Before I write the story of the last
shift, I want to first say this: There are many people who have read
this blog and who have subsequently saturated us with thanks and
praise, pouring us over with statements of what great things we are
doing, how selfless this work is, and how we are doing such
phenomenal things. While this praise does indeed lift us up and make
us feel good, I want to acknowledge that we are doing nothing
special, nothing requiring anything but a love and respect for life,
and the heart to care. The word 'altruism' comes to mind, and there
are times I wonder if true altruism exists. Don't we all do things
for a purpose of our own heart and conscience? I cannot say that
volunteering my time does not make me feel “good,” simply. That
in itself is a selfish reason.
I've recently finished a book that was
very insightful. It gives an understanding of early Haiti, how Haiti
came to be the Haiti that it is. Mainly, it is the story of an
ordinary man and woman, not much unlike you or me, detailing how
these two individuals did extraordinary things in Haiti. This book I
speak of is called Song of Haiti, which details the lives of Dr.
Larimer and Gwen Mellon. The recurrent theme (and purpose of Larry
Mellon and his philosophical mentor, Albert Schweitzer) speaks to
what draws me to Haiti: “Reverence for Life.”
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| A little girl at the feeding center |
Our evening started off rather
eventful, and not in the usual way. We rode to the hospital in the
usual fashion, riding on the back of a moto. This is something that I
fear dearly. The black and white logical thinker that I am, has
mulled over many times the various ways that we could come into harm
while in Haiti, and I've concluded that the moto is likely the #1
culprit for injury. Further add that we are most often on motos
during dark hours- going to the hospital in the evenings after the
sun has set, and returning in the morning, before the sun has fully
risen. The darkness adds the factor of limited visibility, in
addition to the dirt roads entrenched with large stones, rolling and
bumping land, that further creates an unstable journey on two wheels.
As we were riding to the hospital, I thought to myself, “I wonder
if we are going faster each time, or if I am becoming more paranoid?”
It was as if Glen read my mind because as soon as I finished my
thought, he says out loud, “It seems like the moto drivers are
going even faster than before!” Oh Lord, it wasn't just me. Not 1
minute after that, I look forward and see the single headlight of
another moto coming straight at us, both us and him going full
moto-speed, directly toward each other. I think, “Oh shit, we are
going to die,” and instinctively yell out, “SHIT!” My hands fly
up to grab the first thing they could grasp onto to brace myself-
that being the drivers neck. As I yelled, “SHIT!” I felt my nails
sink into the driver's skin. Thankfully both motos slammed on their
brakes, bringing us to a halt right before collision. I am also
thankful that SHIT wasn't my last word before I died. I apologized
profusely to the moto driver, and even though he spoke no English, I
am certain he got the gist of what I was trying to convey, as I
tapped his neck and said repeatedly, “So sorry!!!!”
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| Our view from the back of a moto |
Planting my feet firmly on the ground,
I was relieved to get off the moto and walk the few hundred feet from
the outside gates of the hospital compound, to the entrance of the
Maternity Ward. As we walked through the hospital grounds, the sky
above was thundering and rain started to fall down on us. I stopped
just before the metal gate entrance to the ward, and stood there
under the falling water. Even in the dark night with a deep blanket
of clouds above, the air here remains thick. The cool rain felt good.
We began our night by making rounds on
the antepartum, postpartum, and post-op units. These are each one
room units, lined with beds on both sides of the room, each bed
numbered on the wall above. The first patients we see is a mom and
baby. The baby is about a week old and is being watched for a
low-grade fever. The first observation is that the baby is swaddled
up tightly with a thick winter blanket. It is hot as hell in here,
and no one should be using a blanket, baby included. I have no doubt
this is likely contributing to her low-grade fever. We take her
vitals and do a full assessment. I see that the baby's diaper is
full, and note that it is soft, yellow stool. Just as it should be. I
help Grandma change the baby's diaper and discover that this baby
girl dressed in all pink, actually has a penis. I laugh at my own
assumption, because really, using whatever clothing you have is
simply practical.
As we are doing our rounds, one of our
favorite Haitian midwives Carmell says to us, “I will let you know
if we have anyone in labor come in. I know you like to do
deliveries!” I smile at that. I know she likes the help, and she is
right- I do like birth.
