Breech

It’s a word we hear a lot these days.  From a breach in security to army/swat movies talking about busting through doors it’s something that is not uncommon.  Well, I feel like it’s definitely not rare.  You don’t have to argue with me on this, just roll with it.  So it should come as no surprise that we doctor-type people have our own special situation that we refer to as breech.  And that is when the baby is coming out bottom first. 

If you’ve ever seen a normal, uneventful delivery – of which many OB’s would say there never is – then you know that babies are supposed to come into this world sliding head first.  Sounds like a good way to get a concussion (See that?  Full circle.).  A breech delivery carries with it a number of risks to both mom and baby, and being as obstetric doctors like to do everything they can to minimize risk and thus liability (and rightfully so) they’ll often try and turn a breech baby prior to delivery or just perform a cesarean section.  Both reasonable options.  However, anyone who is trained in obstetrics learns “how” to do a breech delivery.  You just never do it.  Except I did.  Just now.

OB is one of those fields that I came into not knowing what to expect.  It seemed pretty simple.  Millions of babies are born all the time without any doctors or nurses present and definitely not with all of the interventions they have us doing at Wesley.  #BusDriveItself  But the more I’ve done it the more it kinda terrifies me.  What am I gonna do that one time in a hundred when there is a shoulder?  How seriously should I take the heart tone phone calls when it’s 3 a.m., I think they’re hogwash for the most part, and I really don’t want a cranky attending?  And a cranky attending can happen either with a phone call or with sitting on the “tones”.  Post-partum hemorrhage?  Stat c-section?  The. List. Goes. On. And. On. Of what can go wrong with the laboring and the delivering…and heck even the after delivery stuff with both mom and baby.

But I’m in Haiti.  It’s the middle of the night.  My wi-fi doesn’t refresh well enough for me to youtube a quick breech delivery.  And…I didn’t really know it was breech until it started happening.  There’s one thing I also forgot to tell you.  The baby was an IUFD and she was somewhere in here early 20 wga based on a femur length.  So we were inducing a still birth.  From a mechanical standpoint it would be really hard to screw this up.  But from a psychosocial standpoint, how do I get it right?  She was “diagnosed” yesterday in clinic after showing up with the complaint of no fetal movement for 5 days.  We sono’ed her, “Ou bebe pa gen couer.”  That’s it.  That was the delivering bad news.  She was still half-naked. 

The time is 0020 and it really seems like her contractions are pretty regular and dammit if she doesn’t act like they hurt #PaGenEpidural.  I really don’t want to, but I’m kinda tired and would like a rough idea of where we are at.  We’re AC with a very tense amniotic sac… That EXPLOOOOOOODES with digital pressure.  #BadTimeToNotHaveShoesOn.  The fluid is a reddish brown, almost like metabolized blood products.  With the bag out of the way I run into something not normal.  But then again, when was the last time you delivered a 24 wga infant?   Never?  Me too.  Misshapen face?  Hand?  Butt?  Anencephaly?  I don’t know.  I depend on smart people to tell me these things. 

With the amniotic fluid still pouring out - I mean, like a fountain.  I decide now might be a good time to throw on some shoes.  The “mom-to-be” is still screaming with contractions and her parents sit anxiously outside the “delivery room”.  Every time I walk by the start talking to me.  And every time I try.  I try so hard.  And FAIL.  No clue what’s being said to me.  For those that aren’t familiar, creole is a language that really lends itself to being “lazy”.  Very guttural.  And then people just make up their own contraction patterns that don’t make a whole lot of grammatical sense.  She when people mumble  quickly and quietly I am just out of luck.  And that’s exactly how I perceived grandma and granddad. 

The child came.  When I realized I was in fact feeling a butt presentation I tried my darnedest to remember the moves.  Leg.  Leg.  Hips.  Arm.  Arm.  Head.  #AndYouShakeItAllAbout #ActuallyTakeThatBack… #NeverShakeABaby  Not sure how it all worked out or looked, but I got baby out.  But now what.  Everyone is still asleep.  I clamp and cut the cord.  “Eske…ou vle…’hold’ bebe ou?”  Confused looks.  “Yeah, I don’t know your word for ‘hold’.”  Porte?  Mette?  Nothing worked.  You’d think everything around it and the context would make it kinda obvious, but apparently not.  I even pantomimed, and anyone who has played charades with me before can tell you how I’m at least mediocre. “ Eske ou vle we [see] bebe ou?”  She said something and it wasn’t a “wi” or a “non”…so I just uncovered him and held him up to her and her parents.  They stared… “Oh Jesi” x 1.  And that was it.  They were done.

