Still hate it!

When I was working in the pediatric part of the hospital, I saw the devastating effects of malaria just about every day. Since I've been working in OB, I haven't been confronted with it much.

Until now.

We are currently really short staffed with just 2-3 of us manning the ward 24/7. Therefore, although OB hasn't really "been my thing" in the past, it is quickly becoming "my thing" because there's no one else who's "thing" it can be. I digress. So yesterday I was in the ward and it was really busy. I was in the middle of helping deliver a baby when I heard the ambulance go out again for another pregnant woman. They were gone for several hours and when they got back I discovered that the woman they came with had actually given birth at home and delivered twins. They were premature.

I got the bed ready for her and the twins. When they got to the bed I started asking the mom questions about bleeding and felt her uterus which was normal. Ok, mom's good. I went to look at the kiddos. One, breathing ok. The second one, already gone. Somewhere along the way the baby died and no one had noticed yet. I got to be the one to deliver that news.

The second twin was breathing but was struggling so I went and got our little oxygen concentrator and gave him some oxygen. I called the doc to see if there was anything else we could do and she suggested keeping him warm using hot water bottles so one of the med students brought one down.

I started focusing a little more on mom and when I went to take her vital signs found her to be raging hot!! She said that she'd had the fever for about 4 days. Malaria. The anemia from her malaria made her go into labor prematurely and deliver her twins too soon. I gave the mom some Tylenol and medicine for malaria and went to check on the kiddo again. He was now barely breathing. Although I knew it would probably be a moot point, I went and got the bag and bagged him for a little while, trying to see if it would stimulate him to breath on his own. Nothing. He died in about 15 minutes. Later I found out that the woman had just completed the funeral for one of her other children. She has now delivered 6 children and has one living. Malaria!

Later a woman came in with her husband, complaining of side pains that had started after riding a motorbike. I assumed it was probably just some muscle pain but went through the motions and got her checked out. Her blood pressure was fine but when I went to touch her, her skin was on fire! Her heart rate was also really high. Baby's heart rate was high too and the estimated gestational age was about 8- 8.5 months. I decided I would admit her, give her some fluids and start treating her for malaria. As I left that night, she was doing fine.

This morning I went in to work and found out that she'd delivered her baby in the middle of the night. Yikes! I did NOT see that coming! I was really glad I hadn't sent her home! (Thanks Jesus!) The baby was doing ok but wasn't breathing great. I left the ward for a few hours to rest because I was coming back in the evening and when I came back, the baby had been placed on oxygen. She lying on an empty bed next to the nurse's desk.

After the nurse told me about the ward, I went to get a closer look at the baby. She was not breathing very well at all and her color was...bad. I knew the doctor had mentioned keeping her warm so I picked her up and held her really close to my body. I got my oxygen saturation monitor and checked. 38-40%. Very, very bad. As I held her, the oxygen machine started beeping, letting me know it was going to die soon. I took the oxygen off and her saturation stayed about the same but her heart rate started dropping. And dropping. She wasn't breathing anymore, her skin was mottled, and her heart was barely beating. All of the sudden I felt her body just completely relax. At that moment I realized that although I've sat by countless beds and watched children die, this was the first time I'd actually held one in my arms as she passed away. I was staring into her little face when all of the sudden she took one more breath and shot her first up into the air. I jumped out of my skin!

I wasn't really sure what the culturally appropriate thing was to do in this situation. The people here do not like to deliver bad news. They will almost never tell a patient when they have a fatal disease and more than once I've seen them take a dead baby via c-section and not tell the mother that the child didn't make it. They just left them to figure it out when they didn't bring a child into the room.

Anyway, I took the child who was essentially dead, to the mother. As I think back, I wonder if I should have taken her there a little sooner so she could have held her. But would she have wanted to be the one to feel the life go out of her little girl? I'm not sure. The baby was still taking a few reflexive breaths so I asked the mom if she wanted to hold her but she wouldn't take her. I honestly didn't know what to do. When the mother I told the mother that her child had died, she just looked at me. She looked sad but didn't shed a tear. I started bawling. Some other women crowded around us and eventually one of the older grannies took the child from me, placed her on the bed and covered it with a sheet. They kept telling the mother to be strong, be strong.

I really hate malaria.