13th of June 2012, Wednesday. In Thekerani Health Center.
My job teaches me one thing: always expect the unexpected. Just like when I am about to leave the health centre this afternoon. There are couples of women banging at the door, rushing to enter while carrying a wooden stretcher with a severely ill-looking middle aged woman on it.
© Husni Mubarak Zainal
Sometimes, all I want to do in the afternoon is to lie on my couch with a cup of black coffee to release myself from the burden of the day. But here I am, my forehead is sweating while I am trying to find a vein of the shocked patient. I check her pulse and it’s pounding so fast. It feels like something banged at the back of my head. It reminds me that my time is limited. “Find the vein or sign a death letter!” The second option is not my favorite.
After three failed attempts to find a collapsed vein, I am finally inserting a 16G canule – the biggest intravenous canule we have here - into my patient’s vein that I barely see on her upper arm. I collect a blood sample and give fluids (a ringer lactate) in estimated amount of time into her vein to catch up with the blood loss.
The patient has been suffering from massive vaginal bleeding in the past three days. She thought it was just one of her menstrual periods until she started shivering the whole day. It was too late, she fainted in her house, the family said. That’s when they decided to bring her to the health centre.
The family is busy talking in Chichewa, Malawi’s mother tongue. Andy, my translator, tries to keep them calm and instructs them to wait outside the consultation room. Gift, the medical assistant, comes to help me. He had dealt with a woman’s complicated delivery in maternity the whole time. This afternoon, it seems that everyone has a life to save.
It is not the first time I encounter a patient with massive vaginal bleeding here but still my heart races like it did the very first time I treated a patient with a haemorraghic shock.
“We need to refer her to the hospital now.” I tell Gift. “I agree but we don’t have the ambulance, it’s on the way from Thyolo carrying a dead body to Chipo,” he answers back. “Probably it will take more than two hours before the ambulance arrive and it will be too late!” I tell Gift, with my voice slightly raising up. He looks at me and raises his hands and I know he doesn’t have a solution either.
Gift inserts a catheter into her bladder. A dark yellow urine slowly fills the clear plastic tubing. I collect some of it and do a pregnancy test: it’s positive. Most likely, she has an ectopic pregnancy [what does that mean?], a nightmare! I look at her, she’s shivering behind a chitenje that covers her body. The laboratory technician arrives with the blood examination results. They’re bad. Her hemoglobin – the blood that carries oxygen to the whole body – is just 2.4 g/dl [what does that mean? What is a normal rate?]. She has lost so much blood due to the massive bleeding. It’s far below the normal range for women. In between life and death like this, what can you expect?
Gift asks me what should we do, I don’t answer him. I don’t have any answer. As a doctor, seeing someone dying, knowing I should save her life but there’s nothing I can do anymore, is the most frustrating feeling there is. I want to blame myself, question how the world is not a big fair ground, and how little human beings can do sometimes. But I know, all the ranting won’t help at all...
From the small window in the wall, I can see her family is staring at us, waiting for us to do more. I tell Andy to let them in. With the limited medical equipment that we have in the health center there’s nothing more we can do here, but I am hoping it will make my patient feel better when she is surrounded by her family. No one likes to live alone, especially when you are dying...
Gift tells me seconds after I finish writing the refferal letter that a car to take the patient to the hospital is now on its way. Great, at least now we know that we are waiting for something positive.
She is conscious now but still very weak. Her husband wipes the sweat and spittle from her face. I look at her but leave before she catches my eyes. And then one-by-one her family beginsto kneel down and pray. It creates an atmosphere of silence, hoping that their prayer will be heard and granted by God. And in silence, the only thing I can do is to look at the drops of fluid that are falling from the bottle into her vein. Sweat runs into my eyes. I am feeling a stinging sensation. I feel the pain in my heart - maybe this is the kind of feeling that people describe as an effortless pour of emotion...
They pray in Chichewa and there is not a single word I understand. But prayer is a universal language and I find myself whispering “Amen” in every word that they said...
This article is first published in www.kompas.com in Bahasa Indonesia language.