Jenny’s Blog

When It Rains…It Pours

So, I had to use this title for one of my posts.  When I first knew this was the rainy season, I thought- great… (my thoughts are even sarcastic sometimes).  My frizzy hair adn that less than desirable smell (like wet dog) that follows the rain were two things I wasn’t looking forward to tolerating.  The rainy season in Ghana is not what it is cracked up to be.  First of all, it doesn’t rain but once a week or so.  But obviously when it does rain, it’s buckets– meetings get delayed, roads wash out, gutters overflow.  And as for being cool…I’m curious to know what the dry season is like.  Yeah, it’s cool after a rain or in the early morning/evening.  But for the most part, it’s hot…especially in clinic where you’re working in a small space or in the OR just before they decide to turn on the air.  Fans really are a blessing.

I don’t know why I think so much about the rain.  but I thought the title held a significant metaphor to one particular instance– my first night on call.

We were all at house 6 finishing station meeting (getting together, praying, singing, etc) when there was a knock on the door.  One of the nurses was standing there asking for Dr. Dickens.  Dr. Faile actually spoke up and said, “No, you want to speak to the people on call tonight.”  So me and Tiffany stepped up.  At that point, I took a deep breath and thought– alright, I can do this.  The nurse explained to me that a pregnant woman full-term has the complaint of vaginal bleeding.  We were given no other information.  I even asked about exact weeks, how much blood, any heart tones or fetal movement, the patient’s stability…anything to give me a better clue as to what is going on.  At that point, my deep breath and positive attitude switched to my stomach sinking and my only thoughts were- Oh my God.  Dr. Faile and Dr. Hewitt were sitting close to the door and just told us to check an ultrasound first to see if there was a placenta previa.  Now, I had been working with Dr. Dickens doing all of the ultrasounds, but a few days of training wasn’t enough!!!  But we said, oh yeah, no problem…  As we were walking out the door, Elizabeth Faile tells us, “Girls, you will be fine.  The patient may not, but you girls will survive”– big thanks for the encouragement.

When we get to the maternity ward, we see a woman lying there writhing in pain.  Luckily, I thought, she’s stable.  There isn’t any obvious bleeding, but you can tell this woman is not in a very happy place.  She’s pretty much screaming bloody murder.  So Tiffany and I take her down to the theater for ultrasound.  I see that the baby is cephalic, and I can’t see the placenta anywhere near the cervix.  I then move to find a heart beat…nothing is moving!!!  I kept thinking I was doing something wrong.  I think I was staring so hard that it seemed like the whole screen was moving at that point, but still, I couldn’t see this baby’s heart beat!!  Since there was no obvious placenta previa (placenta that covers the exit), I did a cervical check.  This lady was fully dilated, and the head was hanging out just outside the uterus at 1+ or so.  We wheeled the lady back to maternity ward to let the midwifes know what we found.  At that point, one of the midwife says, “Oh yeah, I had trouble picking up heart tones on this baby also.”  I had mixed feelings on that comment– glad that I was right about the baby’s heart, or upset that I had to deliver a dead baby that first night of call.  It was pretty brutal.  My thoughts were still blank at that point, but I couldn’t stop saying– Oh my God.

We decided to call on Dr. Dickens to help us at that point.  The lady was pushing with contractions, but she was holding her knees together like she had been waiting hours to use the toilet.   While Tiffany was gone getting Dr. Dickens, I tried my best to position the woman for pushing.  Language was the biggest issue– no English, no Mampruli, nothing remotely close to either.  There was no way to instruct this woman on how to push much less give the heartbreaking news that she won’t have a baby to take home.  The nurse just sat backa dn watched while I tried to move the woman on her back adn teach her how to take a deep breath adn push but I might as well have been doing an interpretive dance while speaking Chinese.  Dr. Dickens finally came to the rescue adn reassured us that we did everything correctly.  But at that point we tried to assist with a vacuum, which popped off three times.  We then decided to let her push for awhile on her own.  So in the meantime, Tiffany and I finished rounding on the wards– checking labs, writing new orders, seeing new admissions.  Luckily it was pretty quiet elsewhere in the hospital.  By the time we walked back to our lady, the Labor and Delivery room was empty– Dr. Dickens came back just before us, and he used the vaccuum to deliver the baby.

I remember the rest of the night was a blur.  We didn’t have anymore calls, which was nice.  But the whole next day seemed to just drift off.  I hope I never forget how hopeless I felt at that moment.  There was nothing I could have done differently.  Everything had already taken place by the time Tiffany and I got there.  But it’s still a chilling feeling, nonetheless.  I’m not sure what I learned from that experience– relieved that I can handle really tough situations without a whole lot of instruction?  disconnected because I will never know how this woman was really feeling?  motivated to work in underdeveloped areas to teach and provide adequate obstetrical care?  humbled by the fact that some situations cannot be fixed or helped– they just are?  My feelings are mixed, and I’m learning each day how to manage all of this.