A Grief Observed.

Yesterday morning I heard wailing coming from the clinic, and I knew. I knew from the strength of the piercing cries and the intensity of their sound that it had to be about the boy. The little cherub that I had prayed for the night before --the tiny toddler with pneumonia-- must have died.

He was very sick, struggling for every breath. We had put him on oxygen until we ran out of fuel to run the machine. But even when he was on it, he struggled.

His mother had come two days before, got medicine, and was told to return the next morning bright and early. Instead she stayed home, only coming late that night once the convulsions started.

She was frantic, wanting to take him to the witch doctor since our medicines were not working as fast as she liked.

Dr. Tom was not sure he’d make it through the night. But he did.

However by sunrise the shallow rasps coming from his chest finally stopped. He was dead.

When Tom pronounced him, the mother let out a guttural shriek that carried some distance in the dawn silence. It shook me from my bed.

When I arrived to check on another patient a few minutes later, I found her still shrieking and wailing sharply every few seconds. She punctuated her grief by throwing herself again and again on the ground --arms flailing --feet pounding.

Her family and friends sat quietly by and watched. Silenced by her grief, they did nothing to calm her.

Each wail eventually faded to a sob, then slowly she would stand again. Once standing, she would start to pace which eventually led to another wail more pitiful than the one before; and she would throw herself to the ground. Pounding. Stomping. Beating.

No one approached. No one comforted. No one joined in.

It was a difficult grief to watch --too fresh --too real. But eventually there were no more screeches to be uttered, and she quieted to a steady sob, prostrated in the dirt.

Only then did her family gather her up from the dust and walk her home. A friend followed with her child wrapped tightly in his arms.

The wails may have stopped, but the grief was just beginning. Please pray for her. I don’t know her name. But God does. Thanks.

Stillness.

Caution: This story is not for everyone. It’s about a stillbirth. I know that such stories are hard to read at times, however these are the realities of my work here.

It was the monotonous way in which she spoke that told me something was wrong. There was no urgency or fear in her voice. There was no hope.

“My baby is not moving,” she announced to my translator flatly.

This I’ve heard before. Most often it’s nothing but an overly anxious mother in need of a little reassurance. So I didn’t react.

“Okay... so she’s worried about her baby, right?” I asked, trying to determine if her ‘not moving baby’ qualified her to jump to the front of the line. She had arrived late; there were 25 woman ahead of her. I didn’t want to play favorites if all she needed was reassurance.

“Is there anything else wrong?” I asked again, wanting to hear her voice as much as know the answer. 

She answered in a slow cadence that unnerved me: “I was treated for malaria 4 days ago in the market. I think the medicines they gave me hurt my baby.”

She didn’t bother to look at me while she spoke. Instead she gazed off in the distance, trying to separate herself from something. What could it be?

It’s as if she was somewhere else and her words were spoken by another. Strange.
    --What wasn’t she saying?

Although nothing she’d said up to this point would have normally given her priority in line, I asked her to get up from the floor and follow me inside.

My translator thought I was being silly. He didn’t say so, but his exasperation said it all. He seemed irritated that she was jumping the line.

I was breaking my own rules, but I didn’t care. My internal alarm was blaring. Something was wrong.

Once inside, I asked her to lie down on the bed and tell me her story from the beginning. While she spoke, I measured her fundal height, then searched and searched for heart tones.

In the same monotone voice as before, she explained that 4 days earlier she had had a high fever. She’d gone to the market pharmacy and was treated for malaria. They gave her an injection and then pills and sent her home.

Her belly was small (28 cm) and as hard as a rock.
    --Was she in labor? Preterm?

She continued on with her story.
Two days later, she thought something was wrong so she went to the government hospital where she learned that her baby was dead. They gave her an IV drip and kept her for observation. But the next morning they told her she needed a cesarean and referred her to Wau.

She didn’t go.

Instead she went home, and later that night her labor started.

