Thursday, December 2, 2010

Nyibol's Tears ~

(Warning: This story is hard to write. It might not be for everyone.)

This morning started early. I was called out of bed - dragon breath and duck puddy galore - to attend a lady in labor. The strain in my translators voice when he called, put urgency to my steps.

The robot drone in my brain issued orders: Dress. Do NOT stop for coffee. Do NOT brush teeth. Go directly to birth. Go.

I obeyed. But as I was going, I woke up Racheal (my roomie) for help. Last night, the health worker on shift was up all night with 9 admissions. (yes. 9 admission. A record, I think.) He was sure to be too tired to help me much. Would she come? She dressed and was out the door even before I was.

I also met Dr. Dave on the way, and invited him and Dr. Tom to join in. For some reason, I knew this one would need a few extra hands. Even if not, more the merrier. Right?

We all arrived in unison and were greeted by a sweet girl named Nyibol. She was expecting her first and was obviously in hard labor. I was happy to see her. I’m always happy to see my prenatal girls. And this one has been coming for months.

Month after month, as I measured her belly and listened to the toc-toc-toc of her baby’s heart, we bonded. She was looking forward to this day. So was I.

She squirmed in pain as I measured her belly for the last time. She winced, then smiled, when I palpated for the head. The contractions were on top of each other. I smiled back knowing it was close and then reached for the doppler. 

Finding the baby’s back was easy... but I couldn’t find the heart. But then a contraction hit again. It was probably just the contractions... or the head was too low in the pelvis, I told myself.

I handed off the doppler to my assistant and put on gloves for a vaginal exam. I wanted to make sure she was fully before I asked her to push.

Immediately I could feel there was something amiss. Membranes. Fluid. Something sharp. Little things with bumps. She was fully dilated and her bag of waters was still in tact. But... I felt things in there that didn’t belong. Only after prodding a bit, did it occur to me that I was feeling a hand.

A hand?  -- not good.

Hand presentations can cause obstructed labor. My mind raced back over the catalogue of articles and research I’ve done on this. What I remembered was not good.            This was not good.

Only then did it occur to me, the hand wasn’t moving. “It should be moving,” I thought. I risked rupturing the membranes and pushed in deeper. What EXACTLY was I dealing with? I found something sharp and straight -- and very un-head-like.

I told the crew we had a hand presentation and possible fetal demise, de-gloved and grabbed for the doppler again. I was determined to find a heartbeat.

But I didn’t.

Nyibol, blissfully ignorant of my hurried whispers to the crew, labored on.

--“Honey, can you feel your baby moving?”
--“No.”
--“How long has it been? When did you feel your baby move last?”
--“I felt him move yesterday, before my labor began. But once it started, I didn’t feel him moving anymore.”

I then explained that she was close to delivering but that I wasn’t sure if her baby was alive. I told her the baby’s hand was in the way and I was going to have to push it out of the way. Did she understand?

It was a solemn few minutes as realization sank in. The room got crowded with question marks and whispers. “Do you understand what I’m saying, Nyibol?” I asked. She just nodded quietly.

Dr. Tom, eager to learn all he can about birth leaned in to say, “I’m so glad I’m not in charge. If I had to deal with a hand presentation right now...” And then shook his head.

Did that make me the expert? Am I in charge? Oh, Lord! Help me. Help me, please.

Not long after, her water broke and then the pushing. There was hair - lots of it. But the head was soft. Squishy. Swollen.

Hydrocephalus?    No.       Maybe.      Oh! I don’t know.

The skull was broken. Shattered. Sharp edges poked out beneath the skin.

“Where is the face?” I wondered. “Where are the ears?” The head just kept coming. “Lord, does this baby have a face?” So much was so wrong.

Minutes stretched out to hours. Moments lasted forever. Even now, as I think back, the birth felt like a movie played in slow motion. Frame by frame, it flashes through my mind.

Eventually, I found his face. An ear. The head was born - swollen and hopelessly deformed. The shoulder. The chest. The hips. His body lay limp on the bed, arms flopping to one side. Skin peeling in places, exposing white flesh beneath.

He was dead.

And from the state of his peeling, he had been dead for at least a day -- maybe longer.

Niybol, relieved the pain had stopped, sank back on the bed, exhausted. She was too tired to wail but not too tired to weep. Tears streaked her face. She made no attempt to hide them.

She had done all she could to be healthy. She came regularly for check-ups. She even came to the clinic for delivery. The kowaja delivered her child. What more could she do? What went wrong?

“Do you want to hold your little boy?” I asked. “He’s beautiful. So perfect in so many ways.” She wouldn’t even look at him, let alone hold him. “Are you sure?” She just shook her head.

After examining him and wrapping him tight, she eventually took him in her arms. But she held him away from her and refused to look at him. More tears.

Her family came in, heads hung low, eyes downcast. What should they do with the baby? (Here they bury the baby immediately. There is no hub-bub, no fuss and certainly no casket.)

A man, tall but slouching, stepped forward to take care of it all. I took her boy and placed him in his arms. He held him like a box of breakables-- delicate and fancy -- and walked out.

Nyibol didn’t say another word the rest of the morning. She answered my questions with nods and slight shakes of her head. I monitored her for a few hours and she recovered with ease. She was able to sleep and eat something, but didn’t find her voice. Her tears spoke for her.

As I went to discharge her, she sat sullen and dejected. Quiet. Her family looked on. She couldn’t speak so I spoke for her instead. I spoke loud enough for everyone to hear.

“Nyibol, I want to tell you the story of your baby’s birth. Can I tell you what happened? What I saw?” She nodded and looked at me, eager to understand why. But she didn’t speak.

“When you arrived, your baby was already dead. He was most likely dead since yesterday when your labor started.” She didn’t move. She just looked at me, remembering. “When he was born, I could see no reason why he died. He had no deformities. He was perfect in almost every way.” She nodded, hearing if not believing.

“The cord was not wrapped around his neck. There was no sickness that I could see. But I did notice something strange about his umbilical cord. It was very red and very swollen near his belly. Perhaps that is what caused him to die.” She looked at me, eyes brimming with tears that she could no longer hold back. She silently nodded, glad to know all that I had to share.

I continued, “I want you to know, Nyibol, you did nothing wrong.” The tears started to flow. “I want you to understand that you should not feel guilty.” The tears flowed so hard, she had to turn her face to the wall. “Do you understand, Nyibol? This is not your fault. You did everything right. You got good prenatal care. You took care of yourself and your baby.”

She looked at me relieved and broken. Her whole chest sighed with each sob. “Do you hear me, Nyibol? You did nothing wrong.” I was speaking as much for her family as I was for her. “I want you to know that this is not the result of a curse. And if anyone tells you that this is your fault, remember what I’m saying. You tell them that your doctor said you did nothing wrong. You explain to them that the cord wasn’t normal.”

She leaned her head on mine and we wept. There was nothing left to say. Nothing left to do. So I prayed. Her family silently watched on. And then she left.

I grieve for her loss and pray. Pray with me. For He is no doubt collecting many tears tonight.

“You keep track of all my sorrows. You have collected all my tears in your bottle. You have recorded each one in your book.” Psalm 56:8