COTW: Loss and Redemption

by Rachel

One of the downsides to being a physician in our setting is lack of follow-up.  We don’t have “continuity” patients the way docs in the US do.  I remember one of my attending docs at St. Joe’s, where I did my residency, telling me once that he had just delivered the baby of a woman that he also delivered 20+ years earlier (he had delivered her and now, 20 yrs later, he was delivering her baby, if that makes sense).  Delivering two generations in one career, wow.  Here at Kibuye, I see women for a day or two and then they disappear.  Sometimes there are sad stories, sometimes happy, but I don’t know if I’ll ever know the rest of the story or experience the rest of their lives.

Today I got to experience two stories.  A story of loss, one that I hope will one day experience redemption but that time is not yet.  And a story of redemption that had a history of great loss, great pain, but now joy.  The first woman had been on our service for several days.  She has a healthy 9 year old, but 6 years ago her second baby died just after a C-section for unknown reasons (common here).  Then she had a miscarriage.  Now she was coming in a week after her due date.  We did a few small things to try and get her labor going naturally, but this morning she had a low-grade temperature and had made no progress so we decided to repeat the C-section.  There had been no evidence whatsoever of fetal distress.  My student and I did the C-section and pulled out a very limp, misshapen baby.  There was a heartbeat, but the baby did not breathe.  Minute after minute my colleagues worked on the baby.  She took a few shuddering breaths, but that was all.  I was stunned.  How could we explain this to the mother?  After such a tragedy six year ago, she had waited and waited for this child, only to experience tragic loss again.   What is there to do?  What is there to say?

As we were finishing up in the OR, a second woman came in to the hospital.  Fourteen years ago, she was a teenager in labor.  Long labor.  The baby didn’t come and didn’t come and eventually when she was able to push the baby out, it had already died.  Worse yet, due to the length of the labor, she developed a fistula.  Many of you reading already know what that is (many famous talk show hosts and activists have raised awareness of this terrible problem).  Basically, a woman with prolonged labor who doesn’t have safe access to a C-section can develop a hole in between the bladder and vagina.  It happens because the long labor puts enough pressure on healthy tissue to cause the death of that tissue.  After the fistula forms, she leaks urine constantly, causing her to smell, to develop infections, to be ostracized by her family and community, and sometimes to be divorced by her husband.  

This lady suffered for 10 years.  And then, hope arrived.  The organization Doctors Without Borders set up a training site for fistula surgery in Gitega, 30 minutes away.  She received surgery, and it was successful.  Now, four years later, she arrived at Kibuye, pregnant with her second child, coming for a C-section that is available to her now.  I delivered the baby, a boy.  He was beautifully healthy, with screaming lungs and pink tinged skin.  This woman has waited for fourteen years, and this afternoon she held a baby in her arms.  

That’s the story of redemption.  I didn’t see the beginning of her story, but I’m privileged to be a part of the next beginning, the new beginning.  It was, for me, a day of loss and redemption, so common here in our setting.  Highs and lows, joys and triumphs, successes and failures.  We don’t always get to see the redemption story that we long for, at least not here on earth.  May the second be a story that carries me through the days of loss like the first.  Days that have come, that will come.  May these two women be stories that remind me that someday, all of our losses will be gathered up, all our our tears will be dried, and we’ll see a beautiful picture of love and grace woven together to make up our lives. 

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