Sunday, March 30, 2008

Full Circle.

After working over 21 hours on Friday, a restful weekend was welcomed. The rain has slowed and the sun has returned ferociously. Sunday afternoon, after spending the day in the sea, marveling at starfish and delighting in homemade coconut ice cream, I was excited to get back to the maternity ward.
I walked in a bit past 4:00pm, took a look at the board, checked out some charts and was approached by a mama who wanted to sit-sit (push). We went into the delivery room and 6 minutes later she had a small boy. This was her 6th pikinini and I’m not sure she even broke a sweat delivering him. There was quite a bit of meconium in her amniotic fluid and the baby came out a bit floppy (or as they call it here-flat). I wiped the young one’s face, talked to him a bit and within seconds I could see (or feel?) his spirit arrive in his body. He opened his eyes, quivered his bottom lip and let out a wail. He was just fine.
I spent the next 2 and a half hours admitting 5 more laboring women, four of which were in premature labor. These four got a combination of nifedipine (a tocolytic used to stop the uterine contractions) and dexamethasone (a steroid injected aimed at helping mature the fetal lungs). For laboring women, the protocol at this hospital is to assess them about every 4 hours, offering a bed to those in early labor (less than 4 cm dilated) and encouraging those in active labor (more than 4 cm) to ‘walk about’. The laboring mother, I’ll call her Eve from here on out, was only about 3 cm, so she was given a bed in the antenatal room. She was a quiet, young woman, only 23 years old, having her second pikinini. She whispered almost everything, and was timid in her responses and way of walking. She looked down at her feet when she spoke. I admitted her, checking the baby and her vitals. The CTG (cardiotocogram, or electronic fetal monitoring strip) looked good. As I reviewed her chart, I noticed that she was a victim of domestic violence and was still married to her abuser. Perhaps her timidity was more than just a cultural manifestation?
An hour later I heard a woman’s cry just outside the labor ward. One of the midwives and I went out to quickly assess the scene, as we both thought there was a woman having her baby just outside the entrance. We stepped out the door to find a procession of women…grieving. Their son/brother/husband/father had passed only minutes before. Just 35 years old, died from lung cancer secondary to liver cancer. Their cries permeated the ward and the night sky seemed to lose a bit of its luster. Death. The other side of life. Inevitable, really. Almost always excruciatingly difficult for the ones left behind.
Eve approached me at around 9:20 saying she felt she had to push. It had been just under 3 hours since she was last checked. We went into the delivery room to assess her cervix. Fully dilated. Immediately she began to push and the midwife present drew up the syntocin, an injected medication routinely given after the birth of the baby to help decrease the incident of post partum hemorrhage and speed the delivery of the placenta. The baby came quickly, just 7 minutes later. It was flat. I wiped the baby’s face, clearing meconium stained fluid from her eyes and lips. I rubbed her chest and dried her off. No response. I felt for her heart rate at the junction of the umbilical cord and her belly. Nothing. Per hospital protocol, the cord was clamped, cut, and the baby was taken to the warmer where oxygen administration was initiated. Keeping my eye on the mother, for she still needed to deliver her placenta, I approached the baby girl. One minute Apgar of 0; no heart rate, no respiratory effort, no muscle tone, pale in color, and no response to any stimulus. After a bit of oxygen, I started chest compressions and called for another nurse, who arrived shortly with a pulse oximeter (a device used to monitor oxygen saturation of the blood). She immediately calls the pediatrician. I continued resuscitative efforts for the next 6 minutes (which seemed like an eternity) until the doctor arrived, upon which she took over my role and I went back to the mother as her placenta was just beginning to detach and needed to be delivered. I prayed to the Creator to be present for this young one, for her mother, for her family. After 15 minutes of resuscitating, the pediatrician called me over. She opened the baby’s eyes with her fingers and shined her light in. No response. The pupils were dilated, fixed. She called the time of death: 9:40 pm. Apgar scores at 5, 10, and 15 minutes, 0, 0, and 0.
She walked over and informed the mother. I took the placenta in to the workroom, attempting to hide my tears from the room. The doctor approached me and smiled. This stuff happens, she said. She felt fairly certain that the small girl had died in utero. A fresh stillborn. With absolutely no response to any form of stimulus, lungs full of fluid, an absent heartbeat, and her clinical experience, she diagnosed the loss. There was nothing we could have done, she said. She asked me if this was the first one I’d seen. Yes, I replied through silent tears burning my eyes and stinging my cheeks. It gets easier, she assures. (Really? I thought…and doubted). After a few moments of stolen, sobbing filled solitude, I went back to the delivery room to speak to the mother. I gave her my sincerest apologies and asked her if she wanted to see her daughter. She shook her head no and immediately said yes. Yes, I do. I brought the small one over to her mother and helped her uncover the face of her daughter. Beautiful little girl, slightly blue in color now. Her mother touched the face and chest of her daughter and closed her eyes. The father and aunt came into the room, both having been informed by the doctor. They surrounded the mother and her baby girl, and I stepped out of the room, once she let go of my hand. For the next 5 (or 20?) minutes I sat in the dark in the break room, trying to make sense of what had just happened. Nothing came. No reason, no rationalization. Nothing.
I was reminded of the times I’ve counseled people through their own grieving process. Death is another phase of life. A different door that opens while an all too familiar one closes. A completion of the circle. While I truly believe those words intellectually, my emotional body was having a quite difficult time resonating with them. In this moment, they were complete bullshit. I could speak them, but was not yet ready to own them. My head spun.
I went back into check on Eve. She was alone with her daughter, cradling her in her arms, and they both appeared to be sleeping. I didn’t wake her, I just witnessed. Trying to hold space for her and her daughter. I prayed for the spirit of her daughter that never seemed to reach her physical body; for her strength as she grieved the loss of a child; for compassion for the husband/father; for the family and for the community. She woke, offered a weak smile and said, “I’m so sorry for my baby”. I’m sorry too.I wheeled Eve back to her bed and told her to try to get some rest. I then went back to the delivery room to get the small one. I picked her up, taking her into the pediatric workroom, managing to make it through the halls without audibly sobbing. My silence was brief. I lost it. Entirely. So there I was, weighing a lifeless infant, wrapping her in her warm blanket and cradling her. Both of us covered in my tears.
Please, keep her in your thoughts.


