Waves

A couple of dramatic things happened on recent nights. There is a lot in them that bears on the essence, or one of the essences, of “doctoring” (that is, of being trusted, for variable lengths of time, with a person’s fate). I don’t want to go on and on about that right now, though (I think I already did in Sierra Leone). More just to tell you about them.

Three nights ago, I was called back to the hospital (after a nice evening socializing with a Swiss borehole team) for a C-section on a woman with twins. Despite my still-unfamiliarity with the room and the equipment here, everything went fine – spinal in fairly quickly (one of the upsides of no one here being fat), worked well, woman stable and comfortable. When the first baby came out, though, I could see she was floppy and grey. I went over to help the people at the warming bed. But nothing we did brought her back. By the time the second baby was delivered, she had no heartbeat at all. 

That had never happened to me before. Without, as I say, going on and on, let me just state that one is never perfect in one’s work, and one is even less perfect in things one has never had an opportunity to practice. That was the first time I had ever been faced with resuscitating a newborn, and I KNOW I could have done it better. I don’t know if it would have made any difference – she might have been dead from the moment she was delivered, and her brother – whom we did manage to revive – died a couple of days later. But I do know I could have done a better job. It is sad, and hard. 

(Sadder and harder for the mother, of course. But, even without the spacesuit I had to wear in Sierra Leone, I often feel like I am from Mars here – a visitor from an irrelevant, alien world with whom people do not share their inner lives.)

Then, last night, there was a woman in maternity who was at only 25 weeks, but had been feeling bad for a few days and so came to the hospital. Her abdomen was distended, and getting hard (bad). Her x-ray showed that her large intestine was stretched and inflated. But the only surgeon here who might know how to deal with it (not an MSF employee) was already at home. Cell phone reception was down on the network we use (no one has a land line), but I found someone with a phone on the other network, called the surgeon, and luckily he answered. Security concerns made him hesitant to come back to the hospital, but he said that if we could transport him (he is from Ethiopia, and they don’t give their people fleets of cars), he would come back and evaluate the woman.

Shortly thereafter, we took her to surgery – where we found the most blocked, bloated large intestine I have ever seen. She had a “volvulus” – a twist in her intestines, blocking all movement through them. All the poop and, more importantly, gas that is produced down there had been backing up for days. If we had not been able to operate, at some point her intestine would have literally burst (or, if not that, would have necrosed – died – from all that pressure blocking its blood supply). She very likely would have died, last night or not long after.

She still has a hard road ahead of her. She had a miscarriage a few hours after coming out of surgery, and some of her intestine may still die, requiring us to operate again. But last night, at least, we gave her what she needed.

So. Makes me think of The Waves, the Virginia Woolf book where she manages to re-create the entire world in 250 pages. Love and hate; life and death; inner and outer; together and alone – we move back and forth between them, rising and falling like waves in the sea. Success and failure, too.

And I said I wasn’t going to get philosophical.