Intensive days in Intensive Care

It is Saturday morning in Rwanda, and I've had a cafe au lait and crepes at a small coffee shop frequented by ex-pats. I needed a taste of Western life after two hard days at the hospital. Even more, I needed time to process these experiences with my best friend and partner of 29 years, Doug. We are at our best when engaging in introspection together.
Thursday I spent the day with Claude, the resident currently assigned to the Intensive Care Unit. We made rounds on the patients, some on ventilators (everything from an antique pressure ventilator to a rather current model), some recovering from head injuries, some head injured and clearly not recovering. I won't burden you with the medical details.
Claude is quiet, not overly self confident, and eager to learn. I must admit ICU care is not my forte, and I told him that. However, we could google on the subjects and learn together, so this is what we did. I would explain concepts that came up in the articles, and also some of the English abbreviations, which are very hard for the Rwandans to understand. There are several patients who are in pulmonary edema, so we spent time learning about ARDS and other forms of lung injury.
One of the frustrations for me and I think for the residents also is the vast gap between what one reads about optimal management of illness and what is available here in Rwanda. Imagine being taught that the best medication for a certain condition is X and you only have access to Y. Sometimes, Y is not even mentioned in the discussion because it is NEVER used for this purpose in the countries doing the research and writing the articles.
On Thursday evening two brothers were admitted through the emergency room with severe burns. They had received good initial treatment at the district hospital and needed further intensive care. The little one is only five months old, the other 3 1/2 years. We were concerned about the baby because his burns involved his whole face, so decided to protect his breathing by placing a breathing tube down to prevent swelling and obstruction. Claude placed the tiny tube, but the tissues of the mouth and larynx were already swollen and it was not correctly placed. He gave it a second try but then Dr. Bosco, the Rwandan staff doctor placed it successfully. Claude was very quiet. When I left for the evening, I told him that this case was good for his learning. He replied "I failed." I remember that feeling so well from residency, the sense that I would never be able to do a procedure correctly. I told him that it was not a failure to gain experience with a situation you have never before encountered, but that this experience would be in his memory next time he faced a burn patient. I hope he understood.
Friday I went with another resident, Christian, to the maternity area. There were no scheduled cases, but another postpartum woman in pulmonary edema. The entire morning was swallowed up with managing her care and eventually tranfering her, in her hospital bed, down the ramps, along the sidewalks, parking lots with potholes, etc. to the ICU. A nurse walked beside the bed with an umbrella over the patient's face because it was raining. When we arrived there she had a respiratory arrest (the oxygen in ICU had run out) and we did CPR. Her heart restarted but she never regained consciousness and this morning when I stopped to inquire about her I learned that she had died.
I don't have any words of wisdom about these experiences. I do know that God is good, and I have to trust Him to show me how to live each day. I Skyped Mom and Dad this morning and they were very encouraging and supportive, and reminded me that discouragement is not from God. I am grateful for them, for Doug and for those of you at home who pray for us, because we are dependent on His grace to sustain us.