I took him away.  Her pain was gone.  Her grief seems non-existent.  She still has that pesky placenta, but that too will pass.  Again, her parents ask me a very lengthy question, of which I understand exactly zero words.  “Mm pa konnen.  Dormi asweya.” 

For those who are curious.  I examined him in another room.  Appears to likely have been chromosomal.  Lymphadema in the hands and neck.  Single palmar crease.  Small jaw.  In Haiti there is no paperwork.  No death summary.  No delivery note.  No formal autopsy with karyotyping.  He is still sitting in the delivery tray with the packaging from my sterile gloves covering him up.  I can only assume he will be burned, but I would at least like to offer the family the chance to take him home and offer him a proper burial.  Just another day in Haiti.

Boule Un

The burn was unlike anything I had felt before.  It literally felt like I had been shot.  The group of Haitians that had gathered around me started cackling at my clear discomfort.  The klarin sonson had done it’s job, it had made the blan cough. 

I’m not one to succumb to pressure, especially in Haiti.  If I handed out money every time a kid came up to me with a “bum senk goude” I’d be more broke than my loans would indicate.  But this time there was enough of a burning curiosity in me that pushed me over the edge.  I’m in Gran Bois working with the ServeHaiti clinic and Dr. Leo.  There’s a couple of “bars” about a mile down the dirt road.  The one I went to was aptly named “Brother’s”.  It was really like my B1G homes of Iowa City and Champaign.  There were some signs in the back and I’m pretty sure one of them said Wing Night Wednesday.  It was Creole, so I may be taking some liberties with the translation. 

The scene was bumping with some God-awful rap blaring over speakers that were probably bought at a Costco in 1984, broken, shipped to Haiti, then “repaired” three years ago.  A group of pre-teen boys were playing dominoes on the one table.  I think the pool table was around back, but I’m sure it was occupied.  I had just bought some minutes so I could make some phone calls back to the states and my old buddy, purple shirt “Vote Roger Galle” found me and started in his best English to get me to give him something. 

I’ve been through this rodeo a hundred if not a thousand times.  “Bruddah.  Can you help me.  I have no money.  Give me two dollars.  Be a good bruddah.”  And I respond, in limited Creole but phrases I’ve become fairly adept at, “I cannot give you money and no one else.  I came all the way from the U.S., you should give me money.  I am hungry too.”  They usually get a kick out of my failed Creole, which is enough to satisfy them.  But this guy was persistent, and then he pointed to the jugs of moonshine on the counter in Brother’s. 

I had been eyeing the shine since earlier in the day when I was helping a couple workers in the garden plant some plantain roots.  We were walking back to the clinic and when they thought I wasn’t looking they bought a small bottle of it and killed it behind the bar.  #BlanSeesAll.  When I joked to them about it they started laughing, but did say it was good.  I wasn’t sure, there were too many leaves in the jug for me to feel too comfortable with it.  But the seed was planted.

And all it took was “Vote Roger Galle” to keep hounding me for free stuff for me to cave.  The agreed upon transaction was for me to buy a small bottle of the moonshine and then everyone could pass it around.  That way no one was left out and he could say I was a good brother.  So that’s what we did.  Twenty Goude is all it cost for a half-pint sized bottle of this concoction.  It was red.  And I was first to go.

There was no countdown.  There was no chaser.  No LMFAO song or drinking game to offer me any sort of encouragement.  Just me and my manhood…And thirty Haitians watching closely with bated breath. So I closed my eyes and took a pull.  And I couldn’t be a wimp; it had to be a fair sized pull.  And I’ll be damned if I didn’t give myself alcoholic liver disease and gastritis all in one fail swoop.  I composed myself quickly and held up the bottle to pass on to the next taker, and around it went.  #USA However, no one had near as much fanfare as I.  When the bottle was finished Mr. “Vote Roger Galle” gave me a firm handshake and we were officially brothers.  And so it was.  I stumbled my way back to the hospital with a rumble in my tummy that I was no longer accustomed to and the people went about their day with a new story about the "blan". 

