Tuesday, October 2, 2012

Circle of Life

Last week I was in the OB ward, per usual.  A man came in and brought his wife, obviously great with child.  I asked them what the problem was and her husband said she was having some abdominal pain and was a previous c-section.  These are my favorite patients because they are no brainers.  Previous c/s?  Let’s tell the OR team we’re getting ready for another C/S.  No hemming and hawing about “can she give birth for herself?”  “Pros, cons, etc.” Nope. Easy capeesy. 

The husband left the ward and I went to tell the OR team that we were going to do a C/S.  I took the woman back to get her prepped. First I told her to go and wash well.  Then I started her IV, and gave her the pre-op antibiotic.  I had her lay down so I could insert the foley catheter (rubber tube that goes into the bladder…for those of you who haven’t had the pleasure).  She’d been perfectly cooperative up to this point, but when she saw what I was trying to do started balking, saying she didn’t want this done.  I explained that in order to do the surgery we have to put this catheter in…just like the last time she’d had it done.  That’s when she looked at me like I was crazy.  “Wait! I’m going to have the baby today??”  Then it was my turn to be surprised.  “Wait! Isn’t that why you came here in the first place???”  Turns out, nope.  She had complained of some belly pain (evidently not labor pain) and her husband was concerned and brought her here to get checked out since she’d had such a hard time with the last pregnancy.  She wasn’t even aware that because she had a c/section with her last baby, she should have one with this one too.  Oops! There’s a “lost in translation” moment for you. The poor woman had just come in because her tummy was hurting a little and I’d made her wash, started an IV and was trying to put in a foley.  She must have thought I was insane. 

Needless to say we had to put everything to a halt and sort this mess out. Her husband had left to go find some food so I told the OR guys we had to wait for the husband to come back.  When he came back I explained the situation.  The couple was from really far away so since the baby was term and I knew that if we sent her away she probably would not come back to us again, I told them we really should do the operation today. He was totally in favor of that and said that he’d come because he wanted to make sure they would be ok.  Surgeries here are not cheap (about $125 so….I guess it depends on your perspective) so the fact that he so readily agreed impressed me.  We took the woman to surgery and it turned out that the baby was breech so it would have been even more difficult for her to deliver for herself.  Mom and baby both came out doing great. 

When women in America have c-sections, I’ve heard that they stay in the hospital for 3 days. Here we keep our patients for 5-7 days. Part of the reason for that is because when they go home they will have to immediately start carrying heavy buckets of water and doing other strenuous work like washing clothes, cooking, and caring for the other children.  In reality most of the women end up staying longer than the 7 days because they’re not allowed to leave before the bill is paid and it usually takes the husbands longer than that to “find the money.” 

Over the next week the husband came every other day or so to check on his wife and baby.  During that time he always made a point to tease Kadiatu (my little roommate) and call her his wife and ask what she cooked for him that day.  One Saturday he came to talk to me about the bill (as a lot of the men do).  He had paid a significant amount but was having trouble coming up with the rest.  This is a common problem and whenever I’m approached with this I always refer them to the hospital administrator who is in charge of the fund that we have to help people who truly cannot pay. I told him to come back on Monday to talk with him about it.

On Monday I saw him talking to the hospital administrator. As I walked by I heard him say that he had a child who was sick.  Later I saw that the balance of his bill had been marked to the fund for people who couldn’t pay.  I was going up and down the halls that evening and saw him sitting on one of the benches. I started giving him a hard time because he’d been pestering me to have his wife discharged for so long and then was still hanging around.  He told me that his child was in having surgery.  I knew there was a kid with an acute abdomen that they’d decided to take to surgery that evening.  I put two and two together and realized it must be his son.  Poor guy!! His wife just had surgery a few days ago and now his son was in there. 

I was working a double shift that night so later that evening, around 9pm I saw him walking down the hall and asked how his son was doing.  He said he was doing better now.  Good!!  Literally 10 minutes later I heard wailing coming from the peds ward.  I went down there to see what was going on and found the man’s son dead.  I asked one of my friends, a nurse working down there, what had happened.  He said that the child had spiked a temp and she had given him the Tylenol as ordered.  She had called the doctor to let him know what was happening and by the time she got off the phone, the child was gone.  We honestly have no idea what happened.  As I passed him in the hall a little while later and told him how sorry I was, the phrase “circle of life” passed through my head.  But I don’t think it’s supposed to be one child entering a family and a second one leaving in the same week.  Oh Sierra Leone.  Ee no easy-o!!!

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