To compare health between nations, one most often uses statistics. When
I was working as an editor at a medical journal, I asked for an article
on common indicators. I asked my potential author to explain what they
really meant. Numbers are meaningless. What lies beneath under 5
mortality rates? What shortens a country's life expectancy? What does
maternal mortality really mean? Why do the mothers die, what is the
human cost? He wrote the article, and answered some of my questions.
More have been answered in the past few months.
Last night I was on call. I was asked to come to the hospital to see a
woman with a severe headache. As I was walking through the hospital
gate, I heard the handset crackle with a call to Tina, our midwife.
“Tina….there is a woman here who delivered a baby at home two days
ago….she has a high fever and it feels like she has another baby
inside….i can feel a part. Can you come to the hospital?”.
She would. I walked into the hallway that leads to our delivery room. A
young dinka woman was lying flat on her back, her eyes closed. Her new
baby was on another bed, crying. He appeared healthy. His mother was not.
She had been losing blood since the delivery. I felt her abdomen, and
could feel the bulk of her uterus through her hot skin. It was so
swollen it came nearly to her chest. I reached for the pulse in her
wrist, but could not find it. When I moved the sheet back to feel for
one in her leg, I saw the umbilical cord hanging limply between them.
The placenta was still inside, infected. She was both septic and
Tina arrived, and together we carried the patient to a delivery room
bed. She could not walk. I asked for the national midwife to put a
cannula in place, and called on the handset for our lab technician. The
woman would certainly need blood, and we needed both her blood group and
to screen donors. Tina and I finished our examination. We agreed there
was little choice but to remove the placenta manually and risk the
hemorrhage. I left to gather the necessary anesthetic drugs, antibiotics
for the infection, and ergotamine to help the uterus clamp to itself and
staunch the bleeding. While I was in the pharmacy, I threw two vials of
adrenalin in my pocket and grabbed a bag and mask. I can recognize last
breaths when I see them.
By the time I returned, she was worse. She was unconscious and her
breathing was becoming noisy. I started to assist her breaths. A cannula
had been put in place. I looked at the intravenous bag. It was running
too slowly. I didn’t trust it. We needed another IV. Better two. The lab
tech arrived, with the other Sudanese doctor. I asked, do we have blood?
No. Are you O negative? No. You? B. You? B.
Someone take over for me….no, like this…..fingers under here, squeeze
the bag like this….here, give me a cannula…an 18…. and a syringe so I
can get some blood for cross match. Someone go and ask the relatives if
they will donate.
The veins were tough to find. They were flat, and slipped one way or the
other. The other MD was working on the other arm. Couldn't get it. No
central line. I felt for her femoral pulse. None. Her neck?. Barely. Her
breathing was becoming intermittent, agonal. It stopped.
Ok, keep bagging. Yup, like that. Faster. About ten times per minute.
I laced my fingers together, felt for the hard flatness of her sternum,
and started compressions.
Now, someone take over for me. Like this. Push like this. One, two,
three, four, five, breath…one, two, three….
I took a glass vial of adrenalin from my pocket and snapped its top off.
I drew up a milligram in the syringe, and pushed it into the slow, first
intravenous. I reached for her neck and felt for the carotid pulse.
None. I took the second vial of adrenalin, snapped the top and drew it
up. I pulled back her sleeve. HerI arm, above the cannula, was a
balloon. The fluid was trickling slowly underneath her skin, not into
her vein. No intravenous, no fluid, no blood, no adrenalin, no breathes,
no pulse. No more. I checked her pupils. No response.
No more. Stop.
Fifteen minutes. That’s what it took, from the first crackle of the
radio to no more.
No death is easy. If it starts to become that way, one should change
professions, for his job has gotten the better of him. This one was more
difficult than most. The four of us stood for a minute, then bent
silently to clean up the ground of scattered, useless intravenous lines
and tossed pieces of gauze. We cleaned her body of lines, and wiped the
tiny bullets of blood that were scattered on her arm from all of our
attempts. We did not meet eyes.
I left the room. The baby was lying on the bed, crying. A man with wide,
wet eyes looked at mine, and he knew. Malesh. I’m sorry. Sorry I can’t
speak Arabic or dinka and about the intravenous and the baby and your
wife and the fifteen minutes and the no more. So sorry.
He wanted transport to the graveyard. I told him we don’t do that, that
we can’t. That we couldn’t save his wife, and that we can’t move her
body. He asked, what am I to do, hire a car, where, the market, where? I
don’t know. Malesh. Sorry. For so many things.
When I arrived back to compound one, there was a meal prepared for the
departure of a member of our team. They were waiting for me to begin. I
ate quickly and moved to my bed under the tree. I saw clouds for the
first time yesterday. They hung around the horizon, lurking. They were
still there. I could see their flickers of lightning. I lied there for a
long time, watching the flashes, and finally fell asleep. When I
returned to the hospital this morning, the body was gone.
Today, the rains arrived to Abyei one month early. They lashed us,