Tuesday, January 14, 2014

Tropical Vegetation at Buea Seventh-dayAdventist Health Centre


“Doctor, I’ve brought you a patient.” My neighbour caught up to my stride as I walked toward the clinic. It was late in the afternoon. The day has been a cacophony of sick clients, ultrasounds, labs, and all the usual suspects that go along with a busy health centre. Things were gradually quieting. All those who had come in the morning had been attended to – there was a semblance of calm as Nurse B went through the register of the day’s clientele.

I smiled at my neighbour. “OK,” I said. In the clinic, Nurse A was already talking with my neighbour’s referral. She was a young girl of around eighteen years old who worked as a nanny.  In return for room and board, her duties were to watch over a young, energetic toddler.

Nurse C came out of the consultation room with our nanny’s medical booklet. Together in private, she filled me in on the situation. She shook her head. She pointed to our nanny’s last menstrual period. “She say’s her last period was two months ago,” Nurse A shook her head, “I don’t think so.”

I read over the history as Nurse A continued. “She says she had an abortion and the baby came out.”

“Did she actually see the baby come out?”

“I don’t know.” She shrugged. “That’s what she says. “She says there was a lot of blood and clots but I’m not sure. I think her cervix is open.”

I tried to wrap my mind around the entire disjointed history. “So, our 18 year old nanny who is complaining of severe abdominal pain took medicine for an abortion 2 months ago? She says the baby came out but now she’s having contractions?”

Nurse A nodded. “It seems that way.”

“OK. Well, does she need an ultrasound? Is she bleeding?”

“Yes, we can do an ultrasound. No, she’s not bleeding.”

“Ok, bring her back to my examination room.” She handed me nanny’s medical book and returned quickly with a hobbling, bent-double, clearly in pain, young lady. She supported Ms Nanny by the arm as she helped her walk.

After a brief confirmation of the main facts, a cervical exam revealed a bulging amniotic sac in the vagina and obvious strong labour contractions. Ultrasound simply confirmed the pregnancy. Single foetus. About 5 ½ months along. “You’re in labour,” I informed our young nanny.

She looked up and then groaned in pain as the next wave of contractions hit.

“We will admit you to the hospital and you’ll deliver soon but, the baby is not big enough to survive.”

She wailed. “Doctor, how can this be happening?”

“I’m sorry.” I gave her a sympathetic nod. “We’ll take care of you. Don’t worry. You’ll be ok.”

She continued to cry.

“Is there anyone you can call?”

“Doctor, I don’t have credit on my phone.”

“It’s ok.” I reassured. “Your friend will help. I’m sure they’ll call him for you.” I let her sob a few more minutes but the contractions continued in earnest. “Come, you need to go over to the hospital.” I helped her up and led her out of the room. Nurse A and I assisted her to the hospital and directly admitted her to the labour and delivery room.

We made a sad procession. Two medical personnel and a sobbing, young lady bent over with labour pains. It was not a happy celebration when she delivered. Her employer was not happy. Her neighbour was the most optimistic. “It’s a blessing in disguise. She could never have cared for the baby. Her family doesn’t have the money to raise a baby. Maybe now she will have learned her lesson.”
Two hours later…

“Doctor, I need your help!”

I could hear the panic in her voice. Normally Nurce C was calm and collected in her work. “Doctor, please come. Twins!”

“Are you by yourself? Who is there to help you?”

“There’s no one doc,” she pleaded.

“Can you call someone? I’m not at home right now. I’m out.” There was no answer. She’d hung up the phone. Matters were urgent on her end.

“Do you think you need to go?” my husband asked.

I considered the brief conversation and the possibilities. Twins. Panicked nurse. Apparently no one else around to help. I nodded. “Yes, I think I’d better go.” I said goodbye to my dinner friends and headed back up the hill to the hospital.

I arrive just a few minutes later, parked the vehicle and quickly changed into more appropriate attire. As I crossed the entry into the hospital, a young man with sweat beading on his forehead and an anxious expression pulled me aside. “Doctor, how is my package?”

“Your package? I’m not getting you. What do you mean your package?”

“The patient. My wife. Is she ok?”

“Which patient is your wife?” There was more than one female in the hospital tonight. A few more details would be helpful in identifying his woman.

“The one that just came here.”

“Is she in labour with twins?” I was beginning to narrow down the possibilities now.

“Yes, yes, doctor,” he bobbed his head excitedly.

“I’m just going back to check on her. I’ll let you know.” I freed myself and changed shoes as I entered the L&D area. Promising cries echoed to my ears before I opened the door.

Poor Nurse C! Normally so calm and unperturbed. In spite of it all, she’d managed beautifully. Two crying babies lay on the receiving table wrapped in their blankets. Newly delivered mother remained on the delivery bed, quietly exhausted, as she surveyed the nurse’s proceedings.

“Doc,” she turned to me, slightly out of breath. “The babies were coming out when she came. I tried to take the history but then… I didn’t have time to send for anyone…” her voice trailed off. We understood each other.

“Good job!” I congratulated her as I put on a gown and turned my attention to the new mother. Placenta still needed to come out. Oxytocin still needed to be given. A small laceration of the perineum needed to be sewed. Nurse C still could use some help with finishing the babies’ care too. Not to mention the paperwork. I called for backup. Eventually, all was taken care of and things calmed down.

There was much rejoicing in the hallway as twin babies were brought out to the waiting father and family. A tired smile flickered frequently across the new mother’s face. It was a happy celebration. What a contrast from the delivery just a few hours ago.

Life is full of contrasts. One never knows what lies around the next moment. Savour the memories; be fully engaged in the present, fear not for the future. The only thing constant is change.
 “There is a time for everything, and a season for every activity under the heavens: … a time to weep and a time to laugh, a time to mourn and a time to dance…” Ecclesiastes 3:1&4