Loss and Love

When I walked into the ward on Friday morning, 15 minutes passed before I saw Malika lying face down on a bare green mattress in a black winter coat and red underwear, still and grunting, her mother squatting to clean a puddle of blood from the floor with an old chitengi. The nurse said she had hemorrhaged. Before she started the next sentence I ran to get an IV, urinary catheter, and tubes for blood samples. Someone else brought the oxygen concentrator and another nurse searched the hospital to find a face mask or a nasal cannula. The whiteness inside her eyelids and of her gums reminded me of fair skin stretched tightly over clinched knuckles. She arrived the previous night, labored until early morning and delivered a stillborn, her second dead child, and then she bled. The few lines in her chart said she was given 10 units of Pitocin (the standard dose of oxytocin given to all women) nothing else. The night had been busy for the two nurses and the single clinical officer and Malika in the farthest corner of the room was dying inconspicuously.

After a few hours, three liters of fluid and 2 pints of blood, she looked around weakly, her original Hb of 2.3 (normal is 12-14) probably hovered somewhere between 4 and 5. Her mother handed her a cell phone which she accepted then returned. We started to hope. I went to theatre for a c-section and when I came back Deb told me Malika called the nurse and to say she had started bleeding again. I looked and saw a slow trickle of blood, the towel between her legs was soaked although Deb said she had just changed it. We called Dr Tarek Meguid. He came quickly, examined her, and then stood for long minutes debating whether to remove the uterus of a 23-year-old with no living children. I went to get more blood and order fresh frozen plasma and returned to find them in theatre. I felt a vague sense relief to know a decision had been made.

At that point I got caught up with Masauko who arrived with his wife and 2-year-old son. His son’s tongue and fingernails were also pale, his face, and hands, and feet swollen. Masauko said Peter refused to eat and had recently weaned. He looked malnourished. I took the family to Lisa who tenderly and slowly examined Peter, drew blood to check his Hb and gave them instructions to meet her in the hospital Saturday morning.

When I took Peter’s blood to the lab I found 3 bags of fresh frozen plasma for Malika precariously placed on the edge of a wooden table. I asked the lab technician what time they had arrived, he said before 1pm, it was now after 3:30. Trying to contain my fury I asked why they were still on the table. He responded that he went to lunch; the other lab technician added that someone from the ward said they would come to collect it. I reminded them that the woman was hemorrhaging and that her life depended on the blood products. They smiled meekly. I ran to theatre and was told that Malika had been transferred to the ICU at KCH. Luckily I found an ambulance outside and once I explained the situation to the driver, he promised he would not go into town to buy light bulbs as planned, but instead go straight to deliver the blood.

That night at dinner with friends Tarek said Malika had started producing urine. A hopeful sign.

Saturday morning I headed to KCH to meet Peter and his mom. On my way down the hall I stopped in the ICU. A concerned anesthetist sat at Malika’s bedside, he said she was no longer producing urine and he could not get the results of the labs he needed because the hospital had no reagents. She looked almost hopeless, unconscious, eyes half open, a ventilator breathing for her. I continued toward Pediatrics but before I found Peter, I found sister Namaleu with over 100 patients in the malnutrition ward on her third consecutive shift with no relief coming for the night shift or for the Sunday day shift. I returned to the hospital entrance and found Masauko’s wife, I brought them to Pediatrics where sister Namaleu stopped everything to weigh and exam the boy. She said he would be admitted for a minimum of three weeks. Confident that he was in good albeit overworked and exhausted hands, I left and went upstairs to the female ward to visit Clement’s aunt who had been admitted the day before. I found her, looking weak and a single nurse caring for the entire ward of over 80 patients. On my way out I met Lisa and together we peaked into the ICU again to see Tarek and the chief anesthetist fretfully discussing Malika.

I left the hospital and rushed to buy a crate of fanta orange and unfortunately a cake, which I planned to bake, my contribution to Grace’s (Frank’s daughter) first birthday party. From there I collected Clement and rushed to meet Deb, Zack, and Johan. Deb and Zack arrived on January 17th for 5-week visit with 3-month-old Johan. I began counting down the days to their arrival months ago but now I refuse to look at a calendar and see the steady approach of February 18th.

