Here are a couple stories, sort of ‘one step forward, and 2 steps back…’
When we committed to service here at LDL, I was asked if I do obstetric medicine. Hmm. Well, I used to but I haven’t delivered a baby in over 8 years. Do you need me to do OB, would it be helpful? Yes? Ok, sure, I’ll dust off my ol’ baby-catchin’ skills and give it a crack. I have to say that it has been a very rewarding, enjoyable, and sometimes terrifying experience.
Last weekend was my Saturday for OB call coverage. I got a ‘hand off’ of a young lady bright and early that was going slowly in her labor. Her labor was being ‘augmented’ (we were giving her stuff’ to make the baby come faster) and she wasn’t making much progress yet. I nonchalantly made my way down to the hospital to see how she was doing. It was quiet in the hospital, as all the other missionaries had gone down the road a ways to participate in a missionary conference. So I was the only doc there.
I decided I should ‘check’ her progress. You ladies who have had babies understand what this means. It is the rather uncomfortable process of the doctor “palpating the cervical os, or opening of the uterus, to assess the dilation, effacement and station of the baby’s presenting part.” In other words, I had to put my fingers ‘down there,’ to see where the baby was.
Usually one’s fingers encounter the firm surface of a baby’s skull. What I felt was not a skull. I wasn’t really sure what I was feeling, which is always a bad sign. After awhile I realized that my fingers were going down into an opening, and there was a slightly firm flappy thingy in that opening. It felt just like an open mouth with a little tongue… And next to a nose-like lump, and just above the mouth-like thing, was a squishy tube that felt like an umbilical cord. Ah, ok, I get it. This baby is coming out face first, and the umbilical cord is draped across his mouth.
So, like I said, usually a baby comes out with the top of it’s head straight down. It’s rare that they come out face first, and can actually be a potentially difficult, painful and even dangerous ordeal. Add to that the umbilical cord coming out before the baby’s head, and you have a disaster about to happen.
As I realized all of this, the monitor that keeps track of the baby’s heart beat took a plunge into the 50’s, which is bad. The rate went back to a good level, so I quickly got on the radio and called Dr. Ann to gather the troops back to the hospital ASAP to perform a C-section. The heart rate went down again with her next contraction, so I put my hand back in ‘there.’ I had to push against the baby’s head to hold it back so it wasn’t compressing the umbilical cord, thus cutting off it’s own blood supply.
The phone call to Dr. Ann and Dr. Isaac literally cleared half of the missionary conference attendees out of the room. In a cloud of dust, trucks and motorcycles sped down the dirt road to the hospital and the team sprang into action like a well-oiled machine. I am not usually a part of the C-section team, other than occasionally waiting on the receiving end of the baby to help resuscitate it, if it is necessary. However, in this case I was still providing a service: I had to keep the baby’s head pushed back up into the uterus. So, when they wheeled the young lady into the OR, I had to curl up at the end of the bed, hand still positioned on the baby, and ride on in. With each contraction, I had to do battle against the uterus to keep that head up high. I was worried that I was jabbing my fingers in his eye, or up his nose.
They put drapes over her body, as usual, in preparation for this sterile procedure. However, in this case they had to put a drape over me as well. I felt like the wizard of Oz, hiding behind the curtains—nothing to see here…
After some quick work, Dr. Isaac’s hand met mine in the uterus, coming from different approaches. That was weird. He pulled the baby out, I bailed from the OR table, and then I followed the baby over as they handed its lifeless body to Mr. Dave Fields.
Dave and I hustled over to the neonatal resuscitation table and started our process. The baby was pale, limp, and not breathing yet. However, his heart was beating at a reassuring pace. Ironically, Dave is our IT manager, but has quite a bit of experience as an EMT and has participated in many newborn resuscitations, so we were in good shape. Slowly but surely this little guy came around. He never took the big, loud, reassuring gasp of air that is music to a doctor’s ears, but little by little he started to breath stronger, and gain better tone and color to his body. Finally, we were in the clear, never having to initiate significant breathing or cpr for him.
Thank you Jesus! A good outcome for mom and baby. This story would have ended differently had this mom gone to any other providers in the region. The baby would likely have died. I was really proud of how our team made everything happen quickly, competently, and calmly.
On a sad note, Dr. Isaac was sharing with our men’s group a tough case he had seen earlier in the day, one that wrenched his heart and ours. He saw a very young girl with congenital cyanotic heart disease, which means that the blood in her heart is bypassing the lungs to a certain degree and she is starving for oxygen. In the states, she would just go for heart surgery and fix the walls of her heart. Here however, not an option. Her management has to be done with medicines, which only just get her by. Dr. Isaac was surprised at how unknowledgeable the child’s mother seemed to be regarding her medication administration. Well, it turned out that the lady was not her mother, but a temporary guardian. Her mom had just been killed. In fact, it was a story we were already familiar with, since bad news travels fast: Her 17 year old mother had been brutally murdered by the father, at a bar in the little town of Rio Esteban down the road, with a beer bottle.
This story reminds me of how much darkness is still down here, of the powers that we are fighting, and of the importance of bringing the Light here.
Until the next time…
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