At 9:50pm I catch a baby- a normal
vaginal delivery, a healthy mom and healthy baby. As I am finishing
up and helping the new mom get cleaned up, Glen listens to heart
tones on another patient who is being induced with misoprostol due to
severe hypertension. This mom looks terrible and seems to be very
sick. Her whole body is extremely swollen, tight from the fluid that
is collected in her body. Her face is so swollen that even her
eyelids are puffy. I am certain she is nearly unrecognizable from
what she normally looks like. Just looking at the woman is a reminder
that hypertension in pregnancy is no joke. It may cost this woman her
life, or her baby's life. Glen puts the doppler on and we hear
clunk.........clunk..........clunk......................clunk. The
baby's heart rate is in the 80s and stays there. They reposition her
and continue to monitor baby. There's no oxygen available. The baby
continues there, sometimes skipping beats. With this mother's
hypertension and severe symptoms, along with misoprostol induction,
there is no doubt that this baby has little reserve. Glen checks her
to see if we are close to delivery and can somehow expedite it. She's
only 3 cm. We know that this baby is not going to tolerate labor much
longer. He calls a c-section. It's 9:55pm. The Haitian midwives call
the Haitian OB. He's busy and can't come. He says that Glen needs to
do the c-section. The midwives hang up and jump into action. Within
mere minutes, a foley catheter has been placed and the patient is
prepped for surgery. Honestly, I'm dumbfounded. I have never seen
anything happen so fast in Haiti. There is true urgency in the room,
and I have never before witnessed this in Haitian culture. Maybe I'm
naïve, but this is my honest observation. Glen tries to listen to
the baby again and can't find heart tones again. Is it because of a
positional issue or have we lost the baby? We are all wondering the
same thing. He continues to try, and nothing is heard. The clock is
ticking...ticking...ticking...we wait and the minutes pass by. The
Haitian OB who they previously called cannot get a hold of the
anesthesiologist, and neither can they. She isn't answering her
phone. Glen can't do a c-section without anesthesia.
Tick...tick...tick...the minutes are ticking by, and this baby is
dying with each tick. Finally, an ambulance arrives to the hospital,
and in the ambulance emerges not a patient, but the anesthesiologist
and a scrub tech. How interesting that the ambulance brought them to
us. As we would find out, this crew is Cuban and only speaks Spanish.
So there they went, an Anesthesiologist
and scrub tech who only speak Spanish, an OB and RN who only speak
English, and a Haitian O.R. assistant who only speaks Creole. As Glen
leaves he shakes his head and tells us that it is inevitably too
late. There is no way this baby is still alive. My chest is heavy as
I think that we listened to that baby's heart slow down as it
gradually stopped beating altogether. I walk to the storage closet,
to where Shelly was, and I ask her (as if she were more insightful
than I was on the matter), “Do you think the baby is still
alive???” I feel as if I am grasping at straws, wanting some
reassurance that this little life is still in existence, that we even
have a chance. Not just the he or she has a chance, but that yes, WE,
have a chance. This life is valued. This life matters. I don't know
the swollen face of the mother from any other random face of the day,
and I might never know her baby, but in these fleeting minutes, tick,
tick, ticking away, there is Reverence for Life.
Shelly looked at me and answered my
question. “I don't know...probably not. But I hope so.”
I would walk away to another mom laying
on an exam table who was pushing. I would do this delivery by myself,
as Glen and Camille were likely just beginning the c-section. I
couldn't help but to think that as one life blazed into the world
screaming, one life was ending, coming into the world silent. That is
a profound feeling. As Glen and Camille would later tell me, Glen
would lift the blue, lifeless baby boy from his mom, hand him to
Camille. He was certain this was a lifeless baby he was handing over,
and contemplated this as he sutured this mom's very sick body back
together.
I had just finished with this mom when
Camille entered the room with the tiny bundle in her arms, pressed
against her body. I heard her say my name, “Tara.” She called it
out firmly, not exclaiming but still, making a statement.
