Fieldset
I wish I knew what happened

I am working a double life.  By day, I continue to manage our project in Chaman remotely.  There are emails, phone calls, and Skype meetings with my fellow expats regarding the coordination of the project.  It’s a full-time job just staying on top of the HR responsibilities, and trying to perform

I am working a double life.  By day, I continue to manage our project in Chaman remotely.  There are emails, phone calls, and Skype meetings with my fellow expats regarding the coordination of the project.  It’s a full-time job just staying on top of the HR responsibilities, and trying to perform my distance-limited clinical duties over the phone. At night, I am on call for both Chaman and Peshawar. Fortunately, I am only required to travel to Peshawar if they need help; Chaman is a little too far away at 898kms by road. So, due to the sleep deprivation of the double on-call shifts, I sleep like a log between the regular phone calls that come at all hours.

 

Crash back to sleep

 

Zzzzzzzzzzzzzzzzzzz

 

Brrrring Brrrrrrring Brrrrriiiiiiinnnnng

 

“ Hello, this is Chaman birth unit, we have a multigravida with……….. ok, no problems, please do……….”

 

Crash back to sleep.

 

Zzzzzzzzzzzzzzzzzzzz

 

Brrrring Brrrrrrring Brrrrriiiiiiinnnnng

 

“Hello this is Peshawar, we have a patient with X, Y & Z,…………………..”

 

Crash back to sleep.

 

zzzzzzzzzzzzzzzzzzzz

 

Brrrring Brrrrrrring Brrrrriiiiiiinnnnng

 

Night shift workers will understand.  Unless you are worried about the patient or the decision that you have made, your body barely registers that you were momentarily awake. Colleagues have given complex instructions over the phone yet completely deny the phone call occurred when asked about it later. You can fall straight back into the deepest sleep, or the contents of the phone call can even be incorporated into your new dreams if you were in the rapid eye movement stage of sleep.

 

But last night, it was a little different.

 

“Hello, this is Chaman, we have just had a baby born with no cord.”

 

My mind takes a few seconds to compute.

 

“………..Whaaaa?!”

 

“The woman we called you about earlier who is now in labour with the baby that had died in-utero a few days ago ….”

 

“Yes….”

 

“The baby had no umbilical cord.”

 

My mind is rolling over the possibilities. An umbilical cord delivers oxygen to a growing baby.  Without oxygen, it cannot grow.  Without a cord, the baby would never have grown larger than the initial placental tissue that develops in the first weeks of pregnancy.  You cannot have a perfectly formed newborn baby with no cord. It is an impossible physical abnormality.

 

“What do you mean? What does the belly button look like? Has it been cut?”

 

“Eh… it looks strange.”

 

“Did you ask them what happened? The waters broke a few days ago, yes?”

 

I am reminded of the story.  Her waters broke a few days ago.  But they deny anything else happening.  The say they have just been waiting for the labour to start.

 

So my mind starts to wander.  I recall all the genetic abnormalities I can. All the weird and wonderful malformations that result from toxic chemicals and drugs that are not safe to use during pregnancy. I ponder the local diet and nutritional inadequacies. I’m left stumped; it is simply impossible.  So I walk my mind through the more routine complications of pregnancy. The waters often break before labour starts.  If the baby’s head or bottom is not ‘engaged’ in the pelvis, acting as a sort of plug, then anything else can begin to come out as well.  For example, a common problem is that when the ‘plug’ is missing, the umbilical cord can fall out.  This is an obstetric emergency.  Due to the sudden change in temperature, the arteries that supply precious oxygen-rich blood to the baby can spasm. Without the cushioning support of the waters, the cord can also be blocked by part of the baby’s body. The blood can cease to flow and the baby can die.

 

In the end, I decide I have to find out: did the umbilical cord come out, and then after the baby did not follow in the eight days since the waters broke, did someone pull the cord out?

 

I speak to the staff again the next morning.  As we are running though the cases from the night before, I try asking again.

 

“Did we really have a baby with no cord?”

 

“Yes, it did really happen.  You did not dream it!”

 

“Did they tell you any more information?  Was there any bleeding before they came in? Did they pull anything out?”

 

Nothing. Apparently everything was normal.