Experiencing death in Africa

On Saturday, Kavara and I were assigned to call. We had several admissions that we were called to evaluate and work-up. When Kavara and I got there we started to work up the first patient. He was a small 10 month old baby boy that looked pretty sick - he had a high temp, vomiting, and diarrhea for 3 days as well as a cough. On exam, he was irritable, eyes rolling around in his head, painful belly, and chest exam showed diffuse ronchi throughout. With the fever and how bad he was doing, we did a lumbar puncture on him. It went beautiful - Kavara had attempted only one other time, but she got this one on the first stick. Here they don't use spinal needles on kids - just a regular old needle. The fluid was clear and we sent it for a VERY basic analysis - WBC's or not. I ran down to the OR suite to get something for a brief minute and then the nurse came running down saying the medical student needed me right away. I ran back up the hallway and turned into the peds ward. Across the room I saw Kavara giving chest compressions and mouth - to -mouth rescuscitation on the baby. I ran over - no pulse, no breathing - the mother stood quietly at the end of the bed, saying nothing. The families of other patients all sat and watched - the nurses watched us.....the baby coughed only once in this entire thing but blurped up some phlegm into Kavara's mouth. None the less we kept on, but knowing in our hearts it was over. After a couple of more minutes - it seemed like an eternity, the mother waived her hand at us to stop. She had seen enough, and we weren't making any progress. We had not been told what to do should an infant or adult patient code. Our instinct in the US is to save - here it is to let die. I broke down in tears and put my head down on the cart and gazed into the childs blank stare - Kavara got teary eyed - then we got up and walked back to the work station. The mother cried for just an instant, patted the baby briefly and walked out of the ward. The death certificate came up and three men that were obviously part of the family, came in, wrapped up the baby in african cloth and left. I have never been part of anything like this.......they just see death differently than we all do in the US you know. Dying is just part of living, and is accepted as part of illness. A similar event occurred the following night as well. This time however, the baby stopped breathing a little later after the LP was completed. Our team let this baby go........no code, no CPR.....just let the family be with the baby......and be together to say goodbye......what I describe above, happens everyday in this hospital.....adults and children alike. It's so different from how we practice back home........it really opens your eyes and you learn so much from these special people we are taking care of everyday.