Monday, January 07, 2013

The Pain and The Privilege of My Calling

I’m coming off of about five hours of restless sleep this morning. A baby kept me up last night. But it wasn’t my baby. No. It was a baby who had died in his mommy’s womb before I met either of them. I often find that this blog becomes a place of therapy for my soul; somewhere where I can pour out my heart during intense times like this. Therefore this will likely be a longer post. So if you don’t feel like reading through to the end, no worries. This morning I am writing for myself.

Last night we were hosting a back-to-school party at my house for the youth in our life. We also had a few American volunteers over for supper just before the party. As I was feeding my son and the visitors were fixing their plates, someone came running to my back door saying that there was an emergency at the clinic and the nurse on call was asking me to come. I know that this particular nurse is super-capable and if she was calling for my help it was probably bad. 

She actually had three patients come in, in a very short time. She was the only nurse on duty as it was after-hours. Two of the cases she had under control, but one needed me to use my ultrasound skills. It was a young, expectant couple who are not from our community. Just the two of them, no support team of in-laws, friends etc. that you usually see during the birth of a baby in our small community. The nurse explained to me that the mom was in active labor, had been having pains for two days, and had not felt the baby move since early morning. She couldn’t find a heartbeat with a Doppler so she had already set up the ultrasound for me to use.

I am most certainly not a perinatologist, neither am I even an OB/GYN doctor. I’m simply a nurse practitioner who has sought out some extra training for times like this. And it did not take a specialist to see that this full-term baby was not moving in the womb. I located the heart and did not see any movement. I saw something that my non-specialist eyes felt was unusual. It looked like there was a very wide aorta (blood vessel going away from the heart, but I really wasn’t certain. Besides, the point was that the baby appeared to have already died in the womb.

This couple was completely new to our clinic and had received all of their prenatal care elsewhere. I stepped outside with the clinic nurse, visiting nurse from America, and father of the baby. In times like these you have to be so culturally sensitive even as you make medical judgments. I shared with the father that I had some serious concerns about the baby; that we would do everything we could but that I could not guarantee a positive outcome. I asked him if he thought it was better for me to share this information with the wife or to wait. We are in a rural location where getting someone transferred for a c-section is a pretty big ordeal. I needed to know that this mom could hold it together to deliver this baby so that her life was not endangered. He told me that she is a very emotional woman and he felt it would be better to wait and see the outcome before telling her our concerns. These situations are always such a hard call. Whether or not I made the right decision I do not know. But we did not tell the mom.

I recently read about a case in another place in Africa where a woman was referred to a large medical center to deliver because the smaller center had referred her for a fetal demise (same sort of case). In that situation the baby was blue at birth and did not move so they put it to the side and focused on mom. A few minutes later they went to move the baby’s body and found it alive and moving. So I had resolved in my heart to hold on to hope and do my best for this family.

It was not a particularly difficult delivery; her first time, so of course not easy, but not particularly difficult from a medical standpoint. The nurse and I decided that she would manage mom and I would handle the baby. As the baby came through the birth canal I began to suction and do all the things that I normally would during a delivery. But it looked bad. I’ve done resuscitation on many babies, but this one was definitely beyond resuscitation. I walked the baby away from the mom to another exam table. I listened. No heartbeat. I attempted resuscitation for a few minutes all the while knowing that the baby was already gone. I put my hands on the exam table and leaned over this precious baby boy and asked God “What now?” I needed to know that the mom was physically stable before going to see her with bad news. 

The placenta came rather quickly and I knew it was time. I knew that she already had to know something was wrong. I looked up to my colleague and the visiting nurse and told them that I was going to talk to the father and was coming. I shared the news with him. That I had tried, but that the little boy was already with Jesus when he came out of his mommy. We went back into the delivery room together and he wanted to hold the baby but was afraid to at the same time. I helped him. We talked for a minute and then I went to see the mom. She still needed post-partum care but I knew this conversation could not wait any longer. I shared with her that her baby was not breathing when he was born. That his heart was not beating. That I tried but I could not get the baby to breathe or have a heartbeat. That her child was a boy and that he had died.
Oh the anguish. She whispered “My Baby..” in Swahili and then began to thrash and scream. She shouted all of the normal questions that really have no answers. “Why my baby? Why me? I was not prepared for this! I want to die too..” I wrapped my arms around her and cried with her. In a moment like that, there really is nothing more that one can do. My heart broke with this family. 

In my life I have had many pains. One of those pains included losing an unborn child myself.  I did not carry this child to term as this mommy did. I have no idea if mine was a boy or a girl. But I do know the horror of having a doctor look you in the eye and tell you that what you believed and all you had hoped for would not be. 

The passage in Second Corinthians, chapter 2 verses 3 to 4 comes to mind at a time like this. “All praise to the God and Father of our Lord Jesus Christ. He is the source of every mercy and the God who comforts us. He comforts us in all our troubles so that we can comfort others. When others are troubled, we will be able to give them the same comfort God has given us.” (NLT) I’ve always had mixed feelings about this passage.  I ask myself why it is that any of us should need comfort in the first place? Why this horrible, inexplicable, pain and suffering that some are asked to endure?  But in a moment like that moment last night, I find great comfort in the fact that I can truly look these parents in the eye and tell them “I know your pain. I know that it feels like you will just die from it. I have been there. I’m so sorry.”
The job of washing a little body whose soul has left is such a terrible, painful thing. But I did it.  I helped the mother hold her son as she told him goodbye while at the same time hardly believing it could be possible. Her head to his forehead and the tears falling unchecked. I prayed with the family. I asked that God would be the God of all comfort and peace. That they would know His presence and have the assurance that their baby is in the presence of God himself. I looked both parents in the eye and said very clearly THIS IS NOT YOUR FAULT! I asked them to comfort and hold each other as they walk through this unspeakable pain.
As I left them, extremely early this morning, they were discussing where they would bury their son. In this area you bury your loved ones in your backyard. They had recently moved to the area and are renting a small house about twenty minutes away.  They don’t have their own property where they can lay their son to rest. 

My short night was restless as I tossed and turned in my bed. But when I came fully awake I was overwhelmed with thankfulness that I could be there to weep with this family. That I have the honor and the privilege of stepping into peoples lives during their most horrific and vulnerable times. That God can use me as His instrument of peace during times of storms and crises.