I interrupted her story at this point to confirm that I too believed her baby was dead. I could feel no movements and find no heartbeat.

She acknowledge my words with a slight nod as her eyes hardened with resolve. She knew it. She knew it long before she came for help. Her baby was dead.

I asked her about the contractions and was told that they were much stronger now. As I palpated them, I was surprised at their strength. But she didn’t seem to notice them at all.

Turning to my translator I whispered, “Please tell her I’d like to do a vaginal exam, then set up the room. I think she might be close.”

I quickly confirmed my suspicions. She was fully with an intact membrane bulging at a +2 station.

I explained that her baby was coming soon, and asked if she wanted anyone in the room with her. She asked for her friend, and a slender woman with a furrowed brow came in. She sat uncomfortably on a stool beside the bed and fidgeted with her nails.

Once everything was in place, she started pushing. Immediately the membranes bulged outwardly. Another push and they ruptured, spilling a burnt-brick fluid on the bed.

Two more pushes and he was born.

His tiny hands lay limp against his chest as I moved him about. His cord, swollen and red, looked very out of place. And his skin, though tanned, was starting to peel, confirming my suspicions.

He’d died several days before.

After cutting the cord, I asked if she wanted to see him. She again just nodded and I held his tiny frame up for her to inspect. She looked with interest but didn’t reach for him.

Then closing her eyes, she turned away --no longer able to look upon his stillness.

She spent the rest of the morning recovering from the birth with his tightly-wrapped body cuddled in her arms. Our pastors prayed for her and counseled her, then she slept some more.

She slept but didn’t cry. I discharged her later that day.

Please pray for them. Grief is always heavier than one expects. Pray that she would turn to Jesus and let Him lift this burden for her. Thanks.

Choking on Grief.

Saturday, a young girl was brought to me in labor. Her story is hard to share. I want to write about it. In fact, I desperately want it out, but I can’t.

Each word sticks in my throat, choking back bile, grief, and shame. They fester in my stomach, making me sick. Oh, to vomit them up in readable paragraphs! What relief it would bring!

But I can’t seem to manage.

Telling her story makes it truer, somehow.  I don’t want it to be true. I want to forget. So, I push my thoughts down with my words, only to gag that much more.  

Choking on grief, what a nasty way to live.

Hopefully.... hopefully, I’ll be able to write her story down soon. I don’t know how long it will take me.

She lived. Her baby died.

He was such a beautiful baby... sigh. More bile. Gulp.

Her name is Awende.

Pray as the Lord leads.

Joy comes.

When Apiu came in she looked defeated. I couldn’t put my finger on it, but it felt like she was mourning something.        
    Strange.

She explained that her labor had started the night before, but she wasn’t tired. However, she hadn’t eaten anything all morning. Perhaps she was just hungry.        
    I wasn’t convinced.

I sent her husband for tea and porridge; he seemed willing but exhausted, like his legs were made of lead. Grief haunted his steps.        
    Or was it despair? 

What weren’t they telling me?

Worry and fear lurked in the halls and hung on the door frame. I bumped into them every time I entered the room. Unwelcome guests. Bullish intruders. 

Heart tones were solid, and I told her so. She just nodded sadly. Her vitals were good, and I told her so. Again, she nodded, but that was it.        
    What was I missing?

Looking through her chart, I was surprised she even came at all. During her last prenatal, she had assured me she lived too far away, and would be having her baby at home.    
    So, what changed her mind?

Her chart also indicated that this was her second child. So, normally things should go smoothly.
    Why was she fighting it then?

All my comforting words were ignored. All my reassurances were spurned until finally I stopped to pray. She thanked me, but her words sank like heavy stones and clunked on the floor.
    Hum.

After an hour of this, I finally asked her what she needed since she didn’t want anything I had offered. Her response took me by surprise.

She said to my translator: “You tell my midwife she needs to take better care of me. My first baby died during delivery.”
    Ah-ha! I was attending a funeral, not a birth. Of course!

