Monday, 27 February 2017

COTW: The Rest of the Story

(from Eric)

Several months ago, I wrote about a tough Saturday, one of those days where the broken bodies and broken hearts seem to pile up until the windows are all blocked and the light seems to be having trouble getting through.  

One of the patients that day was a young lady named Spes.  For reasons that I don't think will ever make sense, she was locked in a room by her husband for 4 months and given only a minimal amount to eat.  Eventually her neighbors descended on the husband and forced him to bring her to the hospital. It looked like too little, too late.  Spes was malnourished to the point of being barely conscious and definitely not able to stand up.  She had an angulation in her spine from tuberculosis which had taken advantage of her weakened state.  She wasn't moving her legs much, but it was hard to know if that was spinal injury or just her general weakness.

The first week was touch and go.  She was in an isolation room because of her tuberculosis, and that unfortunately gave her husband (who remained in the hospital out of fear of prosecution) ample opportunity to go on neglecting her.  He said that she had some kind of mental trouble.  We never saw any of that, but unfortunately both his and her families seemed to feel equally ambivalent towards her plight.  It's hard to get more alone that this woman.  Her breathing was labored, wandering off and on oxygen.

We found out she was pregnant just in time.  She was only 25 weeks at the time.  The day after the discovery, when she started complaining about low back pain, we discovered her pre-term labor, and Rachel entered the picture.  Medicines were given, and thankfully the contractions stopped.  She was transferred to the OB service, but we kept following her.  We talked to Alyssa and Joyeuse the malnutrition nurse about supplementing her diet.  We don't normally have enough food to do this for all the malnourished adults, but given her special situation and her pregnancy, we made an exception.

But she didn't want to eat.  Even her baby didn't seem to be motivation enough to work very hard at living.  Weeks passed.  She was moved into a general maternity ward, where all the other moms provided some much needed social pressure on the husband.  The students on our services got more involved.  They chipped in to buy her medicines.  One student even organized a bag of baby clothes to give her after delivery and collected a very substantial sum (by local standards) to defray random costs.

Day by day, things didn't change.  But as weeks went by, light started to creep in.  She started doing physical therapy.  She regained bladder control and started taking a few steps with her walker.  Given her tenuous home situation, it became apparent that she was staying until delivery.

Then she delivered.  A healthy baby boy with an amazingly uncomplicated delivery.  He had a slight fever and so Logan (covering for Alyssa) got involved and saw the baby through a routine neonatal infection.  Motherhood becomes her.  She engages people more, considers things more, even smiles.  Even her husband seems more engaged.

After ninety days in the hospital, she went home.  I took a picture with her the last day.  I wish I could post it, but given the sensitive story, I decided not to (Her name isn't Spes either, sorry).  She is sitting next to me on her bed.  Her baby is in her lap, and there is a hint of a smile.  In the background, there is another lady, with her hand over her mouth in a classic "can you believe that crazy white doctor taking a picture with her?" moment.

It was a great day, but let's remember some things.  She is going back to the same home and the same family.  She is just starting to recover from paralysis.  She was severely malnourished and now she is breastfeeding a newborn.  The darkness still looms.  I told her that if she makes her follow-up visit next week, that I'll print a copy of the photo for her.  World Relief is promising to go visit her home, as are the local authorities.  The physical therapist sent her with a walker and will see her when she comes back.  We don't know what's waiting for her, but we're trying to help her out.

The darkness still looms, but it wouldn't do to leave this story without remembering a few points of light.  A lonely mother with her new baby.  Seeds of (something a least a little like) reconciliation with her husband.  Unsteady steps with a walker.  A baby saved from certain death.  Doctors-in-training giving sacrificially to meet the needs of "just another patient".

It's not perfect.  It's not even really good.  But there's goodness mixed up in it all.  Quite a lot actually.  Light shines in the darkness, and it is not overcome.
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