Sunday, June 3, 2012

Life is hard, but God is good

Two nights ago I was in the OB ward. There were only two of us in town so I was working a double. It had been a relatively quiet day (a blessed relief after the busyness of three C-sections in a row the day before). It was 3:15, the end of the day shift and the evening people were starting to come. Just as I sat down to do a little reading, the ambulance driver came to get me to go get a patient. I asked one of the other nurses watch over the OB patients for me while I was gone, and off we went.

We drove for about 20-30 minutes and pulled up to a house. I walked into the house and saw a woman lying on the floor. I asked what the problem was and they told me that she had been “fitting” (means seizing). Her tongue was huge because when she seized she’d been biting her tongue. Her family told me that she had just started seizing this afternoon….but that tongue made me skeptical. It looked like it had been going on for longer than that! Dangit. I didn’t have my blood pressure cuff with me. I was almost positive that I was dealing with ecclampsia (which is when pregnant ladies get really high blood pressure and start doing things like seizing) but was reluctant to give her the medications from the protocol because I wasn’t 100% sure. Instead I decided to get her in the ambulance quick and pray she didn’t start seizing again on the way. It was a long 30 minutes.

We got her to the hospital without seizing (thanks Jesus!) and I got a set of vital signs. BP 230/120. HIGH! I ran to get the stuff to start an IV and give her the medicines when her family started yelling. She was seizing again. I grabbed her arm that was flailing out and as I started the IV, blood started going everywhere. I thought I was in an artery when I realized that the tourniquet was still on. I took it off but she still continued to bleed a lot because her pressure was so high. As I fought to get the IV secured and give the medicine, she jerked her head and started gasping for air. Her giant tongue was occluding her airway and she was having a lot of difficulty breathing. I didn’t have any other staff in there so I screamed at the top of my lungs for one of the nurses. Fortunately (because Jesus really loves me!) the doctor happened to be down at the hospital and was walking to his car when he heard me yell for the nurse. He came in to help me. He literally pried her mouth open and was holding his tongue with his hands to keep her airway secure.

We got the mom stabilized (got her to stop seizing) and gave the medicines we needed to bring her pressure down and prevent her from seizing again. I turned my attention to the baby. I measured to see how many weeks she was and it looked like around 34 weeks. Not quite term. I checked for a fetal heart rate it was 60. A good fetal heart rate is around 130-160, so this was way too low. The doctor and I looked at each other. We had a decision to make. Do we cut her to try and save this baby? He told me that we probably had about 15-20 minutes to try and get this kid.

In the States this would be a no brainer but here, it takes a lot longer to get things rolling. You have to call the guy to come from home and turn on the generator, call the lab man from home to come get her labs, call the surgeon from home, call the assistant from home, call anesthesia from home….it just takes time. So do we put this woman at risk by doing surgery (as I mentioned, her tongue was huge and her pressure was really high so it would be hard to maintain her airway and doing surgery was risky).

When the doctor said, “Well I’m here, I can scrub in.” I said “Let’s try!” I flew out of the OB ward with my phone and called the generator guy and told him I needed the generator on in 5 minutes. One of the lab men (not the one on call) happened to be on the ward so when he saw me flying down the hall with the stretcher I told him what we were doing and that we had just minutes. He helped me get her on the stretcher and into the OR and went to do her labs. Now we needed an assistant. I looked to see who was on call and knew that if we waited for him to come from home it would be too late. I’ve scrubbed in on a few c-sections when there was no one else, but we knew the baby would be in distress so I would need to be available to try and resuscitate him. So I called my friend. It was his day off. He’s a very hard worker and everyone knows that if they call him he will come. I usually make it my job on his day off to make sure that he doesn’t come in. I felt bad, but I called him. He was already in the hospital and agreed to come.

So we ran. The patient arrived at 4:05pm and the baby was out at 5:01pm. I in the US that’s nothing to write home about, but here….that’s darn near miraculous. As SOON as the baby was out the patients BP dropped significantly. Now it was my job to try and revive this baby. When they handed him to me he was blue and he had zero tone. He was a limp noodle. I bagged and suctioned, gave him oxygen, bag, suction, oxygen, repeat. We worked on him for about 45 minutes and very gradually he started to improve a little. His heart rate came up, his color got better and he started breathing on his own. But his breathing wasn’t right. He would breath a little and then take a big “guppy breath” like you do when you’re gasping for air. Praise the Lord we have some oxygen concentrators now so we can give oxygen even when the generator is off. We took he and mom back to the ward and I left him on oxygen. The doctor gave him about 50% chance. That was encouraging to me because I would have given him less.

I have him some antibiotics, left him on the oxygen and continued to monitor him the rest of the evening. He stayed about the same. The next morning when I walked into the ward I dreaded what I would see. But there he was. The night nurse said he seemed to be doing a little better. Mom was doing lots better. Her tongue was still huge so I was concerned about letting her drink anything, but by the afternoon she was drinking little bits of water.

I tried to get the baby to suck, but he would have none of it. He would suck my finger really hard but when we gave him the breast he just wouldn’t latch. We tried giving him formula from a spoon for a while but by the afternoon I was getting nervous he would it would go into his lungs and he didn’t’ need any more complications. I scrounged around and found one lone bottle and tried that. It was painstakingly slow, but gradually he got some milk down. But as the evening progressed (I was working a double again) I noticed some things. He was very irritable. I’d thought he was crying because he was hungry but he kept crying even after he had enough milk. His newborn reflexes weren’t great. They were hit or miss, sometimes he’d have them, sometimes he wouldn’t. He never slept. I read recently that newborns sleep something like 20 hours a day and so far I’d never seen this baby sleep. I’d also noticed in the last few hours that he was grunting in his breathing. As I left that evening I didn’t have a good feeling about my little friend.

This morning I walked into the ward. The baby was dead. He’d died early that morning. I cried

I wish it would have turned out differently. I’d wanted all of the hard work that so many had put into trying to save that baby to make a difference. This woman had had two other children who both died after they were walking. This was her third dead child.

But this isn’t the movies or one of my one of my cheesy Christian novels where everything works out how I want in the end. It’s real life and real life is hard. So what else can I do but turn once again to my beloved God and say thank You. Thank You for helping us save the mother. Thank You for the few hours this child had on earth, and through our tears, we say thank You for taking him. You can see what we can’t.  So thank You.

1 comment:

  1. Love you Emily! Joining you in your pain and decided thanks. Thank you for writing about these two- rc