Apparently, the story we got during prenatals was wrong. She explained that the first child died after a very difficult labor where she pushed for hours.

Telling me didn’t stop the dread from oozing out her every pore, however, knowing helped me tremendously. As I listened to her recount her first birth in detail, she relaxed. When I consoled, she received it.

It’s at this point, things started to change. It’s as if she wanted to mourn the first before she could celebrate the second. So, we mourned until she had had enough.

Another hour or so went by, but I didn’t notice. She was working with her body, listening to its signals. I didn’t interfere. She walked when she needed; she slept when she wanted. All the while, the tiny passenger inside toc-toc-toc-ed away steadily.
    All was well.

When it came time to push, things bogged down again. She couldn’t figure out what a push felt like. She pretended to push with her body, but did nothing internally.

The only thing that helped was getting her on the birth stool where she delivered her little girl within minutes.
    Lovely. 

Would you believe, her baby came out sleeping!? Yep, she was practically snoring for the first and second apgar scores.
    Hilarious!

Apiu’s face positively glowed as she watched her girl sleep on the floor. While waiting for the placenta, I scanned the room for Fear and Worry, but they were long gone. The corners of the room whispered praise; the walls practically cheered ‘Hallelujah!’

With this baby, she regained honor in her husband’s eyes and status in everyone else’s. Her grief vanished at the sound of her child’s first cry! Joy came at last.  

“Weeping may last in the night, but joy comes in the morning!” Psalm 30:5

More than a statistic....

 (Warning: this story speaks of death and maternal mortality.)

Early Monday morning, I was called to attend a young woman in labor. It was her first and she was scared. As I checked her in and listened for the baby’s heart tones, I could hear a patient in the other room trying to breathe. A wet, gurgly rattle of a sound filled the clinic, distracting me. I pushed it to one side of my brain and refocused on my labor.

Her name was Debora and had been coming for prenatal care for months. I got her situated and set up for the birth. Everything was going smoothly, so I thought I’d sneak in a bit more sleep. She was only 4 cm and had three doulas monitoring her every move. I wasn’t needed just then. So, I told the health worker on shift, James, to keep an eye on her and call me if anything changed.

But before I left, I couldn’t help but peek in on the patient in room one. What was causing all that noise? James followed me into the room and showed me her chart. A man, somber and tired was holding her in a semi-recumbent position. She was unconscious and had been that way for over a day.

As I read her chart, I was startled to learn she had delivered two days before. A stillbirth. She immediately got sick and passed into a coma. They waited a day before they came for help. But by then, there was little we could do but watch her struggle to breathe.

And struggle she did. Foamy saliva formed in her mouth with each breath. She was drowning. An older woman sitting by her side, kept wiping it away. Brow knit in desperation, she studied me as I studied her chart. Dr. Tom had seen her. He had done all he could.

I went back to bed but her death-rattle haunted me. I couldn’t sleep. Questions kept taunting me. What had caused her baby’s death? Why was she unconscious? Why did they keep her at home so long? Would she live? No answers came.

It was only a few minutes later that I heard James knocking on Tom’s door across the compound. Murmured whispers exchanged. Doors opening. Gates slamming. Something told me she had died. I got up and James confirmed it. She had stopped breathing. The fight was over.

I wanted to go to the family but ... I also wanted to hide. What did I have to offer this family's grief? I tried to go back to sleep but God kept insisting. “Go now. Go talk to them,” He whispered. I obeyed but my heart in my throat. What could I say?

When I got there, I found the patient covered from head to toe in a blanket. The man was gone but the woman still sat by her side, hands clenched and pale. Tearless, she sat shaking uncontrollably and searched my face for answers. I called James in to translate and sat beside her. I asked her if I could pray for her. She nodded, still shaking.

As I took her hands in mine and prayed, my heart broke. This precious woman died in childbirth. She is the face of maternal mortality. A statistic -- but oh so much more! She is a daughter. A wife. A sister. A friend. Her motionless body, hidden under the blanket, couldn’t hide this fact to me.

