Sunday, November 13, 2016

Vulnerability, Fear, and the powerful Gift of Presence

It was Sunday day off.  I had just had an enjoyable lunch with Jim and I was getting ready to lay down for a bit.  I had some reading and weekly to-do list planning on my mind.  We have a busy two months ahead of us and it is essential for us to stay on top of things if it is all going to get done.  I had just laid down when the phone rang.  It was Dr. Sana, asking me to come assist with a delivery.  I knew immediately that something was off.  He rarely calls for help, even when he should not be attempting things alone.  I said I was on my way.

I arrived to find a 15-year-old in labor.  The family was from a nearby village.  Gnoumou had been in labor for about 30 hours, 16 of which had been spent in our clinic.  She had arrived at 10 pm the night before, and it was now around 2 pm.  This was her third pregnancy, but the other two had resulted in stillbirths. 

I chatted with Sana a bit and then went in to see her.  Poor thing was exhausted....They had been up all night.  As I examined her stomach, I was sure it was twins.  The position of the baby and the feel of the uterus were too unusual to be just one.  She was nearly fully dilated, and baby's head was engaged.  I was concerned that she didn't seem to be making any progress.  She seemed unable to push, which we attributed to exhaustion.  We made her squat, walk, etc., hoping that gravity would be on our side, but nothing helped.  

After 1.5 hours, I called Jim, warning him that it might be necessary to make an emergency run to the hospital....which is only about 40 miles away but takes over 2 hours.  Ours is the only vehicle in either town and riding on a motorcycle was not an option.

I talked with Sana and the family about the need to take her.  Talk of going to the hospital strikes fear into everyone's hearts.  Not known for good, competent care or bedside manner - no one ever wants to go.  But I didn't see any choice.

Jim hurriedly packed a few things and loaded up the truck.  He locked down the house as well.  I ran home quickly and threw a few thing in, including some leftovers and some granola for breakfast.  We went to the clinic and loaded Gnoumou, her mom, and our apprentice, Kanko, into the truck.  I tried to think of everything we would need in case a delivery by the side of the road became necessary- bucket, gloves, water, towels, cord clamp, suction, resuscitation equipment, headlamp, etc.  Off we went.

Now the road between us and the hospital is awful.....tons of potholes and bumps.  Nearly every time we hit one, Gnoumou cried out.  Jim was trying to balance driving quickly to get there, and yet not hurting the poor girl in the back.  We stopped twice when she complained of the pain worsening for me to check her...but nothing had changed.

We rolled into the hospital around 8 pm and took her directly to the delivery room.  The hospital campus was dimly lit...with lights on in only a few rooms.  The delivery room had lights, but it is an open window place, so huge bugs were flying everywhere. We got her up on a table and they sent her mom to register her.  The staff was fairly unfriendly...barely talking to us...just barking instructions to mom and Gnoumou.  The midwife listened for a heartbeat, checked her, and set a c-section in motion.  

It was getting late, and it had been our intention to hand them off and then head to a nearby village to our guesthouse for the night.  But Gnoumou had other ideas.  She lay on the bed, clutching my hand...BEGGING me not to leave her.  "Please" she begged...."don't go.  Do I have to have an operation?  I am so scared that my baby is dead.  Can't you do the operation?  These people are so mean.  Does the Dr know what he is doing?  Is he just a student?"  I tried to reassure her....I prayed with her, asking God to give her peace and health.  

She was drifting in and out of sleep and settled on clutching the neck of my scrubs in her hand so that I couldn't sneak out while she slept.  Her mom popped in for a few minutes....the staff didn't want her there.  I told her of our plans to go and a panicked look washed over her.  She grabbed my chest and begged, "please don't leave us.  Please make them do the surgery with you watching.  I am begging you.  Please stay until she is out of surgery."

And so we stayed.  A tech came in and started an IV and placed a catheter....mostly by the flashlight of our apprentice's phone.  A Cuban doctor came in, barely said 2 words to us, and was out the door.  We waited and waited, the minutes slowly ticking by....Jim sleeping in the truck, me sitting by Gnoumou -my shirt clutched in her hand.  Every few minutes, she would open her eyes, look at me, and sleep again.  Finally, it was time and we walked over to the operating room, her clutching my arm.

The surgery went fast.....only about an hour, as we stood outside waiting for news.  Finally, it was stillborn, mom had a ruptured uterus that the Dr repaired.   Still no word to the family......I didn't know if I should be the one to break it to them.  Eventually, they rolled her out, plopped her on a bed with no side rails, and left her there.  She was still mostly under from the anesthesia.  They took us in to see baby and the midwife explained everything that had happened.  

We called Gnoumou's mom in, and then her husband - more explanations, more words of condolence, more cautions that she should NOT get pregnant anytime soon.  Never saw the doctor again at all.
Around 11:30 pm,  we said goodbye to the family and left to spend the night in a nearby guesthouse.  Mom kept thanking and thanking us.  So did the husband.  Mom walked us out to the car so that she could thank Jim as well.

The next morning,  on our way back through town,  I ran in to see Gnoumou.  She saw me and gave me a huge grin.  I told her how sorry I was about her baby, and how grateful I was that she was ok.
As I think back to that night, many things strike me.

Yes, we brought her down to the hospital in our truck.  It was a sacrifice of our time - and something that they could never have done on their own.

But once we got to the hospital, I really didn't do anything medically.  The staff seemed frighteningly uninterested in her medical history.  They never asked her name, never looked her or mom in the eye, never explained what they were doing. They just did....She was just a case to them.

Now, I am not saying that there are not good nurses and doctors there....I am sure there are.  And I know that much of what I said was cultural.  But it was hard for me.  The fear and vulnerability in both mom's and Gnoumou was overwhelming.  My clutched scrubs,  tight in her hands.....the begging and pleading.  I did less as a nurse and more as  person....providing the Gift of my presence.....the being close, the assurance that they were not alone.

I was reminded how vulnerable hospitals make people feel.....even the high-tech ones.  Fear of the is so powerful.  And of how much we can offer to people.....just being words necessary.

This morning I was sharing with my friend about the experience, and she said, "It is really bad there.  They don't have any compassion. Sickness is so scary.  But the mission hospital you took me too, that was different.  (She was referring to Hope Clinic...where her son had surgery.)  Those people show that they care.....they rub your heart until you aren't afraid anymore. "   And then we talked about the healing effects of compassion.

So there you go.  No medical degree needed.....just your presence... not words or wisdom or knowledge....just your presence!

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