Wednesday, 3 February 2010
Two Births and a Death
Another long, busy day in surgery full of fracture repairs and wound debridement. The smell of the 3 week old wounds is overwhelming. Poor sanitization conditions combined with long hot days spent in crowded tents with little to no ventilation. Thank heavens for Vicks Vapo rub!
I left the hospital around 8pm to return to camp. We now have running water! Immediately headed straight for a shower, which really consists of bathtub and garden hose pulled through the bathroom window. It's freezing cold, but I can't wait to "come clean" of today. I yell for someone outside to "turn on the hose!" and not more than 2 minutes later hear a voice outside running down the alley & coming toward the clinic. A nurse from the hospital pounds on the door for me to "come quick" to the hospital..."a stat c-section". Still soaking wet, I throw on scrubs, call for Sandra (the other anesthetist & native Haitian), and we follow her back to the hospital.
We quickly gather whatever supplies we can find through all of the mess of medical equipment just shipped in (thank you to all who donated!). Turns out there are in fact two c-sections, but only one surgeon. The most critical goes first: umbilical cord wrapped around the baby's neck. Spinal block and within 4 minutes the baby is pulled out, blue, completely limp, and almost lifeless. It was then that we realized that there was no one available to take care of the baby, who is cyanotic and silent. Sandra takes over care of mom, while I attempt to stimulate and suction the baby screaming for help the entire time. A Canadian ER doctor hears me and comes to the rescue. Together we stimulate and suction large amounts of aspirated meconium, and soon....crying. The most beautiful sound in the world!
Sandra and I must quickly get ready for the second c/sec. I wheel the last newborn into the room with us. Again, there are so many things wrong about the conditions we must work under, but we must just adapt and adjust to what we have. There is no NICU. New babies and moms get sent back outside to the yard (literally) just after delivering. This baby was nowhere near stable enough to be left unattended so came in to witness a birth after just being born.
Sandra & I were getting ready to do a spinal block on the next mom when a code was called on a baby that had been rushed into the hospital from the "tent village". She just cried and pleaded (in Creole) to help her baby. The infant was intubated and coded for over 20 minutes before time of death was called. I tried to hide behind my glasses and mask as I cried right there in front of everyone. It was unbearable. And still, after experiencing such heartache, I had to return to the OR to finish the last c-section.
I'm thankful I stayed. As difficult and cold as it felt at the time, I needed a "happy ending". I got just that. One loud, crying, healthy baby. As two new lives were brought into the world tonight, one was taken away...
The hardest part about tonight was wondering and questioning myself, "what if?" ; "what if this baby had been in the US?". ...same baby, same illness, only with better medical access. Would the outcome have been the same?". I heavily doubt it. That's what makes it so hard...wondering why some are so fortunate and privileged, just by the geographical location in which we have been born; while others are born into nothing. It's just seems so harsh and unjust.