Another night in the hospital last week has passed, and I again think about how weird and different practicing medicine is in Kenya, even in our great Kijabe Mission Hospital. The nigh of obstetric call started with handover. This is where the doctors who are leaving, but have covered the day, “hand over” the care of the patients in the hospital to the doctors covering the night. As I listened I felt my stomach drop a little as I realized the night would begin poorly. There was a young mother in the hospital whose baby had fetal hydrops which is a problem in which an en-utero infant for a multitude of reasons has swelling all over the body. These babies do not do well. She needed emergency delivery at 27 weeks of pregnancy, and we knew the baby would likely not be able to survive after delivery. Even more problematic was that she had a scar from a previous cesarean section which meant that we were going to do a preterm surgery. These usually go well, but they have their own increased risks. We took her back to the OR, and as I delivered the baby’s head through the uterine incision it looked so perfect, and I thought nervously that maybe we had the diagnosis wrong. But as the rest of the baby delivered the terrible swelling over the rest of the body was very obvious. He lived just 10 minutes before dying.
I came out of surgery to hear that a twin pregnancy that had arrived just a bit earlier had been evaluated and only one heart beat could be found. I placed the ultrasound on her abdomen and confirmed that one of the twins had passed. The mother cried as I told her, and her husband looked angry wondering what had changed in the last 10 days when her last appointment had shown two healthy babies. What could we say? She went quickly for an emergency surgery, and on delivery the first twin showed signs of having died several days prior. Its hard for a pregnant woman with twins to sort out the movements of her babies. She could not have known that all she was feeling were the movements of one of them.
Obstetrics can be a great joy when it goes well. But when it is bad, it is so sad. God help us all to show compassion!