The Unexpected

She wasn’t sure of her gestational age, as most pregnant women in Chad, since so few get first trimester ultrasounds here, or any ultrasound for that matter. She knew she was big for the 7 months she thought she might be, though. Sure enough, her 31 week ultrasound showed she did not have just one baby in her belly… she had three.

We live in a world where we know a lot of things ahead of time. We often know when it will rain or when it will snow. We know what afternoon the UPS man should deliver our package. We can know the gender of our baby sooner than ever before. But here, in the developing world, the unexpected has a bit stronger presence in our lives.

During maternity rounds, I found her in the labor room lying in bed leaking amniotic fluid and with only infrequent contractions. So we started her on oxytocin, a pain in the bum because we don’t have pumps and so counting the seconds in between drops and writing down each time a woman contracts is how we largely determine the rate we want. Every change in position (which happens often when a women is in labor without analgesics), means a potential change in the rate of the drops. And without fetal monitoring/tocometry, a dead baby or ruptured uterus waits just around the corner if an oxytocin drip is unattended.

She had an ultrasound apparently earlier in her pregnancy, but she did not remember her due date or anything about that ultrasound. So we briefly re-ultrasounded her ourselves just for some quick measurements. The baby measured 39 weeks but the ventricles in the brain appeared larger than normal. Uh oh. We let her know something was probably wrong with the baby and continued with progressing her labor. As she was a first time mom, she progressed slowly throughout the day. And finally at 9:30pm, she was completely dilated and in a lot of pain. 

Her contractions came strong and frequent but she balked from pushing. Around her bed, several women family members gathered to yell at her in the local tribal dialect. I sat at the foot of the bed helping to direct her pushing and encourage her. But with the thought of a possibly not normal baby and the pain of unmedicated first time labor, she went cuckoo for Coco puffs, balking and thrashing and crying for help. For hours she pushed, and I coached, and we labored into the night. 

She continued to make slow progress and finally she pushed that baby out. But her nightmare of a labor culminated in seeing that she had delivered what looked like a monster of a baby with severe disfiguring congenital anomalies. Her screams of anguish pierced the night as we wrapped the baby in her brightly colored traditional fabric. Our golden-hearted volunteer nurse, Sonam, rocked it in her arms until it took its last breath.

Last breaths happen often here to those who should have many remaining, especially on pediatrics. Now is the un-busy season for peds since the rains haven’t come regularly yet to bring the mosquitos sporting their malarial parasites. So our usual census is around 5-10 now. The nurses admit the patients during the day and if they are uncomplicated, we docs don’t see them until we round the next day.

I sat down on Peds Bed 2 with the family and asked the nurse and family a few history questions for the 2 year old girl here with “palu” - malaria.  She had the standard symptoms - vomiting, fever, poor appetite. She lay quietly in her mother’s arms, so I began to examine her there. I put my stethoscope up to her little brown chest and listened. Silence. Uh… did you know the whole time I was taking the history that this child is not breathing? Did you know she doesn’t have a pulse? Do you know she is dead?

But at least I am not dead. Yes, indeed, Sarah is not dead. Sarah, the triplet named after me. I would have never expected it. She was the smallest of the three. Perhaps they named her after me so I would feel more inclined to buy her medicines since they were never able to pay for her themselves (this wife was not the father’s only one and he already has more kids than he can support).

She was about 1.3kg at birth, number 2 in the delivery line up. She was quite scrawny and had fevers and dehydration and struggled to grasp at life every day. But we kept giving her antibiotics and glucose and quinine and encouraged breast feeding and supplementation. And just a few days ago, along with the other 2 babies, I discharged her at 36 days of life. Life, she’s still alive, I would have never expected it as we are by no means a NICU.

I am still alive also, after my first episode of malaria here in Chad last month and many nights of sleep interrupted by patients in distress. Having fun is essential to life, my life at least. I have found that having fun here may have to be in unexpected ways also. In fact, just like I used to do in Idaho where I did residency, the inner tubes of tires can be utilized to float a moving body of water. This same river may be also utilized by cattle herds, the schistosomiasis may be abundant, and the water clarity may be nil, but being immersed in anything cooler than the 110 degree heat of the air may make jumping in be just enough desirable. I just never know for sure what all may be in that water.

« As you do not know what is the way of the wind; or how the bones grow in the womb of her who is with child; so you do not know the works of God who makes everything. » Ecclesiastes 11:5

Yet still, though His ways are too high for me to understand, I can expect that His character of love will never change. « I am the Lord; I do not change: » Malachi 3:6 And therefore; I can have peace that « God is Love; and he who abides in love abides in God; and God in Him. » 1 John 4:16

The day I discharged the lady with the now dead severely malformed baby, something else happened unexpectedly. She gave me a big hug and said, « Merci beaucoup. »