“Fuck them,” V says, watching the ambulance pull away. The sentiment is, I will confess, not entirely unlike my won.
I saw patients in the morning, after long hours spent finding quiet places to sit and pretend I didn’t feel an overwhelming sense of sinus-induced muzzy-headedness. No hangover for me, though several of the boys looked ill and C swore that he’d never drink again.
I gave up the afternoon after E came in to say that one of the clinic doctors was going out to see to a woman in labor. That’s where it began.
It ended with the patient on her way to the hospital, courtesy of a foetal heart rate of 160 and accelerating well with scalp stimulation. V, midwife with experience, was unconcerned. Nicaraguan law calls it foetal distress and requires transfer.
What good? I came in and was asked to do a cervical check; then asked what I thought we should do. It was both terrifying and empowering.
The question, O Best Beloved, is one of frustration and laws and experts and turf. It was a complex dance; a battle. We arrived in the room and the next thing I knew I was counting heartbeats, doing Leopolds and checking her cervix (5 cm, I got it right) and Dr. S turns to me. He explains that the rules say 160 is foetal distress, and asks me – asks me – what I think we should do. I had had no worries until that point; a foetal heart rate of 160 didn’t concern me overly. I stammered, I gave the only answer I could think of. If I were worried about a woman, I say cautiously, but I’m used to lots of instruments and machines – if I were worried, I would turn her on her side and give her fluids, put some oxygen on her, see what happens. And he nods. And the next thing I know they’re setting up an IV pole . That was when I realized my word was being taken as advice, not as a pimp session. I took the next convenient opportunity to slip in a request for V to be consulted. Power I don’t mind; the responsibility that comes with it is always sobering, though.
V is a midwife I respect and have great admiration for. She thought the baby would be fine, no need to transfer, not for the fifth baby and so wonderfully reactive. But the rules and the other doctors said otherwise, and much to all of our dismay, the rules eventually won out.
Dr. S and I spoke, later. He talked about how he would have been willing to keep the woman, but that the team decision stands. We exchanged compliments, and hopes that we would have a delivery while we were there. A good man; he slows his speech when I am listening, and even now I am so familiar with the rhythm and banter of childbirth that his words fall into place; we did not need a translator much of the time. I meant it when I said it was a privilege to work with him. It was in his face when he left to see her at her home; her husband had walked from Las Brisas – a drive that took our ambulance an easy half-hour at dangerous speeds. What a different thing, to be unable to see or even alert a doctor without walking all day.
We found her, her dog, two of four children, and her husband in a house little more than three cubes of adobe bricks with a roof. No doors, no curtains, and only swept dirt for a floor. I saw no furnishings at all. From the windows stretched a vista that carried all the way to Honduras, a summer landscape of verdant hills shading to blue. The natural beauty here never ceases to amaze me.
She came with us; her water hadn’t broken, so coming to the clinic they said was safer. We careened back down packed-dirt roads barely wide enough for our own van, and I took pictures in my mind.
[A two-hour ride over dirt roads in an ambulance whose headlights worked only sporadically if at all, in the dark, was what she faced.]
Tonight, peering out of the compound, I heard whispers: Aiya, la gringa! I ducked back inside. I tore out and folded one torrid page of this journal, and I played silly games with balls. It helped, some, but what I wanted was to sit with someone and speak soft and low, under a sky starless and black, without light, and hold companionship like contact. Tonight, I was lonely – truly lonely – for the first time. My Angel would have known.
No surgeries today. I hope there are babies; shadowing doctors in clinic is exhausting.