Her name was Abuc.

After praying, I asked the woman to tell me her story. What had happened? She hesitated only a moment, then spoke for sometime without pause. My translator listened, nodding encouragingly for her to continue. This is the story she told.

Being of age, her daughter was married earlier this year. But her husband caught her cheating with another man, who impregnated her. Understandably upset, he retaliated by putting a curse on her and the child. This was the result of that curse, she explained. First the child died and now her. She added that this was her only daughter and she was too old to have others.

-- “How long was she sick?” I asked.
-- “Four or five days. She delivered a dead baby two days ago and then got really sick.”
-- “Did she get prenatal care?” I couldn’t help but wonder if this had been preventable. What medical reasons caused this death? Was it preeclampsia? Hypovolemic shock? Malaria? Pulmonary embolism? Stroke?... What?
-- “Yes.” She explained. “She went once to the clinic in Malualmok.” (A small neighboring town.)
-- “Only once?” I asked. She nodded.
-- “What was she complaining of before the birth?”
-- “Headaches, neck and joint pain. But that is all.”

That means it could have been anything-- malaria or perhaps preeclampsia. I couldn’t say for sure. The fluid in her lungs made me think it was a pulmonary embolism. I wanted to grill her with more questions but I didn’t have the heart. She didn’t need answers. I did. She already knew why her daughter had died. She was cursed. So I dropped it.

We sat in silence. Nothing more needed to be said. I wanted to ask her if she knew Jesus but her grief was so fresh. So I sat and held her hand instead. Her shaking slowly subsided and together we waited for the men to return. They had gone to get transportation. The body needed to be buried.

They returned with more men to help dig the grave. Abraham, a family member, asked in perfect English if we could drive them back to Malualmok. I got Mike (our compound manager) and he agreed to take them. It wasn’t even light yet when they drove off with her body.

I couldn’t get her out of my mind but I had to. Debora needed me. Turning my attention to her, I was happy to watch her labor so well. She handled the pain with slight moans, walking the baby down. She was tired but healthy.

In my mind, I couldn’t help but compare these two births. Both were first time moms in their teens. One had come for prenatal care for months, taking vitamins and getting her shots. The other was seen only once. One had delivered a stillbirth at home. The other was delivering with me in the clinic. Her baby was fine.

Later that day, Debora delivered a gorgeous little girl while surrounded by friends and family. It was beautiful watching her go from girl to woman; from pregnant to mother. And best of all she lived. I’m not saying that had Abuc come to deliver with me, she would have lived. I will never know that for sure. But I do think her chances would have been better.

Was her death preventable?

Pray for Abuc’s family and the superstitions that plague these people. Pray for these women to come for prenatal care and to deliver at the clinic. May there be no more preventable maternal deaths. May it stop here! Now!

No-Man’s Land of grief

If each story of each woman that came through my door could be summed up in a tight little paragraph for all the world to read, would they read it? What if the story got complicated and long? What if it wasn’t as interesting as the last one? Would it then be less worthy of the telling?

This week three women came through my door. They had similar stories - all tragic. Some are more tragic than the next. But can heartbreak be measured? Can you qualify that one woman had reason to mourn more than the other, just because she might die?

The challenge I faced this week was how I was to cope with all the death, loss, grief and pain I saw. I kept trying to shut out the pain and sear my heart numb. And when I thought I had succeeded, God would slice it open again in a new area, and gently whisper, “Feel this pain, child. Let it break your heart. It breaks Mine.”

“If you deaden the pain or shut it out, you might survive a little while. But ultimately you will lose your tears, your compassion and start thinking this is normal. It is not.”

So as I write you these women’s stories... know that I only got a glimpse of their pain. I will show you that glimpse. Please don’t dismiss it. Let it break your heart and move you to prayer.

