Saturday, May 24, 2014

Parting is such sweet sorrow.....

I worked my last shift at the hospital a week ago.  I’m leaving to get married in a few days and when we come back to Sierra Leone Peter will be assuming the role of Country Director for our NGO and we’ll be living closer to the capital.  My feelings are mixed.  I love that I’ll get to be closer to my NGO team.  I’m excited for Peter and the new opportunity this will be for him. But I also loved living in the village. It was difficult, but I loved the work at the hospital and I loved living in a smaller community with no walls and will sorely miss the friendships I’ve made there over the last 3 ½ years.  But it's time. 

The time leading up to my last weekend of work was spent  packing up my house while continuing to try and homeschool and squeeze in some last visits with friends before we left.  To be honest, I was bone tired and hoping for a quiet, “lay on one of the patients beds and read a book” kind of shift.  Not quite. 

I was working a double shift and at about 9am a woman come in who I’d seen last weekend as well. Last weekend her complaint was pretty nonspecific generalized pain, and she wasn't sure if she was in labor or not.  When I checked her, she wasn’t in labor. When I looked at her card for her history, I noted that she was a previous c-section patient and had had FIVE pregnancies and had ZERO children alive. No wonder she was conscientious in coming quickly if she felt something.  I’ve lived here long enough to know that by now she’s been labeled a “witch” and everyone’s talking about what she’s done to her babies. 

The policy of our hospital is that once a woman has had a c-section, all future pregnancies should be c-sections. We don’t allow them to try to deliver vaginally. It’s too risky. (That’s not to say of course, that I haven’t had several patients come who had a c-section, then had five normal deliveries and are now coming back for some problems with the current pregnancy.  THEN what do I do?!?!?) 

So when the patient came in this time, I knew that she was a little nervous and needed a lot of reassurance that things looked fine.  I checked her, but couldn’t be sure if she was in labor or not.  She was dilated a little, but not any more than many women can be naturally are after multiple pregnancies.  I decided to admit her and give her some pain medicine to see if that calmed the pain down.  I also checked her blood, so we’d know that information if it turned out to be the real thing. 

Her blood work came back and she had a hemoglobin of 8 grams.  This is low.  In the ICU, we are talking about transfusing patients with hemoglobins this low.  I knew that if she was going to need surgery she was going to need more blood than that to begin with so I alerted the family that they needed to find a donor for her.  Several people volunteered to go get checked. 

When they came back a little while later they told me that one of them was a match but that the lab man told them there were no blood bags, so they couldn’t donate the blood. Wait. What?!! No blood bags?  I didn’t believe it.  I went down to the lab to talk it over with them and find out what “no blood bags” really meant. Surely it couldn’t mean NO blood bags.  85% of our pediatric patients are admitted to the hospital because they need blood!  Turns out, it really DID mean NO blood bags. I take that back. They had two pediatric bags left, but they’d reserved them for a patient they had who was actively bleeding.  Shoot.  I asked  when we could expect some more. They told me that they were supposed to come yesterday via public transport but hadn’t shown up so they weren’t sure when we’d get some more.  The town we needed to get them from was about 3 ½ hours away. 

I went back to the ward and for the next few hours just really hoped and prayed that she wasn’t in true labor.  I asked her about her pain several times that morning and she told me it was better. Awesome!  At around 2:30pm I was watching her and noticed she was shifting in her bed a lot and occasionally a little moan would escape.  Double shoot.  I asked her if she was having more pain and she said she was. Triple shoot.  I took her into the labor room to check her and sure enough, she’d was further dilated than she’d been earlier.  She was in labor.

So now what in the heck do we do?????  She needs a c-section.  But her blood count is already dangerously low and this would mean literally cutting someone open with no way to give her blood if something went wrong and she started to bleed heavily. So that didn’t seem like a great option.  But if we let her try to deliver vaginally we risk her rupturing her uterus which would mean she definitely begins bleeding a lot….and in a much less controlled situation than an OR.  And still no way to give her blood. 

I started running scenarios through my head.  What would I want done?  If Peter was giving birth to my child (yes, he thought that reasoning was weird too, when I explained it to him)  I would want to take him to the town 3 ½ hours away where there was a bigger hospital that could give her blood if they needed to.  But I was afraid.  This woman had been pregnant quite a few times and the last thing I wanted was to deliver a baby in the middle of the bush….by myself….or even worse, have her rupture her uterus and begin bleeding uncontrollably….in the middle of the bush….by myself. 

I called one of the administrators of the hospital to ask his advice. He advised that we go ahead and do the surgery.  I called the surgeon to ask his advice as well.  He said he thought the best thing would be to do the surgery.  So we did. 

I was nervous and was fluttering around the patient in the OR like a nervous little chicken.  Or something else that flutters around nervously.  Do chickens nervously flutter?  But everything turned out fine.  The baby was a BIG beautiful boy and the patient and family were thrilled. 

So that was my last shift. Not as dramatic as some, but still a heavy reminder of the obstacles and challenges of health care in the rural areas.  It can be utterly frustrating…..but also such a blessing!! I’m really going to miss living and working here!

Baby Emily and I
Marie with the nurse that helped me take care of her after I met her for the first time at the hospital

My longtime neighbor Bethany and I

Saying goodbye to my house!