Another Exciting Update

Once again my mother has sent me a very interesting e-mail, once again I am very impressed with her writing skills, once again I am going to post it for you all to enjoy, and once again it is pretty long for a blog post. So if you don't feel like taking the time to read it I understand, but I'm sure you will enjoy it if you do. And if you haven't read the post before this one, I would encourage you to do so (it is quite enlightening).

Hello Again!

It’s 11:28 p.m., and so far the night has been pretty quiet. Maybe I’ll have a chance to both start and finish an entire letter this time, instead of spreading it out over several days! We had a thunder storm earlier this evening, but the only sounds now are an occasional drop of water from the tile clinic roof hitting a puddle on the gravel path below, the ceaseless croaking of hundreds of frogs rejoicing at those puddles, and the periodic harsh clicking call of a lizard who is perched somewhere close by in an overhanging tree.

My lone pediatric patient is peacefully asleep, one leg draped over her mother, lying beside her in the crib. Now that the little one is being treated with IV fluids and antibiotics, her frequent diarrhea and vomiting have stopped, and the mommie is gratefully catching up on rest as well.

Sometime tonight I need to wrap for sterilization in our small steam autoclave the washed and air-drying instruments that Maribel used to suture the nasty wounds of the 18 year old young man whose uncle violently attacked him with a machete this afternoon. The scars he will forever wear from the deep cuts on his shoulder, arm and leg may well fade sooner than the marks of the emotional trauma he is sure to carry inside, buried from sight but never from his mind. Oh, the tragedy that can be avoided by knowing and living for God!

The peaceful calm is a far cry from the happenings of this same shift slightly over a week ago! I was tired to start, having worked 24 out of the previous 40 hours (eight hours on, eight hours off, eight hours back on, etc.,). Our 28th wedding anniversary on July 4th had come and gone. It wasn’t exactly the most romantic we’ve ever had, since Rex was miles away that weekend, teaching a missiology course to national pastors, and I was spending every spare minute between clinic shifts finishing the preparations for the talk on menopause I was scheduled the give here to the women of the local church the evening of the 4th. (That service ended up being cancelled 15 minutes before it was to have started, due to a terrific storm with subsequent power outage all over town. I didn’t mind not having to do my presentation by flashlight!)

The evening of my scheduled 12 hour shift on the 5th and 6th passed quickly with the usual assortment of people coming in to buy medications, receive shots, and seek medical advice. The lights weren’t working in the post partum ward again, but by the light from the hall through the open doorway, the not-quite-six-pounds baby girl whose delivery I’d helped with that morning and who’d had a bit of trouble getting started with breathing appeared to be doing fine. I didn’t need a light to listen with my stethoscope and hear that her lung and heart sounds were nice and clean, and she was nursing well. By 11:00 p.m. the steady stream of walk-in patients had stopped, and mother and baby were sound asleep.

A few minutes before 2:00 a.m. little Miss Newborn woke up hungry and got another meal, but this time she kept crying even after she’d eaten well and should have been satisfied. Her mother had been in labor for 3 days at home before coming to the clinic, and I knew she was exhausted. She gratefully accepted my offer to take her baby for a little while so she could sleep, and I carried the tiny girl back to our linen room for the diaper change my investigating finger had discovered she needed. Imagine if you can the heart-stopping shock I received upon unwrapping her blanket to discover that her face was a deep, dark, ghastly shade of purple! Rapidly unsnapping her sleeper, I found to my further dismay that her entire body was the same horrible color.

Snatching her back up in my arms, I ran down the hall to the delivery room, stripped off her sleeper and diaper and laid her in the infant warmer, quickly throwing the lever to start the powerful bulbs glowing with heat, and pulling the oxygen tank over so I could fit a tiny mask to her face and start a rich flow of oxygen to her lungs. A hurried phone call to Dr. Maldonado elicited orders for a STAT injection of steroid and the oxygen which I’d already started, plus the promise that he was on his way.

