Wednesday, 9 October 2013
Life and Death
How to address one of your patients for whom you've been caring from the time she was admitted with preterm contractions, held at bay for a week or so before elective Caesarean section delivered her a pair of beautiful twin girls, only to be robbed of one of them a couple of days later? Do you avoid her gaze when passing her in the corridor? Try to pretend nothing's happened? What do you say after the paltry and customary 'maleesh' (sorry)?
What words are there to comfort the primigravida (first time mum) whose premature daughter has had multiple episodes of apnoea and bradycardia requiring CPR each week during her one month stay? It breaks my heart every time I see the look of fear in her eyes, wondering if her child will survive to the next day. And this in the context of her having already seen at least three or four others in the adjacent beds not making it. In the photo, her daughter's the one to the extreme left; these three precious bubs were all born at 31 weeks' gestation.
At least, let me tell you the story of Gloria, our miracle baby (not shown in the pic). It's one of the most amazing sequence of events that I've had the privilege of witnessing. She was born twenty minutes past midnight after a difficult second stage via vacuum assisted delivery. There was meconium present and a history of prolonged rupture of membranes but her mum did receive one dose of prophylactic ampicillin. She had poor Apgar scores from the start - floppy, bradycardic and only occasional spontaneous respiratory efforts. We bagged her for an hour but her cardiac output seemed entirely dependent on artificial ventilation, which unfortunately isn't sustainable in our context. After some tearful discussion with family, we decided to stop and allow the baby to pass on in peace. This was followed by a sorrowful outburst from the mother, who cried out to God asking over and over for forgiveness and for Him to spare the baby.
Well, at this point in time, the baby was still breathing but only at a dismal rate of one per minute (contrast this with the normal range of 40-60/min), the kind of pre-terminal gasping that heralds imminent death. We fully expected her to die over the course of the next few hours. The team subsequently debriefed in a separate room; after an hour of wrecking our brains trying to figure out what went wrong and what could have been done differently, I returned and was promptly informed by the baby's smiling aunt that the baby was ok! And indeed, the baby was breathing spontaneously at a regular rate with a strong pulse and much improved tone.
What did all this mean? Was it transient respiratory depression secondary to...what? No drugs were implicated, there was no evidence of a neurological cause, the baby was not floridly septic and yes, the baby was born at term. Was it a divine answer to a desperate cry from the heart? We later found out that the mother had been pleading for forgiveness due to a messy history of the baby being conceived to a different man to the one she was intending to marry - her original plan was to basically abandon the baby to the biological father. Not ideal but it could have been worse (I recall another mother who almost bled to death from a self-induced abortion). Whatever the rational explanation accounting for this remarkable turn of events may be, I firmly believe God was behind it. Nature may elucidate the how but never the why.
I am reminded of the following passage...
1 Samuel 1:15-16 And Hannah answered and said, "No, my lord, I am a woman of sorrowful spirit. I have drunk neither wine nor intoxicating drink, but have poured out my soul before the Lord. Do not consider your maidservant a wicked woman, for out of the abundance of my complaint and grief I have spoken until now." Then Eli answered and said, "Go in peace, and the God of Israel grant your petition which you have asked of Him."
And He did! Hannah had a son, the great prophet Samuel. Only God knows what Gloria will grow up to become but we've a hunch it'd be anything but ordinary. :)