preemies

i can’t get the smell of the gloves off of my hands.
__________________

“bon dia.”

i heard a female voice chirp behind me. i had been idly browsing Facebook, basking in the lull that occured after morning rounds and before lunch. i spun around in my chair to find two middle-aged caucasian women waving cheerily to me. “Margaret,” one of them said. “do you know where she is?”

i sat there for a second, blinking stupidly. “oh, you’re here to see Margaret. okay.” I thought at first that they were Timorese patients, poking their heads into the office in search of a doctor. i realized they were just Australian friends of Margaret’s, probably here to take her out for lunch. i beamed back at them. “come with me.” i got up from my chair, and beckoned from them to follow me out the door. the maternity ward was just a ten second walk away.

as i approached the doors, i remembered that the attending doctor was in maternity too. she had been called away just minutes before by a midwife, asking for help from a doctor. but as i got nearer, it was Dr. Dan who came around the corner, muttering to himself under his breath. “twins. two of them. but the first one’s only 500 grams. five hundred. it’s too small. too small.”

my brain didn’t register what he said at first. i was still on a mission to find Margaret. the short, sassy australian woman was one of several international volunteers here at the clinic today. she was a midwife by training, and had delivered countless babies at the clinic. i started to enter the first door on the left, but from the doorway i could already see her, carrying something wrapped in a pink blanket with gloved hands. she met my eyes for just a moment, then turned back to the item in her hands. i stopped, and spun back around to address the two women standing behind me. “she’s, um, delivering a baby right now. you can come in,” i began, gesturing towards the room, “or you can just wait out here.”

now it was their turn to stare blankly at me. then they realized what i had just said, and both of them started to laugh nervously. “no no, we’ll, uh, just wait out here.” they quickly backed up further down the hall, and i smiled grimly back at them. i had never seen a birth. i wondered if this would be it. i entered the room.
___

she was lying there, naked, on a black leather delivery table. there were no fancy machines surrounding her. there was no doting father with a camera who’d attended hours of birth classes with the mother. there was just a woman lying there, in the middle of the birth room, as midwives and nurses milled about. the first baby had just come out. it was only seven months old, and weighed 500 grams. it lay there, wrapped in blankets beneath a heat lamp, making faint breathing sounds. it was dying.

intracranial hemorrhaging. sepsis. necrotizing enterocolitis. these were all serious problems with babies born at 1.75kg or lower. after all, low birth weight is one of the most common indicators of high infant mortality. i had studied that in classes at Brandeis. but 0.5kg? two months premature? what could we do?

his arms were as thin as pencils. his tiny feet were smaller than the nail on my thumb. and his toes. his toes were the size of grains of uncooked rice. his eyes were still shut. i wondered how it would have felt to have looked that baby in the eye.
___

tiny. he was just so, so tiny. his nostrils were only partially formed, and he was fighting for air. the attending doctor explained to me that the grunting, wheezing noise he made was the sound of him fighting to keep his airways open. if he were to try and take a deep breath–if he acted like a full-term baby, and tried to breath properly on his own–his airways would shut for good. he would go into respiratory failure, because he isn’t capable of opening his airways up yet. “at home, we’d intubate him. we’d intubate him until he at least until he was 700 grams. but here, there’s nothing. absolutely nothing. we can do nothing.”

his ribcage kept thrusting in and out. if this happened to an adult, i’d have thought his chest were about to explode. but the bones weren’t even fully formed yet. the lungs must have been the size of dimes. in and out, in and out. churning like a living, breathing machine. but he had no chance. he was too young. he wouldn’t last the day.

she held him in her arms, warming his body against hers. he couldn’t self-regulate his temperature, and needed to be kept wrapped up. his head was especially important. we needed to keep him warm and comfortable.

there was still a bulge in her abdomen. “twins,” i remembered faintly. she was giving birth to twins. the first umbilical cord was still clamped on the tray in front of her. the clamp handles dug into her thigh, but she didn’t seem to notice. the midwives were speaking to her in Tetum, but i couldn’t quite understand it. “push,” they must have said. “push.”

the second baby crowned. a minute later, it was out. a midwife pulled it out, cradling it in her arms. but it was already dead. it wasn’t fighting for breath like the other one. it just lay there limply–decidedly human, but at the same time not quite there yet. the midwife turned away, cleaning it off. this one had no chance.

there was blood, of course. so much blood. both clamps were now dangling in front of her, hanging over a growing pool of blood. the placenta came out next, sliding onto the tray with ease. a nurse wiped the remaining blood off, wrapping everything up in a blanket. the blanket went into a plastic bag, and a sheet went over the mother. the hard part was over now. both of them were out.

“i don’t know if she wants to see the other one. some mothers need to–they need to look at it for themselves. but others don’t. and i don’t know what she wants. here, it just happens so fast.”

the attending doctor had already taken off her gloves. the only other gloved woman in the room was standing over the still-breathing baby, putting its hands and feet in mittens. i didn’t mind. after all, i came here expecting–no, hoping–for delivery room experience. but nobody expects something like this. nobody walks into the maternity ward expecting to witness a scene like this one. and absolutely nobody would hope for this to ever happen. not like this. not to this poor, poor girl.
___

its head was so big. disproportionately heavy, even for a baby. i wrapped it in a soft, baby-blue blanket. “watch the head,” the attending doctor kept telling me. i repeated it to myself, over and over again. watch the head.

this one felt even lighter than the last. not even 500 grams, perhaps. maybe not even a pound. i held its body with one hand, cradling its head with the other. it was just a few feet to the mother, but it felt like so much longer.

she watched silently as i laid it on her chest. she held it to her bare left breast. for a minute, she just stroked its face with her index finger. such a tiny, precious thing. so fragile, and so innocent. but soon, she started crying.

what could i say? what could i even think? even if there wasn’t a language barrier–even if this was america, or australia, or england, or even indonesia–even if we could have put one these children in an intensive neo-natal care unit, maybe given them a chance–what could i possibly hope to do here?

for the second time in maybe half an hour–good lord, it seemed like ages ago, that Margaret’s friends had come into the office asking for her–i simply didn’t know what to say. this time, i could blink and smile; i could pat her arm. i could hand her gauze to wipe away the tears. but i couldn’t say anything to her. nothing i said could comfort her. at the time, i didn’t even have the will in me to start praying.

i gently touched her hand, motioning towards the other baby. she nodded back at me silently, tears still shining in her eyes. i took it back up into my arms, carefully cradling its head just like before. off you go, back to under the heat lamp. next to your brother. back to sleep.

i laid him back down on his mother’s chest. we pulled the blanket back from his face, taking care to keep his head covered while exposing his cheek to his mother. remember, skin to skin contact was so important for preemies. it keeps them warm. the new mother’s skin, keeping her newborn baby warm.
___

the midwives could feel another mass in her abdomen. it was too oddly-shaped to just be her uterus. a third one? a triplet? none of us were sure.

but this one–the one who still lived–he was fighting so hard. he wanted so, so badly to live. but we knew we wouldn’t. at the end of the day, everyone knew, despite his fussing about, despite how hard his chest heaved in and out with every breath–that he was going to die.

a lab tech came in to draw blood. they needed her hematocrit, to make sure she hadn’t lost too much blood during the birthing process.

he tied off her right arm, and found a vein. the needle went in, and the blood came out.

she didn’t even notice.

she just lay there.

i asked the attending doctor if she’d had an epidural.

she responded flatly, gently–with no hint of sarcasm or malice in her voice.

“i think she just has other things on her mind.”

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