Friday, October 7, 2011

# 61 Return

I started writing this blog 5 months ago. But there was a change in the outcome that was difficult for me, so I did not finish it. Plus our blogs can be depressing enough.

Olen has been gone for 9 days taking oral ER boards in the states. (He’s coming back today by the way). It’s 4:30 in the morning, the 2 boys are asleep, and I was just awakened to check on an OB patient.

In Olen’s absence I’ve been rounding on the whole hospital. Our census is not as high as it could be, but it still takes up a good chunk of the day. Thankfully Scott (surgeon uncle) and Bekki (nurse aunt) are here to help. The last few days Scott has been practicing his French and taking over surgery rounds.

Yesterday I started in pediatrics. We have about 16 or 17 patients on pediatrics right now. Most of them have malaria and severe anemia. One has Burkitt’s that is amazingly improving, but it was my first patient of the day that caught me with my guard down.

The nurse started presenting to me: “5 months old, vomiting, fever, pale.” More of the same things I usually see on pediatrics. But I could not get over the father’s face. He looked so familiar.

The nurse explained more of the history. This baby is an orphan.

“What?” I usually only understand about 1/2 of what they explain to me in French, so I have them repeat it again and again. But I’m getting better.

“Okay, okay, sounds like the baby has malaria, but why do I know him?” I would remember that face anywhere. If you’ve been through something traumatic with someone, it’s hard to forget them.

Then it came out. “The baby’s mother died here.”

Here at this hospital. Here under my care. Here at this Christian hospital where miracles happen.

Then I instantly remembered him. His puffy eyes. His wailing when he received the news.

His pregnant wife had come in initially after having broken her water at 8 months. The problem was that she had 2 c-sections already. I struggled over her plan of care, but decided to hospitalize her and sit on her (no, not literally). I gave her antibiotics. The baby was doing well. I explained to her and her husband that I planned to do a third c-section, but was waiting for the baby to get bigger (We have no Nicu). If the baby came quickly and easily, then maybe a vaginal delivery. Very unlikely.

She was hospitalized a couple of weeks. Things settled down. She did not get infected or have labor.

The family demanded to leave. I urged them not to. I was angry at this man, her husband. He did not understand. I tried to explain. I was probably too harsh. But in the end, they left. I knew she would come back with a dead baby, or hemorrhaging, or with her uterus ruptured.

She came back. With labor. I don’t remember the time line now, but she came back. I ended up doing a c-section, one of the hardest of my life. There was so much bleeding and scar tissue. We had no cautery (it intermittently works). It took me a very long time just to get to the baby. I had to cut and tie off muscle and thick pieces of scar tissue that were attached to the uterus.

The baby boy came out small but alive. I remember searching for her tubes so that I could prevent another c-section like this and maybe prevent her from dying with another pregnancy. I couldn’t even get her uterus out. It was stuck in her abdomen. I couldn’t find her tubes. I irrigated her several times. Her muscles were a little oozy after being cut. I carefully searched out any source of future bleeding. I did not want to go back in this abdomen again.

I planned to write a blog of this great story of both mom and baby returning to the hospital and living.

But the next day she died. She may have bled into her belly from the sounds of things. I was at the river when it happened. I went directly to the morgue where all of her family had gathered. There were gobs of people, but her husband did not arrive until after I did. He had gone to the village.

The family was getting ready to take my patient home to begin the funeral services. But the baby. The baby was still living. Who was going to care for the baby? We unfortunately had gone through this scenario before.

Everything was happening so fast. I ran back home to prepare a quick bottle of formula. I don’t usually like to give away whole cans of formula because babies die so easily here and then it gets wasted. Or they just sell it for money. But I felt compelled to give a bottle and can of formula to this precious little boy.

The father was understandably too upset to listen to how to mix up the formula, so I found a teenage guy who spoke decent French. I explained that the water needed to be boiled, don’t dilute it, and never give plain water to this small of a child. I begged them to return if they needed any help.

And with that they were off.

I didn’t hear from them. I assumed the baby died. Then we went on annual leave.

I still remember the deaths I feel like I maybe could have changed. I think of them often here. Today God allowed me to see the beauty of this little child He is watching over and allowed me to bring into this world. Please pray that this baby continue to thrive.

olen and danae

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad

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