By the time he arrived 5 minutes later, the deep purple color had gradually lighted to a dusky blue-grey, and in a few minutes more, she had almost returned to the much more becoming shade of pink that little girls look so good in. Although it was obvious that she was struggling to breathe, surprisingly, her heart and lungs sounded clear. The doctor left me with an order to gradually wean her to room air, but to keep a close watch on her (which I certainly planned to do anyhow!) and reapply the oxygen if necessary. He also wanted her referred to a pediatric specialist as soon as her parents could take her.

Over the next three hours I discovered that as long as she was not crying, her color would hover around an unhealthy looking pasty, pale pink, but that the moment she even started to fuss, she’d turn blue and mottled. I was kept constantly busy, trying to keep her from crying (stroking her gently, singing and talking to her, and giving her glucose water to keep her blood sugars at the very acceptable level they were when I checked them after the doctor left), and turning on and off the oxygen in response to her color. She looked much better in pink rather than purple, believe me!

I had early on told the mother what was happening, and when a woman in labor arrived at 5:00 a.m., I hurried to the mother’s room and asked her to come be with her baby, showing her how to adjust the oxygen and hold the mask in place, while I checked the status of my new patient. From that point until the day shift nurse arrived at 7:00 a.m., it got really interesting as I juggled care of the newborn with support and monitoring of the laboring woman.

With the reinforcement of another nurse, things got a lot easier. I stayed an extra three hours with the baby while her parents made arrangements for her transfer, and Rosmery took over care of the labor patient. However, my shift, which had by now stretched into 15 hours, was not to be over yet.

During the snatches of time that I’d given support to the expectant mother, she’d somehow gotten attached to me, and wanted me to stay to do her delivery. I assured her that I would, but told her I needed to go home and eat something first, since she was not too far along and it was safe for me to leave and get back in time.

After having breakfast with Rex and Jeffrey, I headed back to the clinic once more and was delighted At Rosmery’s report that mama-to-be was 8 cms. dilated and likely to deliver within the next hour or two as this was her third baby. “Wonderful!” I thought. “I’ll soon be able to go home and get some sleep.”

So much for that optimistic idea! Another hour passed…and another…and another. And still the poor woman stayed persistently at the same stage of dilation, in spite of strong contractions three to five minutes apart, and every position change, comfort measure, reasonable intervention, prayer, and whatever else we could think of to help things along. Finally, shortly before the afternoon shift nurse arrived, things started progressing again, to the point that delivery seemed imminent.

But she pushed…and pushed… and pushed, for over an hour and a half and still no baby. By this point, her labor progress had fallen way off the “normal/average” chart and was definitely into the “Let’s do something!” stage. A phone call to the good doctor and his subsequent exam and decision to have her transferred to a larger hospital was not too surprising. What did startle me was the way he urgently motioned for Maribel (who’d taken Rosmery’s place at 3:00 p.m.) and me to follow him into our tiny pharmacy, the only good place for a private conversation.

“Get her out of here as soon as you possibly can!” He hissed. “She and her husband are bad news! They never pay their bills. That woman has been into everything: she was a former prostitute, a police officer, a nurse and who knows what else. If things don’t turn out here as she wants, they’re likely to sue the clinic!”

I gulped and glanced over at Maribel, who looked as shocked as I felt. She hurried to make the phone call requesting an ambulance, while I headed back to explain to the couple what would be happening next. “PLEASE go with me!” the woman begged, grabbing my hand in both of hers and kissing it. “You’re my angel!” Mindful of the doctor’s dire warning, I figured there was no other choice if I wanted to keep her happy with our services and prevent the trouble he’d predicted. So once again I found myself bouncing out of the clinic yard in the back of the ambulance, fervently hoping this ride would not be as hair-raising as my last.

This time I managed to keep the contents of my stomach intact, to my great relief. I could both sympathize and totally empathize with the poor husband who, half an hour of jolting and jostling later, abruptly thrust his head out the hastily opened window behind him, and miserably kept it there for the rest of the journey, periodically heaving his offerings into the roadside bushes.

We did make it safely and on time to the Santa Barbara Hospital. We also made it safely back home, where I stumbled wearily to bed, VERY thankful to have finally ended my 26 ½ hour shift. Just remembering it makes me tired! So, “Buenas Noches, todos.” May we all sleep well!

Hannah