I knew when I heard her that the baby
was alive. I asked her, “Is the baby breathing?” The baby was
trying to breathe, though not very effectively. The conversation
between Camille and I is a blur. I took Camille's stethoscope and
placed it over the baby's heart and was surprised to hear a heart
galloping away; 140 beats per minute. A couple breathes of PPV and
some stimulation and this baby was breathing on his own. My fingers
remember what that limp body felt like under my fingers. This baby
was not even two pounds. So delicate, so frail. We wrapped up this
tiny, flopping body who was now making an effort to breathe, and
carried him down the hall to the NICU. A pulse ox was placed and
showed that his heart rate was 160 bpm and oxygen saturation was 87%.
Astounding. We would leave the baby there, under the care of the
NICU team. We walked away having done what we could, leaving him in
the care of others who will hopefully do what the can.
Meanwhile, we do an intake assessment
on a young and very tiny mom whose water has broken. She is a first
time mom, looks to be about 100 pounds, and is about 28 weeks
pregnant. There is amniotic fluid everywhere- the exam table is
drenched, and as Camille and I speak to her, our shoes are in a sea
of in her amniotic fluid. She lays on the exam table, without
underwear, her legs spread. Her vulva and legs are dripping with
fluid, smeared with mucous and blood. I place my hands on her belly,
and see that her abdomen hardly looks pregnant. The untrained eye
would likely not suspect this naked abdomen to be a pregnant belly.
My sweaty, gloved hands could hardly palpate a baby. Her muscles were
taut and solid, her skin and muscles from not having held a baby
before. Her vitals were normal and her baby sounded fine. She was not
contracting. The Haitian midwife had already completed a vaginal exam
and said she was 1cm dilated. I went over to the Haitian midwife and
asked if we were staring steroids, to help mature the baby's lungs.
She shook her head no. I asked why. She said because the patient was
already dilated and it was too late, steroids would not be useful. I
felt the need to clarify how dilated this mom was, and asked again.
She said 1cm. I had so much to say but recalled a good piece of
advice that I had just read in the Midwives for Haiti volunteer
manual...the best place for questioning something and to correct or
teach, isn't in real time, in the clinical setting. This is, after
all, their territory, we are just here to help, and teach by example,
or when otherwise appropriate. I walked to the back room where Glen
was and explained the situation. He agreed that the mom should get
steroids and antibiotics. I asked Shelly how I might say this, to let
the midwife know, “This is what we would do at home...” Shelly
ended up doing a great job with translating this, and in the end, the
midwife was very receptive to it, asked Glen the appropriate medicine
and dose, and then said she would do it. [The next day we would find
out that this mom would subsequently deliver her 28 week breech baby
into the hands of another midwife volunteer with Midwives for Haiti.
No one knew if the baby was dead or alive, and when the baby's legs
were delivered. Jamie was surprised when they started to move. As I
write this, the baby is alive and well in the NICU. I hope those
steroids got to where they needed to go.]
We would have another delivery later in
the night, and this one wouldn't be easy on use either. I wouldn't
have expected anything less. The Haitian midwives were taking care of
a mom in labor. I had previously told them to just let us know what
we could do to help, that we were available if need be. While pushing
with the mom, the midwife heard that the baby's heart rate was having
decelerations. It would go from 140 to 80...70...and then slowly
recover back to baseline. That's not something that we don't
sometimes see. Except then she noticed that the baby began to have
repetitive decels that were taking longer and longer to recover, now
staying a good bit of time in the 70s and then not recovering. She
asked for “Dr. Glen” to come help. At this point we were seeing
baby's head at the peak of the push, but not crowning. The Haitian
midwife asks if Glen can do an episiotomy, but he explains that this
will be useless because the baby isn't to the perineum yet. The
midwife nods in undertsanding. I see her contemplating something, and
as I open my mouth to offer a suggestion, she says the same thing,
but in Creole. “What about a vacuum,” we both ask? Glen looks
surprised and says, “Oh, do we even HAVE a vacuum?” Why yes, yes
we do. I had seen them in the storage closet. He says ok, and a
vacuum is retrieved. He puts it on, mom pushes, and he assists her
pushing with the traction of the vacuum. A baby girl is born,
screaming.
All in all, a busy two days...reminding
us and revealing to us in new ways, how delicately precious life is.
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