for Sick Children or St. Michael’s Trauma Centre in Toronto and handing over the care of a severely ill or injured patient to an expert team in a state-of-the-art centre was the best feeling in the world.

Now, I couldn’t take my eyes off the lights of that regional centre as it drew closer. I visualized the neonatal team assembling and preparing for our arrival in the “Promised Land.” Once I had passed our little newborn into their capable hands, I planned to record as much information about this tertiary care centre as possible for our task force.

When we entered the hospital, however, no one seemed to be expecting us. As I continued to ventilate the baby outside the emergency room, I could hear Eric involved in a heated conversation. His arms were flailing, and he was pleading.

Why on earth is he pleading?

He returned and explained apologetically that they were unable to accept the baby. They had no working ventilators in the hospital and the pediatrician was “unavailable.” They were directing us to carry on to the teaching hospital in another city, which was three to four hours away.

I began to vomit again, and I knew I was about to faint. I also knew that this baby girl could not survive another four hours on the road.

I knew I was about to faint. I also knew that this baby girl could not survive another four hours on the road.

After making sure I was OK, Eric disappeared again and, in my unfocused, peripheral vision, I could see him talking to the staff and pointing at me, the semi-conscious, dehydrated, ghostly pale woman slumped against the wall. He returned moments later and announced that we were going home – they had accepted the baby after all. A respiratory technician arrived and took over, promising he would ventilate the baby all night if he had to. I had no choice but to believe him.

We left the hospital, my journal pages disappointingly blank, and I lay down in the back of the ambulance, begging sleep to come and end my misery. About an hour later, I awoke to Eric tapping me on the shoulder. “Dr. Jenn, we have a ‘small-small’ problem. Our vehicle has broken down.”

Of course our vehicle has broken down. At that moment, I thought I might just die on the roadside. All I could do was muster a weak but sincere prayer: “Korowii te ya kere.”

Eric laughed at my pronunciation.

Prayers answered, tomorrow was granted to me and to the resilient baby girl whose parents sent word about 10 days later that she had made a full recovery and had been discharged back to her village.

David Mensah, Ghanaian Director of the Northern Empowerment Association, was not pleased with me when, eventually, word got to him that I had made that journey. Travelling on unlit treacherous roads, the risk of becoming a victim of a traffic crash or crime rose exponentially in the dark of night. But how could I not? The life of a baby girl was at stake.

The last day of my placement finally arrived, and I was honoured to be asked to give a teaching session for the entire medical staff. We gathered in the outdoor chapel and worked through a variety of emergency medicine topics and procedures. With a broader and deeper understanding of the limitations of their system, I could tailor my teaching to the Ghanaian setting. Eric asked me to instruct them on how to use an interosseous (IO) needle – something he had only read about. This was the device we had used on our 2013 mission to save a French-speaking little girl who drank a caustic liquid. I didn’t bring any IO needles with me (incorrectly assuming they would have them), but I used pictures to explain. I promised to send a box by mail when I got home so Eric could train the emergency room staff how to use them. From that day forward, boxes of IOs have travelled from Uxbridge Hospital to Ghana once a year and Eric soon became the regional expert and trainer in IO needle insertion. On a monthly basis, he would send me a picture of IO patients, always with the same caption, “Another life saved.”

When the two-hour teaching session ended, Susan and I bid farewell to our new friends and colleagues. We would see many of them in Carpenter (in Northern Ghana) the following week for the Helping Babies Breathe training, including Eric and my new physician colleague, Ben.

I exited the chapel and relief flooded over me. I was officially off duty! It is a feeling that every emergency room physician anticipates and celebrates as they walk out the door at the end of a shift – the responsibility of saving lives lifted off our shoulders for just a little while. Not only was I off duty, but I had a couple of days off in Carpenter to refresh and recharge before the HBB program would begin.

If I’m honest, I felt a bit proud of myself as I walked back to my room to pack my few belongings. These had been the most difficult two weeks of my life, but I had persevered. Furthermore, I had collected a great deal of information from the countless interviews I conducted with hospital staff and my Moleskine journals were full. I would compile it all into a report for our hospital feasibility group. If I could have properly patted myself on the back, I just might have.

I could tell by the tone of the yell that something was very wrong.

As I made my way back to the apartment humming, I heard someone yelling my name. Please, no. I could tell by the tone of the yell that something was very wrong. I wanted to ignore that cry for help and pretend I didn’t hear it. I was so done. All I wanted to do was pack and leave. Keep your eyes down Jenny, and just keep walking. Just keep walking.

It was Eric. Eric was a national level soccer player, so it didn’t take him long to catch up to me. A toddler with diarrhea had arrived with his grandmother during the teaching session and the ER staff hadn’t wanted to interrupt me. His veins were too flat from severe dehydration to obtain an IV line and they were losing him. Eric wondered if we could somehow make an IO needle, like the one I had just taught them about.

