Saturday, March 26, 2011

Hydatidiform Mercy.

(Updated Information at the end)

A week after Awen’s hydatidiform mole was removed, she came in for a check up. She had almost no bleeding and her hemoglobin was on the rise. She was doing well, and promised to come regularly for reviews. 

She promised not to get pregnant for as long as possible, so that the tissues would be less likely to reoccur. I was looking good; I was hopeful.

However, today she came back. She looked so dejected and morose, I almost didn’t recognize her.

Dread. That’s it. Dread. She looked like a woman awaiting the firing squad. She looked like death had visited her and rattled her chain.

Dread.

Downcast eyes hid her fear, as she explained the bleeding started again two days ago. It kept coming. No clots. Could I help?

My heart sank.

Her uterus (that had involuted nicely last visit) was palpable again. Rubbing it firmly, no clots were expelled, but it didn’t look good. Her clothes were stained with blood- both fresh and old.

Oh, no.

It’s been about a month since her procedure. That’s not too soon for a menstruation, but this was too much blood if so. What was going on? The only thing that made sense was if her hydatidiform mole had re-grown.

To be sure, I did a pregnancy test.

If the abnormal tissues had started growing again, she’d have excessive amounts of HCG (Human Chorionic Gonadotropin) hormones in her system, giving a positive pregnancy test.

I held my breath as the first line -- and then the second line appeared.     --It was positive.

I wanted to swear.

I conferred with Dennis, and he agreed. She needed more care than we could provide. Doing another manual vacuum aspiration (MVA) could cause her uterine scarring or possibly perforate it. It wasn’t safe. She needed a D&C or a hysterectomy.

Trying to explain this to her family wasn’t easy.

-- “Can’t you just give her some drugs to make her stop bleeding?” they asked.

-- “No. It doesn’t work that way. This problem cannot be fixed with pills. She needs surgery and soon.” 

Shaking their heads in dejection, they said they’d take her home, and discuss it with her husband.

At the thought... my heart shrieked ‘Noooooooo!’ but it didn’t reach my lips.

The problem is: I’ve met her husband. He’s a scary, monster of a man. He left her here for three days, with no money and practically no food, after her last procedure. When he arrived, he told her she was not sick, and was just pretending.

When I told him that she almost died and was very sick, he argued with me in loud octaves that shook the walls.

This belligerent beast of a man reminded me of a pirate; one of his eyes, white with scarring, stared vacantly at me during his tirade. He scared me at a level that I’ve rarely experienced, so I quickly got Dennis involved. 

At that time, she told me that he was a hard husband to live with. She was at his mercy, and he was not a merciful man.

So when her family chose to take her home, my heart screamed itself hoarse. It’s screaming still.

He doesn’t strike me as a man willing to spend money to keep this wife alive when he could just buy a newer one that wouldn’t be sick all the time.

I’ll be shocked if he makes any effort to keep her alive.

Her family took her home before I got a chance to say goodbye, but I did pray for her.

Without surgery or at least a D&C, I’m not sure she’ll live.

Please pray for her. I’m sick. I’m sick thinking her life might be in her husband’s hands. Yes, I know ultimately she is in God’s hands. I know this in my every fiber and cell!

Honestly, her death might be God’s mercy toward her. It might be better for her to die than live another month with such a hard man.

I don’t know how to pray.

Lord, You know! Please, show mercy -- however that might be best! Amen.

March 29, 2011 ~
She and her husband came in today for another review. Thank you so much for praying! The husband was a completely different person. He was worried, and willing to take her to Wau. They left this morning, and promised to come back after the procedure. Praise the Lord!!!

Also, a few wonderful nursing friends reminded me that we could start her on Methotrexate or actinomycin D to prevent it from regrowing. Does anyone know how I can get my hands on some?