Saturday, May 28, 2011
The Salvation of her People
I sit in a cool air-conditioned room of Jennie Joseph's birth center in Winter Garden Florida. Much has transpired over the past three days. I'll begin at the beginning.
On the last day in Dr. Delson's clinic, I awoke to the surprise of three laboring women. I had hoped for at least one birth per day, and it seemed as if I would get my wish plus a bonus. Mother 1, 42 years old, came in during the night, a multip on baby number four, dilated to four. By morning she was at six. Mother 2 was a multip, dilated to 3. She lost a child in the earthquake last year, as did Mother 1. Mother 3, 27 years old, was a primip. They all labored nicely all throughout the clinic day as Monsieur saw a full slate of clients- it was actually our busiest day, even though it was only a half day clinic! He got through them all quickly and efficiently in order to attend the laboring mothers.
He expressed concerns about Mother 1 because she was large for dates. He wasn't sure if she had an extra large baby or an excess of amniotic fluid. He turned his attention to her first. The ladies in general were left to labor on their own with whatever support person they brought with them. They walked the courtyard and waiting room floor, and layed on the benches or on a bed, and in general did not make a fuss. After clinic Monsieur checked all the mothers again, and found Mother 2 and Mother 3 had made some progress, but Mother 1 was still at six. He put her on the delivery table and added 10 U pit to her IV (I didn't mention before, but there was no IV pump- all IVs are to gravity by drip, in case you were assuming there was. I myself had never seen gravity pit for induction/augmentatation and was amazed to see it regulated in this way- though mostly it was a very slow drip, but not at all titrated, only slowed down or sped up to his will.) After a couple of hours, she was still at 6, as she had been since morning (this was now early evening). Monsieur looked uncertain but he decided to act on his instinct to call in his anesthesiologist- from Port au Prince, two hours away. Now I began to see the gravity of his situation. Mother 1 and her baby were in no immediate danger, but to even consider a cesarean as a possiblility, Monsieur would have to plan two hours out. After reaching the anesthesiologist for the surgery, he found that she had sent her own car to pick up her children away at school, she was available to come, but she did not have a way. Dr. Delson immediately dispatched his own driver to pick her up. This added to the time and would now be four hours instead of two for the surgery. He thought this gave Mother 1 more time to labor on her own and push the baby out if she could. I began to appreciate how difficult his job was and how difficult a call this was to make- getting a surgery that might be unindicated vs needing surgery and the option is not available. The anesthesiologist was on call at her own hospital that evening, and would need to return to Port au Prince immediately following the surgery (and she was too- she didn't wait till after recovery, she was dressed and beat the Dr. and I out the door!) After all arrangements had been made with the anesthesiologist and the small hospital down the road where the surgery would take place, Mother 1 was taken off the table and off the pit and placed in a bed to resume laboring on her own.
Mother 2 was by this time dilated to 7 and was placed on the delivery table. She too was augmented to speed things up and get her delivered before Monsieur had to leave for the surgery. I labored alongside her and within 2 hours she was complete and ready to push. Mother two was such a strong woman! She was a big, robust woman who embrassed each contraction and roared with every push! I have hardly seen such strong, effective pushes. She needed no 'coaching' from anyone. She was a fabulous pusher. After about an hour of pushing, she birthed a fine, fat, healthy boy. I prayed she would find comfort from the loss of her other child, and that this child would bring her peace and joy (not that one can replace the other, by any means). With Mother 2 barely off the birthing table and in bed with her baby beside her, we raced off to the hospital.
When we arrived, we quickly changed and entered the operating suite. It was the first time during this visit to experience air-conditioning- not the entire hospital, just the operating suite. (The patient ward was actually sweltering.) When we walked in the patient was on the table prepped for surgery, the anesthesiologist had already done her thing and the entire team was waiting for us. Monsieur introduced me, and everyone welcomed me. There was a scrub nurse, a circulating nurse, a first assistant (also a nurse, I learned later, trained by the Dr. himself- usually the first assistant is another physician, but there was no other physician), the anesthesiologist, and a dedicated baby nurse, who also acted as a second circulating nurse. The team worked beautifully together. The surgery was fast and effecient (it had to be, we had one other laboring patient to get back to!) I found it interesting that the baby nurse was handed and upside down baby, dangled by its feet, which she carried that way out of the operating suite to a nearby gurnee waiting with baby supplies on it. (There were no baby warmers or a fetal heart monitor in the hospital). She quickly cleaned and dressed the infant girl, and then left her there on the gurney (completely unattended!) and returned to finish helping with the surgery. She glanced out the operation room door, window every few minutes (as did I!) to make sure the baby was still safe on the gurney that had been pushed up against a wall. With the last stitch sewn, Monsieur and I fled out, just as quickly as we had come and drove back to the clinic. I thought the anesthesiologist might stay until the patient was out of recovery, but she was dressed and headed out the door ahead of us, even though she was still in the OR when we left it!
