Today was one of those roller-coaster days that jerk you around between extreme highs and lows. And like some particularly bad roller-coasters, this day did not leave me feeling exhilarated, but rather just sick to my stomach.
It started during rounds when Tabi and I encountered two pregnant ladies with bleeding. Never a good sign, especially in the third trimester as both of them were. We took them both in for ultrasounds and Tabi discovered that one woman had a placenta previa (the placenta grew over the opening of the cervix), and had been bleeding for a long time in the village before she came to the hospital. The other lady was PPROM (Pre-term Premature Rupture Of Membranes, i.e. her water broke early AND the baby is premature).
The first placenta previa woman had already lost of a lot of blood, and she was getting ready to deliver, which was impossible to do vaginally because she could lose the rest of the little blood she had. Instead we ordered two transfusions to be supplied by relatives or friends, and took her into the theater for a c-section.
Jean and the theater fellas worked fast, and Tabi labored hard to try and resuscitate the little boy that was born. Getting him to cry out didn’t take as long as other babies that I have seen, even those who weren’t at high risk as this one was. The problem was, however, that he was quite premature, and he had also lost a lot of blood from the placenta bleeding for so long in the village. Sparknotes: we were VERY worried about this little guy. As soon as we heard him cry, I thanked the good Lord above and Tabi rushed him out of the air-conditioned operating theater and into the incubator we have in the maternity ward. Keeping premature infants warm is absolutely crucial, even in an environment as hot as Northern Ghana.
There, I was put on the task of monitoring the baby’s vitals very carefully. Its breathing was very fast, but normal for a premature infant. With very hard work and constant diligence, we believed it was possible to save this baby. All the adrenaline pumping through my system for the past couple hours finally slowed as we made careful arrangements for monitoring and instructing the nurses and mother in care of this very special little boy. I almost sighed in relief. Now it was just time to keep close watch and pray.
The next emergency task was taking care of the PPROM patient. We set her up in the labor ward, all ready to deliver, and started silently asking God that this complicated case would have a happy ending. The ultrasound earlier in the day showed that since the membranes ruptured, there was very little amniotic fluid left. Even a vaginal exam showed some meconium (baby poo that comes out in response to stress), which was not a very good sign.
It seemed like Tabi, Stella (the midwife), and I waited in that labor room forever. This was our patient’s first pregnancy and first delivery–still another reason to be extra careful, as these are generally more difficult. Finally our patient was 1/5–the baby’s head was crowning almost completely. Very soon it would stop rocking back and forth in the vagina with each push, and the head would be delivered! Tabi gave me the very important job of sucking the meconium out of its nostrils and mouth with a bulb as soon as they were visible. This is important because as soon as the airways are de-pressurized, the baby can breathe, and we do NOT want him or her to breathe in meconium (feces) or it could die of an infection or drown.
I was all ready and excited for my important task right up until the head was delivered and I actually saw the baby’s nose and mouth. It hit me suddenly how much dangled on the performance of this task, and as I was rushing to stick the bulb into the nose and mouth, I wished that I wasn’t asked to do it. What if something bad happened to the baby and it was my fault? I hated where I was, but at that same moment, Tabi said, “You did perfectly, Ann,” and at once everything switched around. I had been there! I freed the airways from liquidy green poo! And even though it was a very small task that probably anyone could do, the satisfaction of helping someone have a better chance at life rushed over me, and I knew there was little I would rather do than healthcare.
You remember that this was the first live vaginal birth that I had seen! The other two vaginal births I witnessed were still born, and they just broke my heart. I had seen plenty live c-sections, but they are a totally different ballgame than what we call labor and delivery, and the fact that I finally got to play a role in this one with a good result was like I finally got to see a bright shining light at the end of what I thought was a pitch-dark tunnel.
The baby girl started crying within a minute or so, and was pretty well grown for her 36 weeks. Even though I have received no formal medical training and have never had a patient of my own, I felt like she and her mom somewhat belonged to me. I swelled with pride and had the best time weighing the little girl quickly, wrapping the her up tightly, and presenting her to her mama.
Two live deliveries today, and we were thanking God above! There would be a lot of work to do and a lot of careful attention needed for these little babies, but Dr. Tabi and I were trying to take heart and remain hopeful for these delicate babies.
I had to rush off to Pastor Jonah’s for my TZ-making lesson, while Tabi sewed up some tears in the mom. I felt guilty leaving her, but she made me feel better by joking, “If dinner’s not ready when I get home, I will punch you!” Gotta love her spunk J
For a while with wonderful Aggie, I forgot about the cares of the hospital. The nurses were well-informed, the babies were stabilized, and I had to focus on TZ! Aggie is a great teacher, and explains everything really well. But she is just like my grandma when she explains recipes! “One bowl of tomato paste.” Yes, but how big a bowl? They both crack me up! If I want to make groundnut soup in the states, I’m going to have to do a lot of tasting until I get it right!