As an addendum I was able to secure a nice bottle of moonshine and bring it back to the states.  In fact I had a couple.  Unfortunately, in my rush I did not properly secure them in my suitcase.  When I saw my bag for customs in Miami off the baggage claim it was clear that something didn't go well.  The front of my suitcase was clearly wet.  It's not like my flight was Splash Mountain or something.  It was clear that there were a couple lost soldiers riding in my bag.  And when I finally grabbed my bag the smell knocked me down.  Definitely was one of the moonshine bottles that bit the dust.  But that's okay.  I still had one survive.  

Frèt

I’m cold.  And anyone in the Midwest is probably really pissed to be reading that right now.  You’re right, my afternoon was filled with sunny skies and a blissful 85 degree temp.  Cap it off with forested mountains in every background and there isn’t much to complain about.  But it’s night time in the mountains, and I’m getting a little chilly.  After spending a week in La Fit about a year ago with an amazing team, I realized that on the next recommended packing list would be plenty of warm clothes and bedding.  It’s the rainy season.  We are in the mountains.  And it’s cold. 

But that’s not why I chose this topic to write about either.  Two years ago today was when I got the life-changing, gut-wrenching Facebook message.  Guirlene: Bedica malade.  And then minutes later: Guirlene: Bedica mouri.  I was destroyed.  I lashed out at my computer.  I made frantic phone calls.  I drank a bottle of rum, poured out an emotional roller coaster on this blog thinking it might be my last ever, and started walking towards the pedestrian bridge over the Iowa River.

Stages of grief always seemed like a silly concept when I was in school.  And then I lived them.  Sort of.  I was definitely angry.  Angry at everyone in Haiti who had let this happen to her.  The health workers for their lack of working on health.  At Charles who was in country, had a vehicle and seemingly was lost in trying to seek medical attention.  At Chris and Ginny for letting her go back.  At myself for getting attached.  And at God for all of the above.  Didn't really help as anger never does.  But hey, it’s an immature defense mechanism that is easy to turn to in our weakest moments, and I did. 

Denial and bargaining are more with my inability to face her parents with any deal of comfort.  It’s Haiti.  They’re used to dying children.  There is no guilt.  There is little grieving.  They’ve moved on.  But Americans can’t.  I can’t.  I’ve seen parents bury children and it’s always unbearable to watch.  And then the days, weeks, months, and years following can be just as bad.  #InterestingStatisticThatIHeardButCantVerify 80% of couples who bury a child end up divorced.  Not surprised. 

I think it’s because we never really reach stage 5: Acceptance.  How do you accept losing a child?  That’s not the way nature was designed.  And so because it doesn’t make sense we hang on to our anger.  It’s the easiest emotion to possess and one that will ensure that we never forget.  Anger is effortless.  Love takes work.  Love admits fallibility, but in anger you’re always right.  It’s vindicating.  And everyone around you is the victim.  There is no doubt that it can easily couple itself with depression.  Sleep disturbances, anhedonia, guilt, distracted thinking, suicidality.  There’s your five SIGECAPS there.  And so we languish.  Relationships get choked out like the seeds cast among the weeds.  Work falters like the seeds cast on desert sand. 

And so I am cold.  No longer angry to the point of no return, but unsure of where to go from here.  I can say that I will try and not write about this topic again.  But with the looming graduations and the requisite celebrations afterwards this unfortunately is likely to be lived by more people than is acceptable to me.  Thus I thought worthwhile writing.  Perhaps it can help another struggling with loss to have some introspection, or at the very least can offer a gist to an outsider of what someone might be going through.  

Amnesia

Concussions are a huge deal in the U.S., and for good reason.  So many kids get them from playing sports year round and obviously there's the big kerfuffle in the NFL regarding long term consequences of repeated concussions.  But what is a concussion?  A brain bruise?  Any contact to the head that causes severe symptoms?  A stinger?  Having your bell rung?  Seeing spots/stars?  Are these all concussions of old?  Maybe. And maybe even bumping your head on the bookshelf is enough to cause a "concussion" with respect to repeated trauma and long term effects. Fact of the matter is we have a pretty poor understanding of concussion. How hard does your head need to be struck to cross that threshold?  What direction does the force need to travel and what parts of the brain are the most susceptible.  How long is the recovery?  How do we make it better?  What is the long term prognosis?  #NobodyKnows

One of the more common symptoms of concussions is amnesia, which can be of events immediately prior to the incident (retrograde) or of events happening after the incident (anterograde).  Some events are so bad and you come to in a dissociative fugue, or the Jason Bourne disease. Ideally anterograde amnesia resolves and even some of the retrograde amnesia starts to clear with time and frequent orientation. That's kind of how I've felt these last few hours.

