Wednesday, May 26, 2010

Akal, akal, akal...

(Heads up readers: graphic, tragic entry. Please preview before sharing with children.)
Monday afternoon, I returned to the hospital to work the afternoon shift. It was around 2 pm. When I walked into the hospital courtyard Reina was there to greet me. She asked me if I could hurry into he delivery room with her, stating that a mom was in labor and had pushed out the baby's arm.

I gloved up as quickly as I could. The mom was on hands and knees and Reina had tried to rotate the baby. The new shift of midwives was on their way to teach class and came in to delivery with me. We quickly discussed what to do for the mama. The baby's hand and arm was completely blue with no reflexes and Reina said that she had been unable to get heart tones--the baby was dead; probably died en route to the hospital. Reina tried to reach for the baby's head to see if she could get it to rotate at all, but was unsuccessful.

I tried next. I had both hands inside the poor mama and was able to get the anterior shoulder to budge a little, but not enough to make any difference. I tried reaching for the posterior shoulder--nothing. We tried pushing against the side of the head from the outside while trying to rotate from the inside--nothing. No budging. And on top of that it seemed like the mama had also ruptured her uterus and the doctor wasn't around to do a cesarean. That meant that if we didn't get the baby out and if the doctor didn't show up soon we would probably have a dead mama and baby on our hands.

My little emergency guide to obstetric complications says to transport immediately for a cesarean for a transverse lie. And with the mentum anterior (face up, chin probably caught on the pubic bone) this made it all worse. The baby was completely compounded and position changes and reaching in to rotate the baby did not work.

Eventually, the doctor showed up and said that he would be ready to do the cesarean as soon as the anesthesiologist arrived. We explained to him our concerns about timing--she had now been with us for close to an hour--and he agreed that she had a ruptured uterus.

Feeling inside her was strange. Maybe because the baby was deceased. The students couldn't understand why Reina and I were trying to get the baby rotated--I feel like they don't understand that where we come from we keep trying even if it seems hopeless that for us sometimes it just feels better to do something.

The doctor put on gloves and tried just as we had. I doubt he was able to reach into the baby's mouth and try to move the baby that way. Reina and I had both tried that, but again nothing helped. Then the doctor suggested removing the baby's arm. I am not sure what he thought this would accomplish; I think he was feeling desperate like we were and he wasn't sure when the rest of his team would show up.

Again, I tried to get the baby up off the pubic bone and again my efforts were useless. Damn transverse lies. Was he really going to amputate this baby while it was still inside it's mother?! At some point in time the anesthesiologist showed up. He consulted with the doctor and I guess they agreed that cutting off the arm was the next step because now the generator wasn't working and without electricity they could section this mama.

I couldn't believe this was all happening. It was like being caught in some horror film. I watched as the doctor took a scalpel to the baby. He cut through the flesh so easily, right along the little shoulder. I silently prayed that the baby was truly dead--I know that he was, but I prayed anyway. As he cut the babies heart and liver and intestines--perfect, glossy, tiny and smooth spilled out through the cavity of the arm. It was horrible to watch and surreal. The smell isn't something I will forget. I still can't believe I know what the inside of a human being smells like.

The arm came off easily and just sat there on the delivery table next to all those little inside parts while the doctor reached back inside mama and tried again to rotate the baby. Again nothing.
We moved mama back to hands and knees and I tried. I reached my hands inside, carefully slid my hands up the baby's back and chest so as to not get poked my the tiny broken and exposed ribs. I had the dreadful thought that my anterior hand was actually inside the body of the baby. It might have been. It wasn't any easier to slip my hands inside now that the baby was armless.

I still couldn't get the chin up off the pubic bone and I still couldn't get the babe to rotate out of the transverse position. What more was there to do? It all felt grotesque and hopeless and completely heartbreaking.

I am uncertain how much time had passed by then. The doctor gave up and left he delivery room after I had tried one last time to change the baby's position. I guess we all kind of did. But in that moment of surrendering to the hopelessness the doctor came back and said he would go through with the cesarean I think regardless of the lack of electricity. He told Reina and I that we could assist.

