Sunday, March 29, 2009

Approaching the End

This may have been my final day at the hospital. It’s also my Magdalen’s 6th birthday this weekend (today, here, tomorrow in the US). A woman at the hospital lost her daughter today. I had been in a labor with N all day. In labor ward 1, M, a 20-something year old having her first baby, was exhausted and struggling to give birth. She was fully dilated at 10:30 in the morning, but was not really pushing for quite a while. She clearly wasn’t having a strong urge to push. Her contractions were sometimes more spaced out than perhaps ideal. When she did push, it was for short stints. She kept telling us how tired she was. We did what we could to help her: position changes, calm and soothing words, not-so-calm and soothing words, we held her legs, arms, body; we were on the bed/table, on the floor, fashioned a birth stool, let her rest a bit, finally got an IV going, thinking it may give her some energy. For the first bit there was at least one other MW in there with us. Eventually they gave up and left us to it, but eventually the OB on call showed up. Then the real nightmare began. Long story short, this OB attempted a vacuum extraction even though the baby was still very high. In order to get the vacuum on, she cut a huge lateral (yes, those of you who know what this means, it was a lateral, not a mediolateral) episiotomy. Not surprisingly, the vacuum didn’t work. Then she asked for forceps and I tried hard not to throw up with extreme fear that she was committing huge injury to this baby’s head. N and I went in to the C/S that eventually occurred, because we just had to see this baby and see what sort of shape he was in. Amazingly, luckily, this baby was so high up and his head had molded (shaped) so extensively and there was so much caput (swelling) that the forceps seem not to have injured the baby’s face. He breathed and seemed relatively OK. N may have written more details on her blog. I am just too tired to write more at the moment.

Through this all, another birthing woman was brought into the other labor room. I heard her being more vocal than most women here while she pushed, and then there was quiet but by then I was back in the thick of things with M. I eventually went over to see the baby in the other room when I noticed the MW was repairing a tear the woman sustained, and lifted the baby blanket and said “oh, one smol beautiful baby.” The MW looked at me and said, without her typical detachment in these situations, “a fresh stillborn.” Her words cut through the air and reached my brain just as I came to that realization myself. A beautiful baby girl, gone. A terrible oversight was made, and she was gone. The MW came over and uncovered the baby for us to look her over head to toe while she told me, her voice stern and angry, that nothing had been done with the results of the non-reassuring heart tones that were documented in the middle of the night when this woman came in. The MW said the doc on call should have been called immediately. Instead, it appears nothing was done until re-checking the baby’s heart tones four hours later. And then the baby was gone, yet even then they did not tell the woman, they just sent her to ultrasound where she was simply told the baby was gone. Who knows if this loss could have been prevented.

That was pretty much it for me today. All I could do at that point was stand in the instrument scrub area and let some tears fall. I would not, could not, give in to the grief. I think because I could feel it was more than just this little girl... It was the little girl I caught two weeks ago and couldn’t even write about, the baby from the other day, the twins, and really, it was just everything. It was getting harassed by some drunks on the way to the hospital today as I walked alone, in the middle of the morning, by some guys who are the community-sanctioned “head of the family,” controllers of the women…the men whose permission, indeed, whose signatures would be sought before their mates would be granted a tubal ligation so they don’t have to keep bearing children. It was all that, and more, and I had no desire to fall apart at the hospital today.

I’m sure this all comes across with much more melodrama than I intend. Really, I get that this is life. I don’t regret coming here, and I knew what I was getting into before I made this trip. Tomorrow I will go in to the hospital again. I have paperwork to be signed then, and I may or may not “do a shift.” On Tuesday I start my journey home. A flight to Fiji, three + hours to while away there, then on to Los Angeles and finally home from there. There was nothing terribly admirable about my coming here, nothing amazing. As one of my instructors once put it, a monkey can catch a baby (yes, oh illustriously trained obstetricians out there, it’s true and you know it). It’s just life for people here and I have been but a very small cog in it for a few weeks.