Some Days Are Just Bad

“What?”

“Can you deliver my sister’s baby? The midwife couldn’t do it and they said you delivered babies.” I asked where his sister was. “At the clinic” was his reply. DrDaveIt was about 2pm, I had closed the clinic at about noon since most of the back country “taxis” or jalónes (Toyota pickups with metal railings around the bed) had already gone back to the further out villages. After 1pm it was usually only emergency cases and the person in need, or their representative, would come up to our house to seek out the “doctor.”

I went in the house and told my wife I had to go to the clinic for a baby delivery and she needed to come on down right away. I grabbed the keys to the clinic and started the quarter mile jaunt to find out what awaited me.

As we walked, the brother explained that they lived in a village about two hour’s drive from ours. His sister had been in labor since last night. The local midwife had difficulty with the delivery and was unable to get the baby out. They had hired a local villager, who had a truck, to drive them to my clinic since they figured I would be able to help. Obviously the news that I was a dentist either hadn’t made it that far out, or they just didn’t care.

As we walked up to the clinic, I could see a truck parked in front with several people standing around it. As we moved closer, the gravity of the situation started to become much more obvious. As I rounded the back of the truck, I saw something that really burned into my memory and will always be there. The back of the truck had an elderly woman (the midwife) sitting on a spare tire with a very pregnant, and very much in labor, woman sitting in the bed with her back against the spare tire and her head in the midwife’s lap.

The rest of the scene almost defies description. The bed of the truck stank of human waste. It was coated in feces, urine, amniotic fluid, and meconium. The result of two hours bouncing through jungle roads while in labor. The woman in labor was sweating profusely and obviously exhausted. She was wearing a skirt that had been pulled up and there I could see a baby’s leg sticking out of her vagina.

This was going to suck.

I quickly ran in the clinic and grabbed my “baby delivery kit.” It had all the instruments I needed, and had, to aid in delivering babies. I ran back out to the truck, gloved up, and jumped in the truck. Even though I was getting coated in human waste, and the rest of the “soup” that lined the entire bed of the truck, there was a job to do. The OB/Gyn that taught me how to deliver babies made one thing very clear: The baby has to come out.

Since babies are supposed to come out head first, there was obviously a problem since I could only see one leg protruding from the mother. I told mom this was going to be rough. I managed to free up the other leg and got it out as well. Then I was able to work the arms out one by one. I reached in and felt the umbilical cord securely wrapped around the baby’s neck and jammed against mom’s pelvic bones. I slid the cord off the neck and, since I have big hands, it was not exactly pleasant for mom. I felt terrible for her, but time was of the essence. Once the arms were free, the baby was only held in by his head. I told mom to push, we had to get the baby out as quick as possible.

My hopes were already fading, the parts of the baby I could see were already dark purple. This is not what I wanted to see.

As I worked on freeing up the head, I noticed two guys that kept kneeling down next to the truck. Since the clinic belonged to a Christian mission, I assumed they were praying. It was very common for family members to pray while I worked on their loved ones. When I saw one of them stand up with a tire iron, however, I realized that they were not praying. Instead they were changing the tire. All while I was trying to get the baby out of this lady. This just struck me as strange and kind of cold, couldn’t they just wait until we were done and out of the back of the truck? This was surreal enough already.

After a lot of work, I finally managed to get the baby out of mom. My greatest fears were realized when he didn’t take a breath, didn’t move, nothing. I clamped and cut the cord and jumped out of the truck and ran into the clinic ER. I set the poor little guy on the table and checked his vitals. Listening with my stethoscope, and closely looking at the baby revealed he had no pulse and he had no breathing. I started CPR in the vain hope that some miracle would happen. Not having a defibrillator, there was really not much of a chance the baby would come back. This being the first time I have ever held a dead baby, and been involved in his care, I wasn’t going down without a fight. I continued CPR for 30 minutes and never got a response.

I gave up and looked at the little guy who never got to see the sun. He was a perfect little baby boy of about eight pounds, with the exception of the fact that he was purple, cold, and dead. There was nothing I could do to change that and it was a horrible feeling. I told my wife to clean him up and wrap him up so we could give him back to his mother. I wished I hadn’t had to do that to her, but I still had work to do. We put him in one of the regular exam rooms and she started preparing the body.

I went back out to the truck and found that it was gone. The truck owner had kicked mom out and the midwife had delivered the placenta in my absence. I helped mom back to my ER and checked her out for vaginal tears or other trauma. I cleaned her up and she didn’t need any further treatment. I told her what had happened and gave condolences as best I could in Spanish. My wife carried in the lifeless body of the baby and we gave him to mom. She asked if she could leave and, since there was really nothing more we could realistically do, we told her she was free to go.

As she walked away, I began to realize the significance of what I had just experienced. Ever since that day, I have gauged life’s turmoil and trying times against what happened in the back of that truck. I will forever remember being covered in human waste and up to my arms in the birth canal in a position that I never, in my wildest dreams , would have imagined being. I will forever be haunted by the horrible feeling of holding a lifeless baby who never had a chance to take his first breath, and the helplessness that goes along with it. Whenever I think I am having a bad day, I reflect on what happened that day, and realize that I don’t have any problems.

  4 comments for “Some Days Are Just Bad

  1. February 24, 2008 at 8:21 am

    Jeesh – there’s a story to bring a little perspective crashing down. Thanks Dave. I’m sorry it didn’t work out and I hope the mum is doing ok.

  2. March 27, 2008 at 3:19 pm

    I found myself believing that at any moment you were going to say “suddenly, the baby started breathing”… y’know, like in all the movies, where there’s always a happy ending.

    Real life hits with one hell of a thump, sometimes.

  3. June 20, 2008 at 6:27 pm

    Wow, this was a gripping story! Well written, too. I was kinda expecting the outcome, once I read the foot presentation and the circumstances you were in. Still, you being there likely prevented the death of the mother, as well. Thanks for the words!

  4. Harry Burns
    August 11, 2010 at 5:57 am

    Dr. Dave, thank you for showing us what a really bad day is and just as importantly, there isn’t always a happy ending in real life.

    My sincere best wishes………..Harry

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