Series, The Doctor's View

The Doctor’s View: Fighting Death's Sting

HeaderBy Denise Kavuma, Uganda:

Life is annoyingly unpredictable and for those of us who survive solely on the straining but tight grip we have on whatever control we can garner, this volatility can be quite devastating. I once had a love for pregnant women and wanted to spend my life helping them but passion sometimes burns itself out and after a year of doing exactly what I thought I'd wanted, I was sick of it. I knew then that my calling lay anywhere else but obstetrics and gynecology. That and pathology because I mean, come on!

This story has nothing to do with those fun little experiences doctors often jokingly narrate but rather dives straight into that deep pit of maternal mortality. It's all seemingly abstract when you read about it; exactly that sort of statistic that you know you should feel bad about but unless you've personally been touched by that icy hand of death, it's a hard one to relate to. I understand that because I once was that person too until I shook death's hand one too many times.

It had been a quiet evening, one I was truly grateful for considering how much emotional turmoil I was going through as life used me like I was its own human-shaped dartboard. Midnight was fast approaching and the hospital was quiet; I really believed I'd get a good chance to rest that night. Faith that was grossly misplaced because that infernal phone rang just as I was about put my head down.

Doctor, we have an emergency that has just arrived.”

“Ok, I'm coming,” I said, as I dragged myself out of bed. “What's the situation?”

Er…a mother has just been brought in. BP is unrecordable.

I quickened my actions as a jolt of adrenaline gave me the sudden alertness I needed. There was a pause on the other end of the line as if the nurse was trying to look for the right words to say, then:

Doctor, I think she's dead.

Silence and then a nervous giggle.

The public often blames medics for being unsympathetic and sometimes downright jolly in grave situations but oftentimes the reactions are taken out of your hands. I've frequently felt grief and disappointment settle in my heart but had my lips pull back in a twisted smile I couldn't wipe off my face as if I am some kind of psychopath. So when I heard the nurse giggle over the phone, I knew I had to run over and contain the situation.

Sure enough, the maternity ward was eerily silent and there were 3 large men towering over and glaring at the petite midwives who stood by the body of the pregnant woman. The moment I stepped into the room, I was assailed with questions as those hulking figures closed in around me and breached my personal space. It's a small blessing that the white coat in the right environment is a sign of authority and with just a few short sentences, I'd calmed everybody down and went on to examine the undoubtedly dead lady before me.

It was a sorrowful sight. She was soiled with dirt and blood, her body cold showing that she'd been in shock for a while and her chest still, blank eyes staring without blinking. Most disturbing of all was the sight of her distended abdomen and the thought that a baby who'd been ready to greet the world a few hours back had died in there as the mother had breathed her last.

We had to do what we had to and so we wheeled the lady into the minor operating room and I proceeded to open her still abdomen so I could deliver the body of her baby. It was rather surreal and I was hesitant to do it but if I didn't, no one else would. So I evacuated the large amounts of clotted blood I found in her abdomen, delivered a pale, unmoving but otherwise well-grown baby, 3.4kg, and tried to not stare too hard at the large tear in her uterus. A uterus that was so flaccid and deformed, it was like a piece of wet paper. I closed the abdomen and tried to suture the skin as neatly as I could before we cleaned up both mother and child.

The last part was to deliver my findings to the family and I trudged back to the maternity ward at 2am, only to find one of men who'd brought the lady in blaming my midwives for her death. He was saying that they'd brought her in alive but our delay and incompetence had killed her and just like that, a rage I hadn't expected surged up in me. He must have sensed it though because he suddenly quieted down when he looked at me and with my er…gentle guidance, the full story came out and it went like this.

The lady was non-Ugandan and had come into the country to live with the “fiancé” who had yet to pay bride-price to her parents back home; so they couldn't get married. She'd gotten pregnant and had gone into labor but was alone since the fiancé had gone out partying. The labor lasted for a really long time (and I guessed that it was at around this time that the uterus ruptured) and sensing there was something wrong, she literally crawled to her neighbor's door and begged for help, at which point she lost consciousness. The neighbors tried calling the husband but he wasn't answering any calls and after some time of deliberation, they decided to bring the lady to the hospital but by the time they drove through the gate, she was unresponsive. The fiancé was still yet to show up even at that time and none of the men who brought her in were willing to take any responsibility for the body, so she lay abandoned in the morgue for about a day or so.

How does one respond to such an experience? I'd wished to never have to do any post-mortem surgeries and I'm still hoping that even though that was my first, it'll be my last. Maternal mortality is still a large problem in our country and too few people are attempting to deal with it. Unlike most hospital deaths, maternal mortality has a deeper sting because the mothers are usually alive and well just hours before their death.

I'm tempted to believe that had the fiancé been with her as she labored, that lady's name wouldn't now be on a death certificate. This is a problem that can be reduced by regular ol' you and me, not just left to the powers that be; remember that.

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