Midnight. A full day. Off to a good start I can barely remember, happy dogs out for a quick morning jog, the clouded dawn suffusing Longonot and Mt. Margaret with light down in the valley. An hour of Swahili, most of which I now understand but find it extremely painful to extract any spontaneous sentences from my tongue. Rounds in the steamy nursery, constant ringing alarms, the lusty crying of the few term babies, the hot bubble of the incubators, the eerie blue glow of the bilirubin lights. I've brought some articles to read and share with Bob (we never manage), and I try to be patient with the new CO intern who is barely grasping a few basics, teaching as we go along.
Until noon, when an OB nurse bursts in to say we're needed in Labor and Delivery. A mother transferred in from another hospital seizing, her 9th pregnancy but first hospital visit, vague dates, and a decision to induce delivery to save her life. Only what she delivers turns out to be larger than expected, a viable-sized infant. Or just barely so. 700 grams, 26 weeks, a baby who would likely survive in a few places in the world, most surely die in most, and have about a 1 in 3 chance in our nursery. 1 in 3 is significant enough to try hard, but low enough to accept our limitations. And so ensues 9 hours of rising and falling hope. We resuscitate and gently stimulate breathing, provide fluids, warm, start medicine. Twice I go to tell the mother that the baby is dying (to which she says, and I quote, that's OK we don't need this one), and come back to find the baby breathing again. It is uncomfortable to invest in a baby that probably has no chance of life, but I'm not sure the chance is zero, so I go on, even though the mother professes not to care. Finally tonight, while another hopeless baby was trying to die (one with severe un-fix-able anomalies and overwhelming infection) and two new preterm twins were being born, she succumbed to her stiff unready lungs and exhausting struggle to live. A 9 hour life, and I was there from start to finish.
These strike days are like this. The evening is dominated by a mother of twins, also a referral, in labor, bulging belly, agonizing and panting. ONly hours go by and she still hasn't delivered her 33-week twins. When the intern decides to take her for a c-section the first pops out naturally, a boy, bottom-first, with the most alarming chest-wall retractions as he struggles to breathe. By the time we have him stabilized and on CPAP the OB team has decided baby #2 is stuck transverse and they whisk the mother off for a C/S, pulling out a slippery smaller sister who also struggles slightly but revives. (Worst case scenario a la JD: a vaginal birth followed by a C/s, so the mom is sore everywhere). Once they are tucked into their snuggly shared incubator (another strike effect, we're out of space) another referred newborn arrives with her huge spongy head and open spinal defect, her paralyzed stumpy legs and blinking eyes. I work on writing up her paperwork to help the swamped MO intern.
And then one last check in ICU, where the baby with the diaphragmatic hernia rests post-op. And where a feisty toddler whose esophagus was damaged in a failed intubation attempt in Eastern Congo after an allergic reaction to malaria meds has just had a reconstruction of that vital piece of her body. Her dad with his rounded face and trace French accent feels familiar. He's sought care from Butembo, to Mbarara, to Mulago in Kampala, to Kigali, to Goma, and finally all the way to Nairobi, a medical tour of east-central Africa. For six months he's been carting this child from hospital to hospital looking for care. Until he reached Kijabe with her. We talked about familiar towns in Eastern Congo, and then I greeted him in Lukonjo. His face just lit up. I used my half-dozen Lukonjo words and made this peripatetic parent feel happily at ease. The power of a familiar word in the right tongue never ceases to amaze me. He was lonely for his home and the language reminded him he'd go back there eventually. Wabuchire, and wasinge for reading if you got this far.
Home to a last-mintue physics problem (if this ball falls and this one's thrown and the tower is 15 feet hight how many seconds before they meet . . ) and preparing to teach tomorrow. It's been a long day from intubation and writing orders and teaching and a death vigil. 4th call night in 7 days. A day redeemed by the joy of connection from a simple few words. Wasinge, I am thankful to now put it behind me (until the next call).