After all the stress of the morning and afternoon, it was great to relax in the Manyan compound with Aggie and the six small children while the groundnut soup simmered over the coals. I think I finally won quiet little James over by doing the “Jump, jump, jump together!” typical Ghanaian schoolchildren song and dance, and the common clapping and kicking game with everyone. The kids were also fascinated by one hand-trick that I showed them. In the beginning of my trip, I thought it would be so hard to connect with kids in a different culture, but it’s actually almost the easiest thing in the world. You just have to prepare to be completely undignified!
And apparently my dignity quota for the day ran out long before, because trying to stir TZ was quite embarrassing! To make this solid porridge, maize and cassava flour are added slowly to boiling water in a big pot and stirred vigorously with a large wooden paddle until it reaches a very thick consistency. I guess I forgot that I have no upper body strength, and almost burned it all when I tried! Aggie’s deltoids must be so incredibly strong to stir that TZ almost every day for her family’s supper!
At the end of my TZ-making lesson, which consisted mostly of theory due to my insufficient arm muscles, I was able to bring home a really nice batch to Bob, Jean, and Tabi. I ate the most out of all of them, thanks to my TZ-eating lessons with Joe! Ghana has made me addicted to carbs…Not that I wasn’t before! 😉
After supper, I sat down to read a Obstetrics clinical rotation manual that Tabi let me take from her computer. I figured if I got to suck meconium out today, maybe I could catch a baby next, and I didn‘t want to miss the next opportunity! Tabi left me peacefully studying to head back to the maternity ward to check on our placenta previa baby.
When she came back, there was only bad news. Our little boy had passed away during that short time we were gone. He had been febrile, dehydrated, and in respiratory distress. The loss of blood from the mom and the baby had done a lot of damage that was apparently irreversible despite all that Dr. Jean, Dr. Tabi and the nurses had done. We had rejoiced so greatly when we thought we had saved him, and hoped with all our strength that we could help him continue to live, but it all came to nothing. Nothing we did could save this innocent child.
I just cried out for God to make this right in my heart, to increase my faith to reassure me that all happens according to His good and perfect will. I knew that this little baby was in heaven now, and happier and more complete than all of us here. He was no longer suffering and was given a perfect body instead of his skinny, anemic, underdeveloped one. The issue is getting my heart to agree with this head-knowledge and have peace. Tabi says it almost always takes a bit, but it does come. I know she has seen a lot of little babies die in Brong-Ahafo, so I will take her word for it and pray until the peace arrives.
I was washing for the night in the shower, still in slight shock when the hospital called. They wanted us to come in for the premature little girl. It was like a slap in the face, but there was no time to even think about how it felt, only enough to rinse the suds, pull on clothes and rush out the door into the still night to catch up with Tabi who had told me to meet her there. That gravel path between the tall yellow grasses had become like the pathway to a mountain of dread, which I ironically hastened toward.
Bursting into the labor ward I found Dr. Tabi and Emisah, one of our nicest nurses. Tabi was comforting him, “You did everything you possibly could. This baby received better care here than she would have in any other hospital in Ghana.” Then I knew our second baby was gone. I was dumbfounded even though I half knew what was coming when I was running there in the dark. It was just too much for one day. I wanted to give up, just turn around and go back to the house and cry for the rest of the night. But that wasn‘t an option. We had a grieving mother who was suffering more than any of us, and a nurse who clearly felt responsible and significantly depressed. To indulge in emotions and shed tears in that situation might have done much more harm than good to those around. What we could do was just to empathize and reassure that nothing more could have been done for this little girl, and she was given every chance possible to survive. The walk home with Dr. Tabi was almost completely silent except for the crunch of sandy gravel beneath our feet.
Once I was alone though, I let the tears flow. I turned to the wall next to my bed, with the shadow of the curtains moving on it and imagined the two mamas holding their lost babies.
God, whatever you’re planning to do with this, I don’t understand, and I may never understand. But you’ve proven yourself to turn terrible unspeakable things into good so many times, even in my own life, that I can’t refuse to trust you in this. You’re all good, and in control, and I’m leaving this in your hands. May these mamas see your glory in their situations very very soon. Heal their hearts and give them peace now, Lord. Please don’t let them suffer long.
I looked at my watch. It was past midnight, Easter.
I had just finished one roller-coaster day. The joys of new babies. The stress, sweat, blood, and struggle to keep them both alive. The hope when they were stabilized. Relaxed fun in Pastor Jonah’s compound with Aggie and the kids. Now both babies that all of us worked so hard on had left the world within a couple hours of each other. I am going to sleep nauseous. I think I’ve prayed all that I can pray today.