Sunday, October 13, 2013

Those Moments...

There is an oft-repeated lament in Cameroon, “it’s not easy.” One mutters it in response to a friend who informs you that she failed her exam; one can repeat it to the street vendor attempting to eke out a living selling pastries; one might say it to the storekeeper who shakes her head when you ask how the work is going. It neatly sums up life’s struggles.
This afternoon, it was raining as I folded my umbrella and hung it from the window bars of the clinic, returning yet again to the office to finish up some things. I looked up and greeted one of our clients. “Good afternoon. How are you?”

“Doctor, it’s not easy,” she held out her hands and shrugged her shoulders with a sad look. “My son, he’s not well.”

“Ashia!” I replied with a sympathetic smile. I traipsed into the back of the clinic while one of our nurses called the mother into a consult room.

“Sorry to disturb you, doctor.” The voice was soft and hesitant.

I turned to see who might have bypassed the front registration desk and snuck into the back room to my office. An obviously pregnant lady hovered just outside my door with an anxious expression clouding her eyes.

“Please, doctor, I’m not well.”

I gathered that much. Very few clients come to the health centre when they’re healthy and feeling fine. I tossed the toilet tissue in the trash bin (toilet tissue serves as my substitute for disposable paper towels) and assessed the situation. It had been a long week. There had been some sad cases and some frustratingly puzzling illnesses. In theory, I should have finished consulting a couple hours ago. Now I was hungry, tired, and feeling rather overwhelmed. I still had an alarmingly long list of things I wanted to attend to before bed. My sympathy quotient was a bit depleted at the moment.

But the patient didn’t give up. She pressed her case, “Please, doctor, I know I’m late. I’ve come from a long way and I’m not feeling fine.” Her brown eyes certainly bore testimony that she was distressed.

I shrugged helplessly. What could I do? Pregnant. Not feeling fine. She had found my Achilles’ heel. “I’ll see you. Go get checked in at the register.” My long day was becoming longer but I couldn’t see any way out of it. I ran off to check on several problems in the hospital while she registered and had her vitals measured.
By the time I returned, my nurse was with her in the examination room having already gone through the history of her current illness.  The patient was lying on the examination bed while the nurse tried to find the foetal heart tones with our handheld Doppler machine.

I sat down and looked over the written history and the antenatal card that the patient had from her visits at the local government hospital. ‘G4 P0022’… Rather unusual -- pregnant four times, two miscarriages and two living children but no actual deliveries… doesn’t quite add up does it? I scanned further down through her antenatal card to the details of each of her previous pregnancies. Her last two pregnancies had ended with the baby dying inside the womb.

Empty static squawked out of the Doppler as the nurse shifted it over her womb. She shook her head, frustrated. “Doc, I can’t find it.” By ‘it’ she was referring to the heartbeat of the baby inside. Our patient’s anxious expression became even more worried, if that was possible. Two prior pregnancies that had ended prematurely in death would make anyone more than a little fearful at this point!

The nurse had written in the patient’s medical book under the heading of chief complaint “not feeling baby move”. The unfortunate woman had travelled a considerable distance to a mission hospital that she trusted enough to give her a definitive answer. She was frightened. No wonder she was “not feeling fine”. She didn’t have a fever or headache; instead, her heart was filled with fear. She was sick to her stomach, perhaps, with anxiety over whether another baby had died inside of her.

It was the end of the day. The nurse had already spent several minutes sliding the Doppler over the patient’s pregnant belly without a definitive heartbeat. I was not feeling very long-suffering. “Ok,” I announced, “bring her over to the other exam room. No more wasting time.” Like the patient, I wanted an answer – dead or alive – now. Patient and I shared a common desire in this regard.

She was mainly French speaking. Between my limited French phrases and her much better comprehension of my English, we communicated and I took her hand and helped her over to the other room with the ultrasound machine. (It is not one of those small ‘handheld’ units!). A few minutes later, the machine had warmed up, gone through its agonisingly slow ‘in calibration’ process and was poised and ready to scan.

I placed the ultrasound probe on her belly and did a few wide sweeps. I smiled with relief – to be honest – for two reasons: 1) the baby was alive with a normal heart beating and that was good news 2) consult was ended; no need to spend a lot more time counselling a heartbroken woman and then managing the details of what would have to happen next.

I looked up at the patient from my scanning. I had not said anything but suddenly the fuzzy black and white ultrasound image on the screen began to shake because my hand was not longer holding a stationary probe. Tears formed in the patient’s eyes as she broke into sobs -- tears of relief and happiness at seeing her baby’s heart move. She didn’t need to be a trained sonographer to know that a moving dark object on the screen was the heart. All the anxiety, pent up worry, and fear came crashing down in waves over her and rolled away off the exam table. She couldn’t stop crying. Tears streamed down her face as she watched the heart of her unborn child move rhythmically on the screen.

There are moments when I am blown away by the wonder of life. This was one of those moments. So often I have bad news to give patients; at the best, I get to tell people that their illness will improve with patient effort and sticking to their treatment plan. It’s not often that I can simply be the conduit of good news, providing a definitive answer to alleviate the patient’s fear.

After such a long day, I was touched and blessed to be a part of this patient’s joy. A warm glow, a satisfaction, a thankfulness, encircled and hugged my soul, kissed my tired core, and left me with tingles of a glimmering gold that brightened the rest of my day. Moments that take one’s breath away…

“In the end it's not going to matter how many breaths you took - but how many moments took your breath away”

 - Shing Xiong