So I went to the closet and pulled out a newborn onsie and a couple of receiving blankets. I took one and wrapped the arm and the fetal parts up. No one knew where to put them. A nurse said to put it on the floor and that after the baby was born we could put the bundle with the baby. I tucked the bundle of parts carefully under the delivery table. The. Reina and I helped transport the mama to surgery.

Before you can go into surgery it is required that you put on a clean scrub top and clean crocs. Sometimes the surgery ward rubs out and I wonder if they just wait for the clean ones to come or if the staff moves ahead regardless. The attention to protocol here is strange to me. Some things that seem so arbitrary to me seem life and death to the Haitian staff, and things that I wouldn't dream of being casual about are handled in a lackadaisical manner. Reina and I shared a comical moment once we donned our surgical outfits. We had on scrubs that were many sizes too big, pink crocs that were a men's size 11 and big blue hair nets.

Into surgery we went. Miraculously, while the mama was being prepped the generator kicked in and we had electricity. I stood by and watched, holding the receiving blankets in my hands, ready to hold the poor sweet baby. It seemed like it took forever, but eventually I was holding him and being directed by a nurse to place him in the box that was sitting on the floor.

When a baby dies here, it gets put in a box. Sometimes I think more than one baby gets put in the same box. In this baby's box was a blue paper gown, a couple used gloves and some gauze. I was very reluctant to put the baby with the trash, but it seemed I had little choice. So I plopped him in and closed the lid and refused to put the box back down. I watched the mama get sutured, watched her receive a tubal ligation, and held that box rocking it and patting the bottom of it as if it were a live baby I was holding.

The anger came up when the Haitian nurses started laughing. I know that our cultures are different, but it was and still is challenging to feel like this baby was being thrown out like trash. I just smiled and kept rocking the box. It was still very warm. Reina told them that in our culture we hold babies when they die--the nurses just sort of snickered and the doctor commented "this is good."

Eventually, I told Reina that I needed to go. I wanted to clean him off and wrap him up properly. The mama never saw her little son and that is probably for the best, but after nine months of carrying the baby I imagine it is very hard to have nothing. No memory of a peaceful and innocent little face.

Back in the delivery room, I did all of that. I was sad that someone had emptied all the trash bins and thrown away the bundle that was his little arm and other parts. But what could I do? I washed his cute little face and cooed over his sweet little pursed lips. I wrapped him snuggley in the receiving blankets and I just held him and rocked. I was vaguely aware of the midwifery staff and translators watching me.

And I chanted. Akal akal akal akal. Timeless. Deathless. The chant that I was taught in yoga teacher training to do when someone dies. Reina joined in. Then I put the little one back in his box, tucked the blue surgical cloth around him and closed the lid.

On the walk home last night, Reina and I were taunted, yelled at, followed, and harassed. The experience made me so mad. I had just helped deliver one of their own and I was one of two that seemed to celebrate that life, however short. I wanted to yell back at them. I was upset that Haiti and I do not understand one another.

I shared my anger and sadness over our dinner prayers. It felt good to get some emotions out. I know that what Reina and I did took a lot of courage. That it was a courageous thing for me to stand in the delivery room of this hellish hospital and chant akals, but I still feel turned off and numb-- like someone else is attending to the Haitians now, someone else is conducting rounds and getting mothers to nurse. It feels a bit lost over here, a bit defeated.

Tuesday morning, I asked someone where the babies are buried. The little box that I had left in the delivery room was gone. I walked behind the hospital wondering if I would find an area that looked like a little grave yard. Instead I found a pile of trash, remnants of surgical items, syringes, bottles of hospital waste. Among the trash was a lone box and blue surgical draping covered in blood and wrapped like a bundle. Touching it gingerly I realized there was no baby inside. The box and the bundle were empty. I had the horrific idea that a dog had carried it off for a snack.

I have no idea where the baby was buried, if it was buried at all.

“Normally there is no power in the human but the power of prayer. And to do prayer, you have to put your mind and body together and then pray from the soul."— Yogi Bhajan

1 comment:

Anya said...

Oh sweetie,
My heart aches for you and for the mommies and babies. You are so brave and such a beautiful person. Continue doing what you do - we're all behind you and are so proud. You writing is beautiful and it always makes me treasure my beautiful baby boy even more. You are NOT defeated. You are wonderful. God bless.