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Tuesday, February 01, 2011

Why we do it

A call, just before midnight. Outside, into the night, small flashlight on uneven dusty road. Dare to look away from the ruts and rocks, up at the Milky Way stretching brilliantly over Africa, undimmed, spectacular. Wind gusting in unseen trees. Then the hospital, the sleepy guard opens a gate, the empty corridors eerily quiet at last.

I bypass the nursery and ward and head straight to the newly constructed suite of operating theatres, where I change into clean clogs, mask, gown, hair-cover. There is the intern who called me, checking the warming bed and oxygen flow in the neonatal resuscitation room. I peek into the operating theatre next door, through the glass windows in the swinging doors, where the surgeon happens to be Scott. He let the on-call family physician know that one of his goals here at Kijabe is to become more proficient with C-sections, and at this moment he's well into what will be the second of three between 9 pm and 3 am. This woman, I hear, has severe pre-ecclampsia and gestational diabetes. She's been deteriorating all weekend and is now under general anesthesia in an attempt to save her life, and hopefully that of her 35-week (one month early) infant. No time to ask questions because I can see the smooth bloody purple curve of a head being pulled from her abdomen.

A few seconds later the baby is rushed into our room. I thought I heard a whimper, but when the scrub nurse deposits the infant on the warmer, I see no signs of life. He is limp. Not even a gasp of breath. The intern and I rub his back, talking to him, willing him to breathe baby breathe. We dry his slippery brown body and hold the oxygen near his face. I feel for a pulse, and feel nothing. Start bagging, I tell the intern. NOW. The intern places a mask over the baby's face attached to oxygen, and very effectively delivers breaths, a little too fast but that's to be expected in the stress of the situation. I have my stethoscope out, hear good air entry, and now the beginnings of a heartbeat. As we reach the one minute mark, we pause and dry and rub again, trying to wake him up. Apgar 5 out of 10, he's pink and has a good heart rate thanks to the initial resuscitation. Bag another half a minute. Now his arms are moving, he grimaces, and weakly cries. We change for dry cloths, blowing a little oxygen by his face as he now decides to make the transition to life. We check over his whole body now that we aren't focused on the basics of survival. He's beautiful.

Mom is still unconscious and we're not so confident of this baby's strength, so we decide to take him back to the nursery with us. I gather him up in my arms wrapped in surgical cloths, warm and solid, and walk him through the sleeping hospital into the blue glow and steamy warmth of the NICU. Since his mom was diabetic and he's premature we have to watch his blood glucose level, and put him on IV fluids and oxygen and a monitor for a day. But today he's fine, and now I think as a mom more than a doctor and convince the nursery team (who would rather have him attached to tubes and under their eyes) to let him go back to the maternity ward and bunk with his mom, so he can start breast feeding. She's slowly improving, delivery being the cure for toxemia. In the afternoon I check back and am relieved to know he's fine.

An hour or two for the mom, a few minutes for the baby, the difference between life and death. The availability of a safe and competent C-section for her, the immediate response of warmth and a kick-start of breathing for him, and now the prospect of continued life instead of two burials. Most hours aren't so clearly beneficial to anyone, so it is something to savor, to witness pink warm life creeping into an infant body. Of course in the case of Kijabe, this all would have happened without us, there are many doctors here. It just happened to be on our watch this time.

Here is my secret: I love being on call. I like the quietness of the hospital at night, the focus of only one operation, one baby in need, one admission. The thinning of the crowd, the direct contact with one family or one intern. The friendliness of the nurses away from the pressures of the day. The slipping back out into the night when all is settled, the brisk walk back to a sleeping house. The momentary assurance, that's why we're here.

8 comments:

Heather Pike Agnello said...

I feel very, very happy to think of you moving through that hospital late at night. A chance for you to enjoy the focused simplicity of being just a doctor in those moments - pure and unadulterated. And a good one, by God's grace. Thanks be to God.

david said...

why we read it.

Anonymous said...

crisis averted. what heros!! haha i love you guys.

Michelle said...

Having been a mom awake, at delivery, and waiting for her babies (Zach and Mazie) to cry, I am grateful and thankful the doctors and nurses who eventually got them to cry after bagging. Thank you for being one of those doctors! WEBALE!!!!

laura said...

beautiful. so happy to hear of y'alls capable hands safe in the hands of God.

Heidi said...

Scott, wuh hoo for the chance to do sections, and Jennifer, wuh hoo for being on call involving words like "quiet"

Christi said...

This brings back so many memories of Kiara's birth (Apgar of 2, but fine the next day) and the death of our dear friends' son, who did not get good medical care. What you are doing is so important. God bless you.

Mardi said...

Wonderful Jennifer. I love the late hours as well - can't wait to join you!