Unwanted

It's the barking that first wakes me up. Of course, I'd just fallen asleep. Is Caramel just barking at shadows or is there a nurse at the door. Then I hear the sound that has replaced the fear-provoking sound of my residency pager: the gentle "tap, tap, tap" of a finger on a sheet metal door.

I roll out of bed trying not to disturb Sarah (as if she could sleep through the racket), pull on some scrub pants and head out to the porch. A headlamp outside the scree confirms my suspicions: they want me at the hospital.

It's Oscar, one of our new nurses. He did several nursing school rotations at our hospital and was always one of the sharpest students. The problem is that he still looks like a student, a junior high student. It doesn't help that his one lazy eye always makes you wonder if he's really looking at you or not.

"We just got a case referred from the health center," Oscar begins holding out a small piece of paper with some scribbling and the ink from a rubber stamp marking it as official. "Femme psychose." I have to have him repeat it and then finally look at the paper where I recognize that the patient is referred for being a "female psychosis."

"She's nine month's pregnant and is crazy," Oscar continues. "She won't let any of us examine her. The baby's head is half way out but she just writhes and shrieks and doesn't push."

"Ok, ok, I'm coming." I go back inside, pull on a dirty scrub shirt, grab my flashlight and keys and walk back out under the full moon.

As I enter labor and delivery, I see a crowd of nurses and nursing students standing around laughing and joking just beyond the curtain that separates our one delivery bed from the three postpartum beds. The woman is quite large, looks young and has a blank stare on her face as she gazes at the wall, her back arched behind her and her obviously pregnant belly shoved out proudly in front.

I send everyone else out except Delfine, the nurse responsible for labor and delivery this evening. I go over to the side of the bed where the young woman is staring.

"Lapia." I greet her. She rambles something off in Nangjere that I don't understand.

"Bebe gei age." I tell her the baby wants to come out.

"Bebe kang ddi." She denies that there is a baby. I decide not to provoke her. I'm not sure what to do. If I even try to come close to touch her she screams, tenses up and pulls away.

"I have to poop!" The girl continues in Nangjere.

"Ok, go ahead," I place a bed pan under her. "Do it in here."

She pushes it away indifferently. I put some gloves on, still uncertain as to how to proceed. I can't really knock her out because the baby's respiration will be depressed. Yet at the same time, I'm worried that the baby's oxygen is being compromised by his not coming out fast enough. What to do?

Every time the woman has contractions she stretches out her legs, squeezes her buttocks and arches her back: not the classic pushing technique I remember from medical school. Amazingly, after a couple more contractions she actually pushes the head all the way out. Even more remarkable, she turns on her back, spreads her legs and allows me to grab the head and pull the baby out. He is curled up, great tone and starts to scream immediately. I clamp and cut the cord and give the baby to Delfine. Fortunately, the mother is still being slightly accommodating and the placenta delivers almost immediately. Plus she has no tears and her uterus is well contracted with no bleeding so we don't have to touch the mom and freak her out.

As I turn back to the baby, Delfine is finishing tying off the cord. We dry him off as best we can and wrap him in the only thing the mother has available: her head scarf. I go to present him to his mom and she turns away, again denying that she has a child. Now what? I call in Anatole who happens to be there with one of our staff members who is sick. He tries to talk to her in Nangjere and Ngambai but just gets nonsense replies. Still, none of her family has shown up, which is unusual in Africa. I pick up the baby in my arms and go to see Augustin, our administrator. He calls up the health center that referred her. As he talks to them, one of his family, a young teenage girl has taken the newborn from me and is cooing and giggling at him in the chair across the room.

"The woman you referred has delivered, but no family has shown up and she doesn't want the baby. What's the story?"

Apparently, she came from a village down the road called Dabegue. She just showed up and was so uncooperative that the nurse at the health center put her on his motorcycle and dumped her at the hospital. That's all they know. And no one has shown up for her there either. One of the other nurses on duty, Seraphim, is from Dabegue. I take the child back and go to see him in the pediatric ward.

"Seraphim, there's this crazy woman from Dabegue who just delivered, is all alone and doesn't want her baby. I'm trying to figure out what to do with the baby. Would you mind coming and seeing if you know her?"

He agrees and we set off across the darkened campus to the Maternity ward. The woman is still staring off into space. Seraphim goes around and gets a good look at her.

"Nope, I don't know her." I try again to present the mother her baby but she turns away in indifference.

So I take the baby home. I walk into the bedroom and place the bundle by Sarah.

"Hey, look what I brought you." She half opens her eyes and in the light of the flashlight takes in the baby.

"You're kidding! What's going on?" I explain the story but tell her to go back to sleep, I'll take care of it.

I leave the package on the bed and go over to Tammy and Jamie's.

"Hey, do you guys have a bottle and some infant formula? I just brought home a baby that a mentally challenged woman doesn't want . Since she has no family with her I figured I'd keep him tonight and see what we can figure out in the morning."

Jamie comes out and chats while Tammy scurries around in the kitchen and finally comes out with a bottle and matching nipple.

"Do you have any formula as well?"

"Actually I do. I'm helping feed that orphan baby across the street and they're coming tomorrow to get the can but I guess you can use some tonight."

"Ok, thanks." I go home and put some water on the stove to heat up. I fix some formula and put the rest in a plastic storage bin, mix in some colder water until it's just right and try and wash the newborn nastiness off the little guy. I give him some formula (he doesn't want much) and then wrap him in a blanket and pack him in a cardboard box on the couch.

As I lie in bed again trying to go back to sleep only one thought enters my head: "now what?"