This Too Shall Pass

The following was written by Ben Trappey, MD, fourth-year medicine pediatric resident.

Last week was tough. It seemed that death was everywhere. And I was all alone. Nearly every afternoon last week, after the Haitian doctor who works the day shift in Urgence, as well as several of the nurses, had gone home, and I was preparing to end my day, someone--a father, an aunt, a grandmother--would hurry in carrying an infant wrapped in a towel. I've learned to fear the sight of a small bundle wrapped in a towel.

It seems that most women in Haiti give birth at home. I suppose the majority of these home-births go well and the babies do fine.

I don't get to see those babies.

In Haiti, it's not easy to get anywhere quickly, and most people don't own cars. So when something goes wrong with a birth at home--the baby too small, too weak to cry--these family members make their ways to St. Damien however they can: on the back of a motorcycle or in the back of a tap-tap (the garishly-painted vans and pickup-trucks with seats in the back; the Haitian equivalent of a bus), holding their bundles wrapped loosely in towels, moving as fast as Haiti will allow.

But it's rarely fast enough.

The Haitian tap-tap

Last week, when I would look into the towel, I would invariably find a dead or near-dead infant--cold and cyanotic. Usually premature. All born hours earlier. If they had a heartbeat, I would give them artificial breaths and try to warm them up to see if they would start breathing on their own. Unfortunately, none of them did. Every day last week ended the same way. Any victories, any "saves" made throughout the day, any feeling of accomplishment over a child helped were wiped out at the end of the day by the crushing sense of hopelessness as I tried (despite being aware of the futility) to save those babies who had been so cold and so blue for so long.

This week has been much better.

A group of two residents and two attendings from the Children's Hospital of the King's Daughters in Virginia arrived on Sunday, and at least two of them have been in Urgence with me at all times this week. Fewer of these infants have come in this week, but we've had our share of very sick children, several of whom have died. Still, it has been different with extra people here. Extra hands to help with procedures. Other minds to discuss treatment options. Other souls to share in the joy of the victories and the grief of the failures.

Yesterday, an 8-month-old came in with severe respiratory distress, to the point of being unresponsive. Less than 5 minutes later, a mother brought in a 9-day-old infant who was also unresponsive, hypothermic, incredibly pale, and had been transferred from another hospital because he had been bleeding out of his umbilical cord stump for 2 days.

Luckily, we had enough people available for one to be able to stand there for 30 minutes and give the 6-month-old continuous breathing treatments, to which she, thankfully, responded, another to hold pressure on the umbilical cord and warm the baby, and another to run the 9-day-old's blood to the lab and insist that they check the hemoglobin and blood type immediately. The hemoglobin was 3.5. (Hemoglobin in a child that age should be somewhere around 12 or 13, and back home we typically transfuse before anyone gets much below 7.) We were able to transfuse her within 30 minutes of her coming through the door, and she quickly woke up and started crying.

Today, both children were alive and well. I have little doubt that if there were not so many of us there, at least one of those children would have died. So, those were saves. Victories. I'll enjoy them while I can.