A silent grief ~
Alual has been coming to our clinic for months. She miscarried her last child to an unknown and untreated STD. So during this pregnancy we treated her with all that we could. But our strongest stuff wasn’t working. I don’t know if her husband was treated or not. But I do know she wasn’t sharing her bed with him anymore - now that she was with child.

I loved seeing her in my prenatal line. She was always so happy and round and red. (She wore the same dress each time - a red, cotton dress with white spots.) Her name actually means “red cow.”

Well, this week she came into the clinic complaining of lower abdominal pain but no contractions. So I sent her home to rest. She was only 6 months along, perhaps what she was feeling were the innocuous Braxton-Hicks contractions.

The next morning, however, she returned holding a cold but breathing little girl in her arms. I was horrified.

She had delivered at home unassisted several hours before. Her child was glacial but breathing strong. As a team, we worked hard to get her body temperature up (kangaroo care, hot-water bottles, heat lamp) and started an IV. She only weighed 750 grams. Her heart beat was so strong I could see it beneath her rib cage. Clack-CLACK. Clack-CLACK. There was just one problem. It kept beating slower and slower.

We resuscitated and monitored her for hours. She made some great improvements but we couldn’t keep her heart going. Eventually we explained to Alual that there was nothing left we could do. She asked to take her home to die.

I cried... but she didn’t. She calmly wrapped her baby in her arms and went home. She wasn’t bitter or angry. She was sad but this wasn’t the worst thing she’d lived through. She’d go on.

A raw hopeful grief~
The very next day, another of my regulars came in holding a child in her arms. She, too, delivered prematurely in the middle of the night. Her little boy weighed only 1600g and was estimated to be about 32 weeks gestation. He was alive but fighting to remain so. His lungs lacked the surfactant it needed to fully expand and when we listened closely it sounded like a door slamming shut each time. Gasp-KLUNK. Gasp. KLUNK. But he was a fighter.

We started an IV and talked to the family about getting him to Wau. Perhaps they could do what we couldn’t. I didn’t have much hope but... they were willing to try. And I was not going to steal their hope. It was early enough in the day for them to get a bus to Wau and they hurried off, IV still running.

But this mom, she was young. This was her first child. And as she prepared to go to Wau, she wept uncontrollably. The reality of her child’s fate sinking in, must have finally touched her heart. I wanted to weep but I couldn’t. I didn’t want to feel her pain. It was too fresh. Too raw.



A grief unspoken~
And again, the following day another woman came in. Except this time her baby was already dead and she was not far behind. She was carried in by her family. The smell alone screamed of infection and death.

I came late on the scene but I was told she had a retained placenta that was offensive and possibly gangrenous. Margaret got it out but she kept ‘bleeding’ a thin, white, foul liquid from her uterus.

Her family explained that she had delivered a full-term, macerated baby earlier that day. It was black and decomposing which explained the smell and her condition. She claimed that it had only been one day that she hadn’t felt the baby moving but I doubt it. A baby takes weeks to decompose like that.

In addition to the severe uterine infection and continuous flow of fluid, she had a ragged 4th degree vaginal tear. But it had been too many hours since the birth to suture and heck... what do I know about suturing a 4th degree tear?! I don’t. My heart dropped when I saw the size of it.

Fortunately, she didn’t have a fistula (that I could find) and was stable. We treated her with several antibiotics and kept her over night. The following morning, her family was able to gather the money needed and took her to Wau. Or at least... I hope they did.

She, too, was young. She, too, delivered her first child. But she had no tears to shed. She had to stay alive to cry. Perhaps, she’ll live. Perhaps, not. I pray she does and is able to one day mourn her loss.

So there you have it -- a glimpse at my week.

For those of you who tend to worry, let me reassure you. I am not carrying these women’s burdens. I am sharing their pain with you. I weep for them and pray you will too.

Pray for me. Pray that I would learn to live in this no-man’s land -- that place between the joys of birth and the anguish of death.  Pray that despite the sadness and overwhelming pain I see here, I would not be a casualty of this war but instead victorious... and able to lead others into new life.