Back at the clinic, Mother 3, our youngest, and a primip, was hard at work laboring. She too went to the delivery table and was at almost 8. Even so, it took a couple of hours to become complete and a couple of more hours for her to push her baby out. She was a sweet girl and she really fought her pushes. She not only relished my labor assist, she would grab me around my waist with each contraction and bury her face in my bosom! I think if she could have climbed into my lap, she would have done so. She screamed with each contraction, but would also eventually bear down nicely. As with the other primip we saw this week, Monsieur cut an episiotomy. I thought with the other, the epis seemed a little 'crooked'. This time when he did the epis repair after the birth of a sweet little girl, I came around and stood next to him to watch, and sure enough, he had cut a medial lateral epis. I have not seen these done in a very long time- I winced to think of her recovery in this heat. By the time, she was recovered, cleaned up and tucked in bed, it was 10 o'clock at night. The first clinic patient had arrived around 8 am that morning. It had been a long, and as Monsieur had predicted, a very busy day. Sometime between Mother 3 being complete and pushing, he had returned to the hospital to check on Mother 1. All in a day's work for someone on the front line of maternity care.
I could hardly process all that had happened that day. I had to fall into bed, and be up for a 5 am ride to the airport. I had used snatches of time during the day to straighten my quarters, and pack my things. I went up to the Heart to Heart clinic to say my goodbyes. I wolfed down a dinner that might have been the best one yet. There was chicken cooked in a delicious sauce, that had been strutting around the yard this morning. "Monsieur!" I asked agast, "You mean this chicken was alive this morning?" "Yes," he answered proudly between mouthfuls, "this is fresh, organic chicken." I didn't ask about the details of his demise and preparation, all that I had missed with the busyness of the clinic. I didn't want to imagine Monsieur ringing a chicken's neck in between patient visits. Better to think the old housekeeper did it- she was stick thin, but strong and sturdy and has probably wrung more than a few necks in her lifetime. This 'fresh, organic' chicken was served along side beans and rice, and a Russian salad. This was a salad of cubed roasted beets and potatoes, like a potato salad made with half beets. Stirred together with mayonaisse (?) it made a pinkish unpalatable looking mass, but one taste and I was hooked. It was delicious! the roasted flavor of the beets was perfect with the boiled potatoes. I ate two servings and since no one spoke for the last little bit left in the bowl, I ate that too.
I was up the next morning at 4:30 am, packed, dressed, and ready to go. I used the final 30 minutes of my stay to sit quietly on my balcony and allow the morning to unfold. I took a few snapshots, that won't begin to tell the stories, or capture the beauty... Madam and the driver and I packed into the truck and headed for Port au Prince. I never dreamed it would take so long. We must have hit ''morning rush hour" in the city, because we moved at a snail's pace throught the densely packed corridors. The driver tried his best, honking all the way, even driving up on sidewalks (!) and narrowly missing pedestrians, who share the roadways equally with vehicles and animals. Even so, I missed my flight out to Ft. Lauderdale, and was rerouted on the next flight out, an hour later, into Miami.
My intent had been to rent a car in Ft. Lauderdale, and drive up the coast to Orlando. Arriving in Miami, they did not have a car for me, so I instead booked a flight to Orlando and rented a car once I arrived there. Once I arrived in Orlando, I drove to my hotel, and settled in for the night. I called Jennie Joseph, let her know I was in town, and made an appointment to meet with her the following morning.
Today I met with Jennie and spent the morning and afternoon with her. How can I relay the value of such a meeting? She gave me a tour of her birth center and clinic and we went out for a Cuban lunch. The value of the advice she gave me far outweighs the time and expense it took to get here to receive it. I feel so honored to build my life's work upon the foundation that women like Jennnie have built. I now have a perspective of my work that is not predicated upon my own singular successes or failures, but as a smaller part of a much larger work, much like a quilt where each piece contributes to the greatness of the whole. After what I have learned from Dr. Delson and Jennie Joseph, I return home with greater clarity and resolve to do the work that only I can, and must do.
I am reminded of the book of Esther. Who knows that I have been placed here for such a time as this? This is my time, I've long known it. I have one more day here before returning home. I've decided to make it a day of silence, prayer, and writing. There is much to be done.