We had planned to drive to Ireen’s village and were determined to go despite the unrelenting rain and our late start. Mr. Nanthowa had shown up at Bottom the previous Monday with a bag of mangoes and cucumbers that he brought me on his bike 40 kilometers through the rain (later I learned that trip also involved fording a neck high river while carrying his bike over his head). Unfortunately I was at the Embassy but I asked the nurse who kindly called me to tell him I would come Saturday. I had told him several times that I would bring a surprise the next time I visited. I could hardly contain my excitement at the thought of his family seeing Deb with me.

Zack borrowed a four wheel drive vehicle and we set out. I usually arrive in the village in the morning and was certain Mr Nanthowa had given up hope but Clement insisted, “He still has hope.” The first 34 kilometers were slippery but thankfully uneventful but that 35th kilometer held on to us for a while. After consulting a few people walking the roads, we decided on what they claimed was the less slippery route but they forgot to warn us about the 50 yard stretch of new dirt with ditches on either side. At that point the Pajero slowly came to a stop and sank a few inches. Clement, Deb, and I jumped out of the car into the rain and rising muddy rivulets. We all laughed and Clement said, “Now this is getting good.” We dug with our hands, shoved grass and pieces of bush under the wheels, Zack rocked the car forward and back, and the rain came down. We continued laughing until our lips were blue and the twelve men who had appeared one-by-one struggle and failed again and again to dislodge the car. Finally, after about an hour, the car broke free and we, 14 men and 2 women shouted euphorically. Johan sleepily opened his eyes.

Back in the car Deb and I removed our clothes, wrapped our cold bodies in dry chitengis and laughed at the thought of showing up to a village wrapped only in a cloth. The rain continued but we made the last 5 kilometers without a problem. As we pulled up to the cluster of huts Mr Nanthowa emerged grinning ear to ear to welcome me. I took his arm, gently pulling him to where Deb and Johan were climbing down and said, “Mr. Nanthowa, your surprise. . .” Mr Nanthowa screamed joyfully, grabbed Johan and began dancing saying “CONGRATULATIONS, CONGRATULATIONS!” As the rest of us laughed histerically, poor startled Johan was passed down a sea of arms attached to smiling faces and loud voices.

Within minutes a fire was built. Ireen lent Deb and me shirts. I laughed and struggled to dress modestly - pulling dry clothes over wet skin while holding up the slipping chitengi - in a small room overflowing with people. They gave us hot tea and fresh cornbread. They asked us to stay the night. I wanted so much to curl up by that fire rather than face the rain and road again but I agreed when Deb, Zack, and Clement said it was time to go. They killed and plucked a chicken since we could not give them time to prepare it for us. Mr Nanthowa took me into another room, Mrs Nanthowa handed me a bag of peanuts and he said, “I don’t have the words to tell you how thankful I am.” I thought of him riding in the rain, fording the river, calling me his daughter. I could only smile and shake my head, I didn’t have the words. When I tell Clement about thing things Mr Nanthowa does he says, “that is love.” And I wonder how many people are capable offering such love and how many are blessed enough to receive it.

As the goodbyes were passed round and round Mr Nanthowa explained another route to Clement, but uncertain whether Clement truly would find the way Mr Nanthowa insisted repeatedly that he come with us a certain distance then walk home. We said no again and again and again but somehow he ended up sitting next to me in the car directing us back. At one point he led us straight across a field, and he was right, we would not have found the road. Finally about 6 kilometers from his village, he stepped out into the rain with his bare feet, and stood and waved until he receded in the distance and the fog of the windows and the dark of the setting sun.

On our way home as we passed the hospital we mentioned Malika but hurried towards hot showers and chicken dinner. Sunday I glanced towards the hospital but could not bear the thought of going to the ICU. I did not want to know. Monday morning I learned she had died Saturday night.