Angels

Sunday morning I went to Bottom. I don’t usually work on the weekends but Friday my friend Msiska said she would have to work 12 straight days because of the shortage of nurses so I volunteered to come in for her. Saturday she sent me a text at 5:30 saying it was a horrible day, at the end of the day they had a stuck breech and the baby died. The whole of last week was bad, I resuscitated several babies who died, there were several severely asphyxiated babies, and there were several very premature deliveries. A cord prolapse that I assisted with was the one significant happy ending – they were twins and the presenting little girl needed some resuscitation but her condition improved quickly.

Sunday morning I arrived at 7:35, grateful to see that the ward was not full. The clinical officer and nurse were busy doing a vacuum extraction and she quickly told me that there was a delivery in progress on the next bed. I rushed to put on gloves and found Yasintha lying on her back with her knees pulled to her shoulders and a palm-sized portion of her baby’s head crowning. I quickly noted the vacuum sitting on the corner of her bed and took it as a sign that this was either a very prolonged second stage or that there had been fetal distress or both but for some reason – probably the neighbor requiring urgent attention - the intervention was not done. I watched Yasintha struggle through two contractions without moving the head any further then grabbed lignocaine and scissors and cut a small episiotomy. Yasintha pushed her baby out into my hands at 7:42, I clamped and cut the cord and rushed him to the resuscitare.

The boy lies flat at first but then, after several minutes, he blinks and begins moving his arms in wide slow circles. When I tilt him upright his eyes open like a doll’s but he is not breathing. I ask the other nurse to draw up some glucose and I give it to him through his cord. I continue with the bagging. Other staff arrive and greet me warmly, “Mwadzuka bwanji?” “So, we’re together today, great.” No one pays much attention to the baby as I bag it. It is not an unusual scene, me standing at the resuscitare over a limp baby first thing in the morning. I am so tired of this. My heart is tired, and what about the mother? She is now silent behind closed curtains. This is her first baby; does she know what is happening? Is she fearful or exhausted? Does she realize now that her baby may die or that if he survives he may have severe developmental problems? I blink away a few tears and consciously pull my thoughts away. I think of Clement in Ghana, we talked last night, he said he is losing weight, his classes are far apart and they last all day, he is walking constantly and not eating much. His trousers fall from his hips even with the belt cinched to the smallest notch. The baby kicks at my hands. He is still not breathing. I hold him up to the heat, he blinks, I plead with him softly, he still does not breathe. I plead with God. Yesterday Effie and I went shopping for zitengi in the market. For a Malawian wedding the couple is supposed to select an African cloth and then people will buy the fabric and have clothes made from it for the day of the wedding. We chose three different cloths, next weekend when we visit Mangochi we will see which is most readily available there and make the final decision. It feels good to have accomplished something. We only have ten weeks remaining before the wedding.

The woman in the bed closest to the resuscitare calls to me in pain, I look up and she says, “Come here.” She can see me with this baby but her baby is close now, her entire body involuntarily contracting to push her out. She needs hands to catch her daughter. I am the only one she can see. The little boy’s heart beats strongly but he only takes an occasional gasp – nothing very hopeful. I think about when I should stop, it has been 40 minutes, I will continue for an hour. It is a horrible torture to be the one who must decide when to stop. One hour passes. I am not ready to stop, maybe two hours. The woman at the near bed has delivered; a midwife arrived just in time. Her daughter lies wrapped in a cloth in her arms, the mother is quiet. I hold the boy again to the warmer. Watching his abdomen I see shallow breaths, he blinks. I stand over him now, caressing his forehead he breathes like a sleeping baby. After a few minutes I take him to his mother. She is asleep and I wake her to see the baby and tell her I will take him to the nursery. She looks concerned, “He hasn’t cried?” “No, he hasn’t.” According to her chart, Yasintha was tranferred hours ago for prolonged labor. I place the baby in his own cart in the nursery and explain the situation to the nurses.

There are two nurses working in the nursery, they are the same experienced nurses who worked all week. They will retire soon. Tereza walks me around the nursery. She says there are now twelve babies depending on formula. There are the quadruplets, a set of triplets, twins whose mother died, a singleton whose mother is suffering from postpartum psychosis, and two others whose mothers are severely ill. She is changing and weighing the quadruplets as she talks, she says the father and an elder from the mosque came and held a naming ceremony. They are now Mohammed, Hussain, Hassan, and Hamida. Hassan smiles periodically in his sleep, Tereza laughs and asks him, “Are you seeing angels now and then?” She says they are losing weight but their condition is good the only problem is that the mother wants to return home. It is planting season and the garden is waiting. The four will not survive if she takes them now. Tereza tells me that the triplets are in the kangaroo room (where the mothers wrap their babies tightly to their chests) she says they are not gaining weight yet but they are strong and clever, she says they will survive.

At the end of the day I return to see the boy. I find his mother sitting on the floor watching other mothers express their breastmilk by hand into small medicine cups. Her baby is screaming, his hands clasped into tight fists, he kicks and punches with what would be fury if her were older. I pick him up and try to soothe him. I tell his mother he is hungry. I know this cry; it is the cry of a baby who has suffered oxygen deprivation. I hold him while she works at expressing her milk. The milk has not yet come in, she manages to catch only two or three drops. I place him back in the cart he now shares with a premature boy who lies quietly, his thin arm resting over his eyes like an old man. We all need more angels.