Life and death

As doctors at a rural mission hospital in a not-so-developed country, we come face to face with life and death on a daily basis.  I think maybe God gives special grace to missionary doctors to deal with it.  I praise Him for that gift!

But sometimes I am just struck by the reality of my job.  This has been one of those weeks.  I thought I would share with you a few of the stories...

LIFE :).  I had just finished up a c-section when Sister Silvia notified me about a laboring mother with fetal distress... that means that the baby is in big trouble.  I evaluated the patient and heard the fetal heart rate dip into the 80's with very slow recovery.  To do a c-section would take at least 30 minutes to start and get the baby out, and this little one didn't have that kind of time.  Dr. Jim arrived and delivered the baby with the help of a vacuum device.  Baby boy was a bit floppy at birth and did require some resuscitation, but was well recovered by rounds this morning!

DEATH and LIFE.  Jackbee was brought into the labor ward a couple of weeks ago.  She was unconscious, the cause later identified as hypoglycemia or low blood sugar.  Dr. Bill examined the patient and diagnosed her with liver cancer.  Jacbee went into labor and delivered a skinny IUGR baby; he weighed just 1400 grams.  Mom was transferred to medical ward, went into a coma, and died several days later.  D-ward staff fed and looked after the baby until grandmother arrived to take care of him.  I started her on medicine to help with lactation, but she is not yet producing breast milk.  Still praying!  In the meantime, we are feeding the baby with formula.  He is getting fatter and is now well on his way to 2000 grams :).

LIFE.  Elis is from the Jimi Valley, one of the more remote places that is still in our province.  We see some really sick people from there.  Whenever you are talking to another doctor about a patient and start the story with "she is from the Jimi," you know it is going to be bad.  Elis delivered her baby at home.  The baby delivered just fine, but the placenta did not.  Mama also lost quite a bit of blood.  Her family took her to a small health center near the village.  The nurse was unable to remove the placenta, so he referred her on to Kudjip.  By the time Elis arrived at the hospital, she was in shock.  We gave her blood, removed her placenta, started antibiotics, and treated malaria.  Both mother and baby are doing great today!

LIFE or death?  Matina was about 28 weeks when her water broke.  We admitted her to the ward, gave her antibiotics to treat infection and steroids to help the baby.  She went into labor several days labor and delivered a baby girl.  The little one weighed just about 1100 grams.  At this gestation and weight, she is not likely to make it.  She was just not ready to be born.  I imagine she will be transferring to the heavenly nursery in the next day or two.

DEATH.  When a patient dies in the hospital, Gola processes the chart and types up a death certificate for the doctor to sign.  A batch shows up in my office every couple of weeks.  Last week I had six death certificates to sign:  one woman who collapsed and was dead on arrival to the ER, on child on pediatrics ward who died of pneumonia, and four nursery babies.  Most of the babies had died from complications related to prematurity.

LIFE.  Hellen's story is similar to Matina's.  She was about 31 weeks when her water broke.  She went into labor several days after admission and delivered a baby girl.  The baby weighed only about 1300 grams, and had about 50% chance of surviving in our nursery.  After 2 weeks, she is doing well and even starting to grow!  Thanks to the Lord.

LIFE.  Last week we celebrated yet another 2000 gram party... for baby of Anna!

LIFE and DEATH.  Janet was admitted to the hospital a few weeks ago.  She was 29 weeks pregnant and bleeding--ultrasound confirmed the diagnosis of placenta previa.  That means the placenta comes first and covers the cervix.  This is very dangerous for both the mother and the baby, as mom can loose blood quite rapidly.  Janet stabilized after her initial bleed, so we watched and waited and prayed.  On Wednesday morning she began to bleed again, this time quite heavily.  Even though she was preterm (now 31 weeks), we could not wait any longer.  Dr. Andy did a repeat c-section.  Janet did really well.  The tiny baby girl weighted only 1300 grams, and unfortunately was just too small to survive.  I couldn't stop the tears when Janet thanked me for all that we have done to take care of her.

"I eagerly expect and hope that I will in no way be ashamed, but will have sufficient courage so that now as always Christ will be exalted in my body, whether by life or death.  For me, to live is Christ and to die is gain."

~ Philippians 1:20-21