We sprinted back to the emergency room while I frantically brainstormed what we could possibly use to create an IO. As we pushed our way past the boisterous waiting room crowd and approached the toddler’s bed, we stopped short. The little boy’s grandmother made eye contact with me – her eyes weary and stricken in her wrinkled face – holding mine for a long moment while she raised her hands and waved us off. What was she doing? Why did she not want me to help her grandson? Where were the parents? Then, with those same weathered hands, she took off the long, colourful cloth wrapped around her waist. She had used it as a sling to carry her weak grandson on her back a great distance from her village to the hospital. Then, she opened her mouth and began to wail as she wrapped it carefully and lovingly around his lifeless body. I looked to Eric, his protective arm now extended in front of me, preventing me from rushing forward toward the deceased child. Why wasn’t anyone calling a “CODE PINK”? Why wasn’t anyone doing anything?

Why wasn’t anyone doing anything?

The emergency staff continued their work, acting as though the death of a child happened every day. And then it finally sunk in – it did. This was their reality. It was the first pediatric emergency room death I would witness in Ghana or in Canada.

I had to get out of there. I needed to escape the wails of this grandmother and the walls of this hospital that had been unable to save her grandchild. I pushed my way through the waiting room crowd and ran back to my residence.

I didn’t know what to think or how to feel. While I was teaching and then mentally patting myself on the back for a “job well done,” a child had died of dehydration. He was a boy. A son. A brother. A grandson. If I had not been teaching that session, would we have been able to save him? Why didn’t they feel they could interrupt me? If I had thought to pack IO needles, would he now be alive?

I tried to pretend that it didn’t happen. I willed myself to block out those piercing wails and focus on the “good things” we had accomplished. But my intrusive thoughts kept breaking in, uninvited. After all I had endured over those two weeks – bumping into babies left to die on steel carts, risking my life in “ambulances,” learning, teaching, and training – this was how it was going to end? With the death of a child? This would be the memory that I would be forced to forever carry with me?

I arrived back to my room and slid to the floor. A sensation of helplessness, of failure, welled up in me. I began to spiral into a dark place of despair. I dialed my husband Graham’s cell phone. All it took was the sound of his voice and the dam collapsed. I wept over this boy and over the injustice upon injustice I had witnessed since arriving in Ghana.

I tried to speak but my constricted vocal cords would only allow me to utter three words: “EVACUATE ME NOW!”

I wondered what Graham was doing when I made that desperate call. I could tell he was busy – probably helping five kids with their homework and piano practices while simultaneously making dinner. What were they having for dinner? Maybe he was making his famous Shepherd’s Pie or perhaps it was “dipping egg night” (what we fondly call soft boiled eggs in cute egg cups that we dip thin fingers of buttered toast into).

Snapping me back to my Ghanaian reality, he asked me, with deep concern in his voice, what was going on. I told him I was not equipped for this work, that the problems in Ghana were far too massive, that building a hospital in Carpenter was just a dream, that a child died because of me, and that I needed to immediately return home to my family. I wanted back in my nest, and I never wanted to leave it again. I needed him to send me help NOW. I needed sympathy and support – for him to rescue me. Instead, my husband said, “Well Jenny … maybe God wanted you to witness all of that for a reason.”

I heard the timer go off on his stove – and I hung up on him.

Light-headed and dazed, I rose from the floor, still wracked with sobs, and my feet somehow carried me back to that emergency room. The crowd was large and deafening, yet the tiny boy still lay there, silent and motionless on the dirty black stretcher, covered in his grandmother’s parting gift. Why was he still there? Had she gone for help to carry him back to their village? Or would he remain in the morgue until the family could save enough money for a funeral in the months ahead, as is often the custom in Ghana?

I stood vigil across the room and forced myself to look at him – that small, ashen bundle swaddled in the lively patterns and vibrant colours of Ghana. His long journey to me and my long journey to him was over. I realized that he likely had no parents. They most certainly had died and he, like so many orphans, had been left in the care of his grandmother – just as Stephen Lewis had said during his keynote address that awoke me from my slumber.

The permanence of a child forever separated from loved ones moved me deeply. I thought of my kids and how separated I was from them – as they delightedly ate their dipping eggs in my mind’s eye. I reflected on how Graham and I had come close to losing three of them, on three separate occasions, many years ago. It took three wonderful hospitals and countless health professionals to save them – Olivia from complications of Kawasaki disease at age 4, Joshua from meningitis at six weeks of life, and Jessica when she did not draw her first breath at birth. My hand instinctively reached up to clutch my keepsake necklace.

This boy had died needlessly of a treatable condition in a hospital that was ill-equipped to save him.

This boy, like 5 million other children in the majority world every year, had died needlessly of a preventable and treatable condition in a hospital that was ill-equipped to save him.

My global health brain knew these statistics and would quote them to obtain the diploma that would soon hang on my wall – but on that day, these statistics pierced my heart. They now had a face and a name, and an indelible memory attached to them, a memory of a grandmother’s grief and her colourful cloth. An unfamiliar mixture of sadness, anger and longing to hold my own children began to swirl in my soul. The weight of this little boy’s death, and the pain that his loved ones would forever endure, pressed down on me. I felt nearly suffocated by my inability to save him or his 4,999,999 future friends.

Oh God. What on earth am I doing here and what am I supposed to do now? Who am I to be considering these things?

Suddenly, another power outage plunged the room into darkness. The absence of light could not extinguish the image of that boy from my mind. The answers to my prayer and to my nightmare’s many questions would not be forthcoming. Defeated and diminished, I fumbled my way out from my Ghanaian classroom, the infirmary door creaking shut behind me for the final time.