---This is a sad one, but again, with the triumph of human spirit soaring above it all!

A baby died.  It was a few days ago, and I have avoided writing about it for awhile.  I didn't want the raw fresh emotion coming through.  She was a sweet little 9 month old who came to us after an appendectomy had gone awry (why they did an appendectomy on a 8 month old is not known).  During the surgery there was a tear in her intestine, so intestinal fluid had been leaking into her abdominal cavity for awhile and she got sicker and sicker  ... septic by the time we got her.  Our Pedi ICU nurses were incredibly devoted to this little wonder, and our Pedi ICU doc seldom left her side.  There were several surgeries on board ship to repair the tear, to drain the fluid, to look for more tears, etc etc.  Her mother was here with her the whole time with no contact with her family, who live in a small mountain village some distance from here.  Ther one phone in that village was still not operational.  So she did not know where her family was, and they did not know the condition of the child.  IN this culture ... major decsions are made by the family, not just a single individual.  So she had many emotions to contend with.  We all became her family, as did the family members of our other patients on the unit. 

It was hard to see all the effort going into saving her .... I have rarely seen so many drips and so many different blood products being infused in one person before, and we did it for a week and a half!  She was intubated, extubated, intubated, extubated, intubated, and extubated, and that is when we had more discussion with the mother about the prognosis and decisions she would have to make.

She looked no more than a child herself, all of 85 pounds, with several more children at home.  She was stoic, then cried, and then after consulting the our onboard Muslim minister, she was made a "no code".  After so many days of intensity and emotion, the mother made a decision, and was calm.  That day she sat by the baby praying and chanting, joined periodically by the other families.  It was profound and calming to see these people quietly drift in and out by her bedside with this haunting prayer wrapping us all in a sense of calm...it became a beautiful dance, and suddenly the ventilator, the IV's, the medications, the tubes and drains faded into the background.  And we only saw her, her mother, and their new family. 

They made arrangemetns to fly her to the hosptial on shore so that she could die on her own land.  Although we all wanted to accompany her to pay her homage, it was only right that the core team (Pedi ICU nurses and the MD) took her to shore.  We took pictures with her, and made an album, signing it for the mother and the family.  The dental technicians came up and made impressions of her tiny hands (I am still not sure if this was something "western" in approach, and perhaps even a little weird to the mom, as they veiw death so differently from us) yet she accepted her gifts with calm, grace, and a almost divine dignity.  One of the nurses held the mom's hand on the chopper ride in.  They were praying the baby would last until they arrived at shore, as her respirations were increasingly shallow, and her heart rate was slowing rapidly.  They made it to shore, and to the hospital, where they discovered the father had been there just the day before looking for them, and querying about their condition.  I dont' think they were able to get to him before she died.  But she died enveloped in the embrace of a young, devoted, and dedicated mother, and surrounded by the hope and prayers of all of us ---her extended family. 

This is a sad story, but the calm and strength that the mother showed once her decision had been made is another amazing example of human spirit, strength in the face of adversity, and the connection to the universe through profound faith.  I can't help but smile now, as I look back upon our experiences with this tiny baby and her remarkable mom.  It's a series of sweet vingettes, and gentle lullabyes, soothing and invigorating all at the same time.