Wednesday, May 11, 2016

Asking questions

"From that time many of his disciples went back and walked with him no more.
Then Jesus said to the twelve, 'Do you also want to go away?'
But Simon Peter answered Him, 'Lord, to whom shall we go?
You have the words of eternal life.'"
-John 6

It was Monday afternoon and I had just put my books away, having taken an afternoon to study for some upcoming exams.  I returned to the hospital's outpatient department because I could tell there were still patients needing to be seen in the late hours of the day.  I would be taking call that night and I usually like to get a feel for the land, trying to detect early problems and solve them in daylight, rather than facing emergencies in the night when many of my support staff are at home.

I saw a few patients before checking on the maternity ward.  When I went, I recognized Mata - a Papua New Guinean lady who I'd seen just a few days ago for pain and discharge during her pregnancy.  I'd previously thought that Mata's baby looked OK and treated her for an infection in pregnancy, but asked her to come back today.  I could tell almost immediately that Mata was not improving, that she was getting worse.  A repeat examination confirmed, this time beyond doubt, that Mata's water broke and she now had infection which had reached her womb.  Although her baby was alive, it was very small - about 6 months.  Mata was already getting sick with fevers and pain and I knew she was in danger.  So together we decided to deliver her baby at 24 weeks gestation in an effort to save her life.  I gave her medication to start her labor and we both knew that this baby would never live to see a full turn of the earth.

I was summoned to the emergency room to see several patients, one of whom had an abdomen that looked like it housed a small beach ball.  I could tell that Simon had a liver tumor and it was now obstructing his ability to eat and he was losing weight.  I talked to Simon, explained that we couldn't cure him, prayed with him and his family and gave him some medications to treat his nausea and pain.

As I finished his paperwork, sister Nellie from Maternity ward came to get me to see a patient quickly.  "Dokta, mipela nidem yu kam hariap"

As I arrived at labor bed number five, a young lady certainly no older than 18 lay on the table.  She seemed quite relaxed and I wondered what Nellie could be so worried about, until I examined her birth canal.  As soon as I did, blood and clots hit the bed.  I felt one foot of the baby, and the edge of her placenta.

My heart rate crept up as I gave the nurses near me instructions: place a second IV site, call lab to bring a unit of blood, get a delivery tray, bring the suction machine.

Even without an ultrasound I could tell that young Dora was about to deliver a breech baby through a marginal placenta previa.  I could also tell that this foot, perfect in its form, was far too small to be a term baby.  And all the while, she was still bleeding.

As items became available and we gave Dora medicine to improve her contractions, I asked her to push.  One small foot became two, which became a trunk and shoulders, and then the difficult task of trying to safely deliver this little one around her placenta.

Dora's baby wasn't breathing and I rubbed and dried this tiny child the best I could while Nellie gave some additional breaths with, as is commonly the case, a breathing mask a little too big for it.  We got a cry, and Nellie took the baby to try further resuscitation in our nursery.

I turned my attention back to Dora, who was still bleeding.  I delivered her placenta and then massaged her uterus while a nursing student gave oxytocin and cytotec to stop her bleeding.  After what seemed hours, the bleeding stopped and Dora's heart rate decreased from about 140 to maybe a hundred.

Having convinced myself that Dora would survive, I went to Nellie in the nursery to check on her 1100 gram baby.  And I saw something I had never seen before.

A young man, also about 18 years old, stood inside the nursery, alongside several breast-feeding mothers, his dread-locks hanging toward his shoulders and his eyes fixed on the isolette that held Dora's tiny baby.  It was Dora's young husband - and he was the first father I had ever seen come to our nursery.  He wept uncontrollably.  I asked his name, and after several choked efforts he replied, "Joel."

I explained that I couldn't save his baby, that we would do everything we could with our medicines, but that I thought certainly the baby would die.  I told Joel that Dora was safe at the moment and she would need to receive blood and stay in the hospital for a while.  We prayed, and as we both looked at his tiny baby struggling for life, he managed to choke out a small "Thank you"

As I left maternity ward, I noticed a nursing student cradling a small bundle in her arms away from Mata's bed.   And I went home with a sunken heart.

After several weeks working at Kudjip, I found myself asking a lot of difficult questions.  Mostly they centered around me or the hospital.  
 What am I doing wrong?  How can we make our nursery better?  How can I keep these babies from dying?

Eventually, the questions turned into bigger ones no longer focused on myself.
Why are these things happening? 

"He is already half false who speculates on truth and does not do it.
Truth is given, not to be contemplated, but to be done.
Life is an action, not a thought."
-F.W. Robertson

I used to spend a lot of time asking questions.  And I wondered for a long time why I couldn't answer them properly.  I still do, sometimes.

But now I know that I don't have to get the answers to all of my questions before knowing what to do.  I could let my confusion paralyze me.  I could ask questions of the stars and miss the world and lives around me.

The same night that Mata and Dora lost their babies, Susan came to Kudjip with strong contractions expecting her third child.  It was just past midnight and I had just finished stitching a stab wound in the emergency room when Nellie came to get me again.

Susan was eight centimeters dilated but her baby was breech.  We mobilized our surgery team, and within 30 minutes Susan's baby was born and vigorously cried in my arms.

It seemed so commonplace, so routine, that I nearly missed it.  For Joe our anesthetist, Roselyn our scrub nurse, Shekaina the nursing student and myself Susan's baby girl was just "another day at the office."  But for Susan, that new life was a miracle which could just as easily have been lost.

And I realized, as I watched Susan warmly smile and cradle her baby girl, that having the answers to my big questions didn't make any difference to the two of them.  I could ask my big questions forever, or I could focus on the only important question left:
To whom shall I go?

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