Just when I get that tumbling sensation right before you really fall asleep, the sound of my phone pulls me out of it. “Ma’am, this new patient, the babies heartbeat is very low ma’am!” While asking for some more information, I dive out of my mosquito net and swiftly walk to the hospital. The walk is just the right amount of time to organize my thoughts, the moment I step into the labour ward I can act immediately. Luckily the woman is fully dilated, so I decide to do a vacuum delivery. The baby needs a little bit of help with breathing, but recovers nicely. As you can imagine, the sound of a strong newborn cry is very soothing on moments like this.
While I’m still standing over the newborn, in the corner of my eye I see a woman coming in on a stretcher with something small and grey between her legs. While my mind is still trying to figure out what it just saw, I step towards her and realize that it is a tiny preterm baby partly delivered in breech. With some difficulty I deliver the head of lifeless body, and even though the umbilical cord had stopped beating for an unknown time already, to my surprise the baby gasps for air once. I quickly place it beside the other baby on the bed and start resuscitation. I cannot help but laugh out loud when this little creature turns pink and grabs my hands to push away the mask I have placed on his mouth. That cry! The difference in size is remarkable to the other baby, but the preterm little one is easily compensating for its size (not even 1,3 kg) with the sound of its cry. Unfortunately this one will need more strength than just a strong cry to survive the next few days, but I won’t let that thought cloud the joy of this moment.
After seeing some new admissions I go back to my bed. An hour later I am called again, this time it is a woman in labour who has had a caesarean with a previous pregnancy and is now in labour again. The heartbeat of the baby is not very good and she is having pain near her scar. I decide to do a caesarean again. When I open the abdomen the baby’s hand waves at me even before I have opened the uterus: her uterus has ruptured! Luckily I was just in time and I can quickly deliver the baby and repair the quite extensive damage.
Later that night there are a few more admissions, and two other caesareans. When I look outside after finishing the last one, I see that the sun is rising already. Within half an hour my day shift starts. When I walk home looking forward to a quick bucket shower, I pass Inge who tells me that the gas is finished so I won’t be able to heat the water on the stove... Oh well, I guess cold water will wake me up more anyway.
Shifts like this are not really an exception, but somehow we manage to just continue. It is when the stories don’t end well that I notice that I am tired. When a woman arrives for an antenatal check up and tells me she hasn’t felt her baby move for a few days, I suddenly hate it all. My ultrasound confirms what I feared; her baby has died inside her. Was it the severe anaemia? Was it an infection? I don’t know, and will not find out. But it happens too often, and when I am tired I physically hate it. I hate the fact that she is too poor to eat healthy, too poor to take time to come to regular check-ups, that there is nothing I can do and even I couldn’t have prevented it, that her culture does not allow her to cry about it longer than a few minutes, that I can’t talk about it with her because of the language barrier, that her family gets to hear it first and sometimes waits to tell her quite some time. I have to look away, swallow away the lump in my throat and then just continue. There are 6 more women waiting for an ultrasound and even more on the way. Maybe among them there is one that I can help again, a malfunctioning placenta that I can spot before it stops working and induce labour earlier.
On my way home I walk past the nursery to see how miracle baby is doing. The little fellow is still there, frantically waving its little arms. Smiling again I walk home, looking forward to a night of undisturbed sleep, a night without phone calls. It’s the many little victories that count.