From the delivery room

A steel gate divides the two divisions of the First Referral Unity (FRU) hospital.  One side is the government-run trauma wing, crowded with men, women and children seeking some sort of emergency care.  On the other side of the gate Karuna Trust runs the delivery ward, an operation that has grown every month since it opened in 2009.  Last month it set a record of 231 deliveries; an average of 7-8 per day.  Lining the corridors are women at all stages of pregnancy seeking antenatal care, others in labor clutching their backs waddling up and down the hallways, and grandmothers with their new grandbabies waiting for immunizations while their exhausted daughters recover.  A small handful of nurses in white uniforms tend to all of these women with an OBYGN and a pediatrician, a dynamic husband/wife duo who live on the second floor of the hospital.  I’ve spent some time there, shadowing the staff and lending a hand wherever I can.

My first day on the job I observed my first two childbirths.  The first was relatively straightforward, what you would expect, if you will.  The nurse reached in to massage out the baby’s emerging head while the doctor pressed on her abdomen to accelerate the process.  The second was more gruesome, dramatic, violent even: forceps, episiotomy, and nurses holding down a writing mother during a tug-of-war over the baby.  I left a little lightheaded, but composed, and totally confused about why women choose to have children in the first place.

The next day was cesarean sections.  I made it past the first incisions into the fat and muscle layers, but fainted when the doctor separated the stomach wall from the uterus.  Sitting on the operating room floor I stayed to watch the baby lifted out of her, but had to leave when the doctor began removing fistfuls of placenta.  Recovering from the visceral reaction and contemplating adoption on a bench outside the OR, a sister came over and invited me to help her resuscitate the baby from the second of the two c-sections.  I was all for it, thinking a teachable moment would be a nice break from the horror of the operating room.

But the baby girl that came was small and not nearly as vigorous as a newborn should be.  The medical officers anticipated this, for the mother was scheduled for a c-section because of complications that lead them to believe the baby would have died in-utero.  Her limbs were limp, and the nurse could only rub out a few weak yelps.  The pediatrician came in and the two of them set up a breathing tube, hand-bagging device, and began CPR.  At one-minute intervals they checked her heartbeat. It was irregular and faint, her legs still floppy, unresponsive, and blue.

They called in the grandmother to inform her of the baby’s poor status and relay the news to the rest of the family.  She left and returned with this: the father refused to see his dying child because it not a boy.  All I could do was swallow my outrage– It was just a passing detail for the medical team focused on sustaining the baby’s heart and lungs manually.

At this point, two other US interns—another from Penn, the other from U of Iowa—were in the room and it was clear the baby was not going to make it.  The growing crowd of patients outside the NICU demanded the nurse’s and doctor’s attention, and they asked the three us to take over the hand bagging and CPR so they could tend to their other pressing responsibilities.  For another thirty or so minutes we continued, but the baby’s heartbeat grew more faint, its body more grey.  When the stethoscope finally gave us nothing, we called back the nurse. She wrapped her in a plaid blanket, tucked her in the corner of a bed, and the four of us left the room in silence.

So, working there is a clusterfuck of an experience, even though I know most of my shock is because it’s just new to me.  I’ll get used to the blood and guts and return to the delivery and operating rooms, but I’ll always be in awe of the fact that before the FRU, for many of these women the delivery room was the floor of a mud hut.  I’m eager to alleviate the staff’s workload, but when three students with no medical background are asked to tend to a dying newborn alone, the glaring lack of material and human resources becomes painfully clear. And I can handle the death, although sadly, but I’ll have to figure out how to manage my anger and frustration 

when the worst of Indian culture rears its ugly head but is passed over for the laundry list of other problems that take priority.

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