Thursday, March 24, 2011

Three Witnesses.

(Caution: This story is about a miscarriage, some people might find it offensive. I hope not, but it's possible.)

The annoying chirp-chirp of the ambulance wailed as it came through the gate, but I barely noticed. It’s never for me. The cases brought by ambulance are always seen by Dennis, but this time I was called.

I was told a woman claiming she was five months pregnant, started bleeding this morning. Grabbing my watch and pen, I didn’t hurry, but I didn’t lolly-gag either. The number of times, I’ve been called for an “Emergency” because a woman was miscarrying, only to find out she wasn’t pregnant but menstruating... is too numerous to count. Honestly, I’ve become skeptical.

She was sure she was five months pregnant. Absolutely sure! But getting her information was challenging, since she was grunting in wild pain. She looked like she was in labor.

Duh! That’s why they called the midwife! (sarcasm implied)

The thing was: She had no belly! Not even a bump! Nothing.

All I could see was a thick abdominal scar where her last baby was taken. It was huge. It looked like they ripped her open and left it to heal on its own. It wasn’t the discrete bikini cut that you often see. This was a classical incision extending all the way across her abdomen.

I asked her about it.

In so much pain... and while pushing no less!.... she explained that she was here in January. At that time, I examined her and said there was no heartbeat (that’s 2 months ago!). We had discussed the possibility of her being only two months pregnant, since she didn’t have a belly then either.

Again, I asked about the scar.

She explained that this was her fifth pregnancy. The first two were alive, one ended badly in an emergency c-section, and her last was a miscarriage at two months. She was convinced she was five months pregnant.

How could I argue?

She was flaying around in so much pain, I honestly didn’t know what to think.

Was she just being hysterical? No. That didn’t fit. She looked like she was in labor.

If she was delivering prematurely at five months, wouldn’t I feel the fetus? If she was only three months pregnant, her pain was way out of proportion. What if it was an ectopic pregnancy? What if she was bleeding internally!?

Not finding heart tones, I decided to try to do a pregnancy test. It sounds silly now, but I couldn’t tell if she was even pregnant.

Every movement she made, looked as if she was in transition.... like she was ready to deliver any second. Something was off.

As she peed for the test, I sent my translator to get Dennis. He needed to weigh in on this case; I couldn’t figure it out at all.

They returned together, and I informed him of my confusion. I was waiting on the pregnancy test, while he went to check the abdomen for himself.

I didn’t watch what he was doing, but I’m guessing he just pressed on it firmly and SPLASH! I kid you not, amniotic fluid gushed out on the bed, and ran all over the floor!

What?

I was so surprised, I couldn’t move. Shocked into stupidity, I glanced over to see a small baby, only a few inches long, lying on the bed. The thin umbilical cord still attached; the placenta apparently still inside.

How on earth!

Like I said, it took me a few minutes to get a grip. But when I did, I found her in a lot less pain. The contractions had stopped, since the baby was out; there was little bleeding, but lots of water to clean up.

Picking up the umbilical cord, I hesitated. What do I do next?

I told her to please push, and we would see if the placenta would come out on it’s own. She pushed with all her strength, and out popped the tiniest placenta I’ve ever seen in my life!

Everything was in miniature.

As I laid him out on the bed, she asked if her three friends could come in and see. Her husband who had labored with her, was noticeably uncomfortable, and decided to take a breather. When he did, three women, all no taller than my shoulder, gathered around to inspect the child with me. She sat up to see as well.

The cookie-sized placenta was complete, and all the membranes could be accounted for. The cord, though thin and transparent, looked normal, and though his head was proportionately larger than his body, that too was normal for five months gestation.

She wanted to know his gender, so I picked him up and brought him close. We all agreed. It was a boy.

Pressing in close for a better look, her friends murmured among themselves, and sweetly consoled my patient. They were interested, sure, but more than anything, they were witnesses. They were there to see and testify as fact: They saw the baby. They examined his body. He was dead.

Watching them, it finally occurred to me why everyone comes to gawk here. This is not a private place. Labor is not private. Birth is not private. Death is certainly not private. Honestly, how could it be?

Here, nothing important is ever done alone. Life and death. Well, that’s just flat out important! Of course they will all come and see!

Sigh. Why did it take me so long to figure this out? 

Anyway, back to my story.

The shoulder-high group of comforters all nodded approvingly at my excellent work! (Ha Ha! If they only knew I didn’t do a thing!) Nevertheless, they thanked me over and over again, lifting their hands to the sky, and praising God saying: “Inchalich Nalich! Thank you God!

I joined them in their praises. How could I not? (Yes! Thank you God for covering my blundering assumptions and ignorance! Thank you! Thank you! Thank you! Thank you this was not an ectopic pregnancy!)

I asked them what they wanted to do with the child, and she made the comment: “Oh, don’t throw him in the trash. That is my baby.”

Horrified at such a thought, I told her of course we wouldn’t; I’d find a box to put him in so they could take him home. She smiled.

They wanted to stay the night to recover, so I moved her to the observation room, gave her the right meds, and made sure she was comfortable. Her friends all joined her, energetically recounting the day’s events.

Just before I left, I wrapped her baby in gauze and placed him in an old medicine container which had a lid. She nodded appreciatively. Then I prayed. I prayed she’d be able to carry her next child to term, and once again know the joy of holding a newborn in her arms.

They all thanked me again, and I left with the sound of comforting chatter reverberating through the halls. She would be fine.

Moral of the story.

If she looks like she’s labor, it’s probably labor. Forgo the pregnancy test!
If looky-loos come to gather, let them pass. Who else is going to testify?
Five months, means five months.... even if there is no belly!
And last but not least.... when in doubt, press on the abdomen really hard, and don’t be surprised if your shoes get wet!

Postscript:
Some of you might be wondering how I could be so calloused. I am talking about a stillbirth, aren’t I? That’s a good question. Frankly, death is no longer a surprise to me. Yes, I’m sad for the woman. She was sad as well. But mostly, she was just incredibly relieved to stop bleeding. She was grateful she lived. Grief looks differently over here. So if I’ve offended you, I’m sorry. I just can’t pretend to fear death anymore. I just can’t. I hope you understand.