It's been nearly a year since I last stepped foot into Haiti.  I've been so caught up in my first world problems that I've failed to make down once in a calendar year. Seems inexcusable. And, like most trips, you always have to expect the unexpected. So, true to form, I receive a call as I'm leaving for the Wichita airport that my ride to my final destination will be delayed by a whole day.  Kind of a big deal when you're only in country for 7. But, I couldn't change that so I got extremely lucky that Dr. Angie was in country and available to play host to me on the first leg of my trip instead of the tail end like she and I had tentatively talked about.  Ok.  I think everything is settled.  I run to Walgreens to pick up a script for ondansetron.  I nearly laughed as the pharmacist started explained what it was and how to use it.  But, no time for a discussion, I did have to make my flight.  I get dropped off, and in the fluster of an awkward departure I totally left the zofran I had just picked up, my spare apple charger, and my toothbrush...  #Peachy.

My travel day was quite the blur, but I found myself in Port au Prince today morning.   I was being picked up by an old friend, Smith, and driven back to Arcahaie, the place I had called home for a short but significant part of my life, just two years ago.  Really? That long ago?

Things have changed. It has been soooo long since I have been here.  My creole is beyond rusty.  I see relatively major buildings and have no idea what they are.  Turns I used to know by heart seem foreign.  I feel like I've lost it all.  As we get closer to Arcahaie more comes back.  Cabaret, where Smith and I stop to buy some school supplies for his class, is the same bustling market that I remember.  The seasons have always dictated what fruits and veggies are on display, so I find no surprise that there are plump watermelons and mangoes lining the road. The same cat calls of 'blan' greet me as Smith and I walk through the rows of shanty shops.  The same, disgusting fish displays find themselves a little too close to the stand selling me my toothbrush.

We press on and I suddenly find myself walking the familiar path up to Do Digue.   I've taken these steps hundreds of times before.  But as I cross the threshold of the town everything looks different. A new, concrete plaza sits where a dirt-floored, community meeting place once was.  A water pump is established adjacent to it, in the city center, with people lined up to utilize the free water source.  Kids that used to be scared toddlers now run around me smiling, and know my name.  Sorry kids, can't return the kind gesture.  Even Nola's house is a different color!  I'm lost.  I feel like I've stepped into a new world.

Smith and I settle in under the shade in Nola's yard and catch up.  A lot has happened since Nola and I first met two and a half years ago.  Clearly a lot is completely new to me and totally awesome progress.  But the more we talk the more I wish my amnesia were a little bit more...expansive.  Sure my brain will let me forget to bring my anti-nausea pills on the plain and my toothbrush, but I can't forget the frustrations, the hardships, the tragedy and the loss that I've unfortunately come to associate with Haiti.

I know some very special people that seem to have that ability.  Tough days are forgotten before their prayers are said.  Outlook is always sunny.  Arguments, lies, mistakes, and injustices all seem so easy for these people to move past.  They get the big picture.  I struggle with that.  Disagreements between like-minded people with near-identical goals go unresolved because of people like me and we end up with 15,000 NGOs in a country the size of Rhode Island.  But this is neither the time nor place for such theology. I'm trying to catch up on life.

I ask Nola about my God child. "Li en ba." Descriptive...  We walk until this scared little toddler is walking in front of me. Next up is Norline.  Before long I learn that both my kiddos are growing up. Baby David isn't Baby David anymore.  Heck, he's not even David.  He's walking. Talking a little. And knows how to push buttons on an iPhone. Norline is just as adorable but muuuuuch bigger.  Someone's feeding her well.  It doesn't take long before I have them both on my lap. But then it seems like far too soon that I need to pass them back and head out.

I have one final stop and I make this one more out of obligation because it doesn't fill me with joy like he others. But I stop to visit Carole and Jean Roo.  As the moto stops and I descend I still have no idea what to say. I never do. It's nothing but disappointment and failure.  I'm somewhat relieved to hear that everyone is away from the house at the moment. Smith and I hop back on the moto to head back to Angie's house. For now I can continue to feeble attempt of selective amnesia.