Saturday, May 12, 2012

When I grow up

Working at the hospital means that I am around people all day, every day. I'm constantly meeting new patients, families of patients, friends of patients, etc.  Every once in a while, someone will stick out of the crowd and really just "get to me."  It happened this week.

I spent the last couple weeks in Freetown and up country doing the medical clinic, so when I arrived back in the OB ward on Tuesday, I didn't know any of the patients.  I started reading through some charts and saw that one of the patients blood pressure was really high.  Like 260/140 high.  The patient had eclampsia, and as we learned in nursing school, the treatment for eclampsia is delivering of the baby within 24 hours.  I asked one of the nurses if the plan was to go ahead and section her, but she told me that she was only about 26-28 weeks.  In the US, with all the advanced technology, babies at this age rarely make it. Here, where our resuscitation efforts include bagging and using oxygen if the generator happens to be on or until all our battery packs die....there's just no way baby would survive. Since we couldn't deliver, the plan was to try and keep her blood pressure down for as long as we could, ideally until at least 32 weeks.  

The next day the doctor called me to the patients bedside while she was doing rounds.  She couldn't find a fetal heartbeat with the doppler or the ultrasound and wanted someone else to check.  I looked and looked, but didn't hear anything.  Mom said that she had felt the baby move earlier that morning, but we weren't finding any heartbeat now.  We told mom, and she started to cry.  This was her first baby.  

We decided to wait one more day, and readdress things in the morning.  The next day I got to the hospital at 3pm for my evening shift.  They had given her some medicine to help start her labor so she could deliver the baby (although it had been confirmed once again that it wasn't alive), but she wasn't progressing very fast.  A couple hours later I started her on an oxytocin drip to help speed things along.  This made her contractions start coming faster and stronger.  It was so hard because the labor was so painful....just like when you're delivering a live baby, but we all already knew what the outcome would be.  She kept repeating "I'm done, I can't do this.  I can't do this. Jesus, please help me.  Help me, help me."  I tried to encourage her as much as I could.  I prayed with her, told her to get in whatever position was most comfortable for her, held her hand.  It was hard to watch.

About 8 hours after the initial medicine was given to start labor, the baby started crowning and she was pushing hard. The head came partially out, but then it was just stuck.  Because Jesus loves me, the doctor just happened to be down in the OB ward, so he came in to help.  Her pelvis was very small and he had to pull hard to get that baby out.  When it was over, she just kept saying "thank you, thank you, thank you."  Her family came in and one of them started crying.  In her very soft way, the patient said, "Don't cry.  You're supposed to be encouraging me...don't cry. It's ok."  She was an absolute pillar of strength.  I was blown away.

She asked if it was a boy or girl and I told her it was a little boy.  I asked if she wanted to see him and she hesitated for a second and then said yes.  I washed him off and covered up the signs of the difficult delivery and showed her to mom.  She said he looked like his dad.  

I've been a part of two deliveries now, in which we knew that the little baby wasn't alive.  It's not fun for anyone.  This woman, a young girl probably around 18 or 19 years old exemplified such calm acceptance and determination in such a hard situation....I want to be like her when I grow up. 

One positive outcome was that we discovered that she does have a really small pelvis, so we told her that she really needs to make sure to come to the hospital for her next delivery, just in case she needs the help of a vacuum or a c-section.  Hopefully now she'll come early and will give birth to a healthy baby boy....or girl.

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