Premature

>
> I was forced to put in earplugs. I'd tried to think happy
> thoughts. I focused on the pleasant night sounds. In the end, I
> couldn't sleep. The pounding of the drums, not the simple happy
> rhythm of the children singing silly songs in the moon light, but a
> deep, dark, forbidding thumping accompanied by mournful howling,
> this sound I couldn't sleep to. It sent chills down to my entrails
> leaving me feeling ugly and used. The earplugs helped...too much.
> The next thing I know, Sarah is tugging me awake out of the deepness
> of a pleasant unconsciousness into the darkness and chill of an
> early Tchadian morning. It's 3:30AM and Samedi is at the door. I
> stumble over to the screen while pulling on an old pair of scrub
> pants.
>
> "Yeah?"
>
> "Docteur, there's a woman referred from the health center. She's
> seven months pregnant and bleeding. Her skirt is soaked in blood
> but her vital signs are stable for the moment."
>
> "Ok, start an IV, give her ampicilline, place a foley and prepare
> her for a c-section. Call Simeon and Abel. Oh, give her 10mg of
> Dexamethasone IM, first thing. Call me when she's ready."
>
> Earplugs back in, I'm soon back in la-la land. This time my slumber
> is not as profound. It's as if something in my conscious is trying
> to break through. I wonder why I'm still sleeping. Why haven't
> they got me? I get up and pull on a scrub shirt to go with the
> pants I'm still wearing. It's 5AM. I walk up to the hospital as
> the first light of dawn barely illumines my path through the mango
> trees and over the sand covered in horse dung. Even from a distance
> I can see the lights in the OR are on.
>
> I arrive and the woman is still in the delivery room. We bring her
> to the OR, turn on the generator and Samedi scrubs while I shave and
> prep the abdomen. After a spinal anesthetic, the woman is placed
> supine and I scrub as well. After a short prayer I take the large
> scalpel blade and cut into her abdomen cutting the fascia and
> tearing the muscle and peritoneum apart to get to the uterus. After
> deflecting the bladder away, I nick the uterus with the scalpel and
> push a curved clamp inside releasing a fountain of clear amniotic
> fluid. As suspected, she has a placenta previa where the placenta
> covers the exit and starts to bleed profusely when labor starts.
>
> I reach my hand inside the uterus and find a tiny little head way
> high above the placenta. Samedi pushes and the tiny, premature
> infant slips into the world. She grimaces and flexes her arms and
> legs. Her skin is underdeveloped and translucent revealing all her
> underlying blood vessels. Samedi clamps the cord, I cut it and we
> hand the little girl to Abel. We soon here a shrill little scream
> as the girl opens her lungs to that life giving oxygen. As I suture
> the uterus closed I have Abel turn off the fan in the OR and cover
> the baby up. We have no baby warmer and I'm afraid she'll get cold.
>
> I finish sewing up the skin and I take of my gown, clean up the
> blood and mess around the woman and go see the newborn.
>
> She's cold and has a slow heart beat. I pump her chest a few times
> and the heart beat comes back up. I put a tube in her nose and give
> her some glucose water. I have Abel go tell the family to boil some
> water. We'll heat her up that way. Meanwhile I pick up the tiny
> form that fits easily in my two hands and place her naked body
> against my stomach under my shirt. I'll use my own body heat to
> warm her. After a few minutes I feel a response. She starts to
> move more and make some weak cries. I pull out the feeding tube and
> suction out her mouth and nose as she's regurgitated some of the
> glucose water. I feel her stretch her tiny feet against my belly.
> Her hands are grasping. She's reflexively searching for her
> mother's milk. I curl her up in a ball and hold her close flipping
> her around like a burger on the grill to make sure she gets cooked
> on both sides.
>
> I go out to check on the hot water several times and the family says
> everytime that it's ready but it never is. Finally, I can't wait.
> The morning chill is too much. I take her home, held tight against
> me under my flimsy scrub shirt covered with a woman's wrap around
> skirt the family gave me. I knock on Tammy and Jamie's door. Tammy
> lets me in and when I explain quickly heats up water as Cory and
> Brichelle come to help. We put hot, but not scalding water in a
> plastic basin and put the girl in. She seems to like it and kicks
> and stretches. She's breathing well and has a strong heartbeat.
> Her limbs are quickly warmed up as we replenish the hot water
> supply. I gently hold her head up so her mouth and nose stay in the
> air to gulp down that important oxygen.
>