On Monday I went to the hospital to volunteer. I arrived in my freshly cleaned, line dried scrubs. I walked back to the sala de labor y parto and waited as I engaged in the usual conversation with the nurse: where are you from, are you a nurse, how many kids do you have...oh when you do have a baby it will come out blanco, blanco, blanco, etc. After about three hours with no action and no one in labor in the maternity ward I decided to visit Dr Aragon who was on call in emergency. I sat with him for about a half hour as he reviewed children all suffering from the same litney of symptoms: cough, fever, lethargy, vomiting and/or diarrhea. After about the tenth child screamed with tears streaming down their face when he asked to see their belly I felt exhausted. It was in that moment that an ambulance arrived and a stretcher was quickly guided into the emergency room. One minute later a white clad nurse peered her head through the door and yelled nervously "we need a doctor". Aragon was on call so he left the weeping children and scurried into emergeny...with myself tailing behind to see what was going on. On the stretcher was a young woman pregnant with her first baby. She looked possessed as her dark, milky eyes rotated back and forth in her head, as her thick tongue proturded from her mouth, and her black, silky hair billowed about her face. She wore a green hand sewn top and a yellow skirt that was soaked through with urine and feces. Her husband had carried her on a bicycle early in the morning to the town of Rosita, several hours away by ambulance. He thought that when she began convulsing in the morning that it was a normal progression of labor. He later began to fear for her life and placed her on the bicycle. We received her in the emergency room with full blown eclampsia, a disorder of high blood pressure that can occur in pregnacy that almost never evolves in the US which manifests as convlusions, extremely high blood pressure, and at its worst coma and death. In a disorderly fashion the nurses began grabbing the womans arms and legs to prevent her from falling of the stretcher as she seized; her blood pressure read 220/140 (normal is 120/80); the doctors started shouting orders to hang normal saline with doses of magnesium sulfate to stop the convulsions, and I started cutting the womans clothes off to prepare her for surgery. The only way to truly treat eclampsia is to deliver the baby STAT in order to save the mothers life. As I cut through her skirt that was hand altered to fit her growing belly I was swept by a tidal wave of emotion that brought tears to my eyes. how does a woman become so ill in her pregnancy and not know it? how is a disorder that is treated in the US able to manifest in to such a life threatenng state? The emergency room was tense with the severity of the situation. tubes were running into her arm carrying the magensium sulfate, a nasal cannula was held against her nose to provide oxygen, and a tongue depressor was shoved into her mouth to prevent her from biting her tongue. After three boluses of magensium sulfate her body finally quieted. Her limbs lay at her sides, her head tilted upwards, her eyes empty. She was rushed to c-section. In the morning I found out that she had survived. I counted it as a miracle, never having seen someone in such an acute obsetric emergency. Sadly, her baby did not survive.
I was overwhelmed by the experience. I headed back to labor y parto to gather my things and walk home to clear my head. As I started down the hallway a woman was being pushed towards me in a wheelchair in full blown labor. I figured this birth had to turn out okay...so i turned around and followed her back to the room. She wore a fitted, red, v-neck shirt and a camoflouge mini skirt. There wasnt time to get her out of her cloths. We had her get onto the birth table, setting her legs in the black leg supports. I donned a glove and checked her. My fingers barely entered and grazed the babies head that was just about to emerge. The mother screamed with fear that she had had an ultrasound that showed the cord wrapped around the babies neck, and the doctor had prophesed that she would require a c-section to save the baby. I explained to her that it was okay; that we would just lift the cord off of the babies neck like pulling off a necklace. She shot me a pleading look and told me that she had seven boys and this would be her only girl...she had to live. With that she bore down and her little girls head was out. The cord was quickly lifted from around the babies neck and the rest of her body slipped into the world. Tears flooded the mothers cheeks as she heard her little girls first cry. In a moment that I will never forget, the mother grabbed my hand and said thank you. A thank you is hard to come by in this side of Nicaragua, and I will always remember it as a testament of how important it is to be caring and understanding of a patient, particularly in their most vulnerable moment, no matter where they are or in what language you are speaking.
This day in the hospital showed me the faces that birth can have...the fears that women bear, the real ife emergencies that can occur; the joy and the saddness that can ensue. It was a powerful day to say the least!
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