Mary said...

Katie -- I'm so sorry
All my love, Mary

gi_relax said...

we all have to face end-of-life and are never ready for it..but to experience it with a little one who has not even had a chance, it is really hard...let us hope she is in a good place in good hands..
Girija (sunita's mom)

BitzelK said...

Katie, I wish I could offer you hugs and comfort from half a world away. I hope words will suffice: I grieve with you.

All my love, Aaron

dadann said...

By all means cry...then savor every healthy birth for the miracle it is; we need compassionate healers like yourself. Peace & love, dann

dadann said...

By all means cry...then savor every healthy birth for the miracle it is; we need compassionate healers like yourself. Peace & love dann

ellakat'smama said...

I'm so sorry honey. I am sorry for Eve and her little one as well. I truly believe she is in a better place. Situations like this really make you appreciate each and every moment a healthy baby is brought into this world. As always, little sister, you are always in my prayers. I love and miss you very much.
God bless,

Beth said...

oh mamakat,
i'm so sorry about eve and her baby. and while i'm sad, i'm also filled with gratitude for your life in this world , kat - and in this case, for your ability to care for and comfort others during a very difficult time, even as you yourself are grieving. please take good care of yourself, while i know you are lovingly attending to others. i love you mamakat, and also send my love to sunita and caitlin. you women are fabulous and inspire me - thank you for sharing your journey!
sista b

Morgan said...

Sweet pain,
Life bliss,
Death birth,
Cold kiss

Held heart,
Held hand,
Old part,
Grand plan

Where we're from
Where we go
Mystery deep
Take it slow

You are all doing such a wonderful job. Thank you so much for touching us with your learning and living. You make the world a more beautiful place.
Loooong Hugs All Round,