I can feel winter encroaching, trying to steal away the last of the desert warmth, bringing darkness earlier and earlier each day. During the day, it is still warm enough that I break out into a sweat when I walk the mile from the NATO Dorms to the Hospital, but as soon as the sun goes down, the chill sets in. People can now be seen donning jackets, caps and even gloves from around 4pm to 10am.
This is one of my favorite times of the year back in the States. I love the crisp mornings and the colors of the season, especially the bright reds of the maple trees in my yard. I miss the scent emitted from burn piles as people attempt to rid their lawns of dead leaves and pine-needles. And most of all, I miss planning for Thanksgiving dinner, making green bean casserole with the crunchy onions on top, stuffing and my mother-in-law’s southern-style macaroni-n-cheese and corn pudding.
Now that the cold nights appear to be here to stay, we have been experiencing an influx of burn patients from the local community. As there is limited electricity, especially in the smaller villages, the Afghans use kerosene lanterns and oil stoves to keep their families warm. We have cared for several children that have been burned from kerosene lanterns and, unfortunately, the oil stoves can be very dangerous as the Afghans often attempt to refuel them while they are still burning.
Just this past week we admitted five out of ten family members to the ICU who were burned when the stove exploded while the mother attempted to refill the oil. Dad had 25% burns, mom had 40%, their 10 year old girl had 65%, their 7 year boy had 70% and their 3 year old boy had 40%. Within less than 12 hours of admission, we had to let the 10 year girl and 7 year boy go. With more than 60% of their bodies burned, their prognosis for any sort of positive outcome was almost non-existent.
In the states, we would have been able to resuscitate those two children and after months of hospitalization and multiple surgeries, they would have been discharge to begin a long and difficult rehabilitation with intense physical therapy and probably more skin grafts. This would be possible in our country with the health care resources we have, but even if we could have kept those children and performed the multiple surgeries they would have required over the next several months, our hospital doesn’t have the rehabilitation resources required to provide the quality of life necessary to survive in this culture. It was a difficult decision for our doctors to make, but after a lengthy discussion among every single doctor in the hospital, the Commanding Officer and the Director of Nursing Services, the decision to provide comfort care only was made and that is what we did.
I noticed a stark difference in the way that the Afghan parents dealt with the death of their two children compared with how parents in our country deal with death. In our society, we tend to want to remain with our dying loved one not only until the very end, but even for a period of time after they have passed. However, these parents chose to say goodbye to their children early in the night and did not want to see them again after they said their goodbyes. We kept them separate from their two dying children, but pushed the couple close to one another so that they could pray with each other and cry with each other. We also moved their 3 year old son, who did have a positive prognosis, next to the mother so that she could reach out and console him whenever he cried.
The couple went through a roller coaster of emotions through out the next two nights as they remained under our care. Having heard so much about the repression of the Afghan women, I was surprised to see this couple relate in much a similar way as any married couple in the U.S. They seemed to have a mutual respect for each other as they spoke to each other and cried with each other. The woman cried openly while the man tended to cover his face and weep into his blanket, although not always. Even though I could not understand the language, I could decipher that they were reciting prayers to Allah frequently throughout the night as well.
At other times, when they may have been experiencing feelings of denial, they actually spoke in tones reminiscent of a regular day-to-day couples chat. I’m not sure what they were saying, but it seemed pleasant. At one point, the woman was trying to ask me something and after pointing at or holding up every single object in the area, the couple actually started laughing at me because I couldn’t figure out what she was asking. When I finally had the translator come over and help me, he told me that she wanted to get up and sit in a chair. The three of them tried to teach me to say “ksseenawem” which essentially means ”I want to sit up” in Pashto. After laughing at my pronunciation a couple times, I finally got it, but by that time, she no longer wanted to get up. Oh well. At least I tried my best to communicate with them. They were very patient with me and, via pointing and other gestures, we were able to figure most things out.
Then, later in the night, the mother heard one of our other pediatric patients crying on the other side and she suddenly became convinced that it was another one of her eight children. She would not stop crying until we decided to roll the child’s bed over where she could actually see for herself that it was not her son. This then resulted in a long period of prayers from the mother and more tears from the father.
The translator told us that they do not tell them that their children are going to die, when the doctors ask them to like we do with loved ones in the States, because that is not how they prefer to deal with death. They prefer to be told once it is over and, in the meantime, just tell them that their lives are in the hands of Allah to decide what He will. I think there is a much stronger acceptance of death in their culture than in ours as well. These people live a hard life and their society is used to premature deaths from accidents and illness that we otherwise have the means to prevent, fix or cure. The average life expectancy for the Afghans is only 44 years of age. Our life expectancy in the U.S. is 78 years of age, almost double.