A Real-time Google Chat Between Aviva and Tracy Romm
4:29 PM tracyromm: nice day?
4:30 PM me: strange day…got invited to go into the community with the midwives. this was especially good timing since Geoff woke up with a not-too-fun GI thing and wasn't gonna do much good on L&D. so i went….we have been wanting to do this since we got here and today is the first opportunity. Just sorry Geoff couldn't go. And remembering we ate popcorn out of the same bag last night which we joked about because he was already feeling kinda’ not so great yesterday…
The trip into the community was way the heck out in the countryside about 45 minutes from here.
tracyromm: tell me more
me: it was me, 2 nurses who didn't speak a word of English, a driver (Haitian of course, no English) and fortunately James, the translator who found me this morning to see if i needed any help.
tracyromm: right
4:33 PM me: a young nurse who is going to be here for a year asked if she could shadow me and Geoff today and I'd said sure so she rode along, too.
tracyromm: so how was it strange?
4:34 PM me: we got into a pick up and listened to Haitian radio the whole way — music and church preaching. it was a bumpy ride (right now I feel the bruise where I bonked myself) in a pickup with a cracked windshield. some roads had potholes as big as a car so there was some swerving. and of course no seatbelts
tracyromm: ah, an adventure. my first thought was about the car ride
4:35 PM me: we get to this clinic in the middle of nowhere. I'll send a few pics
tracyromm: do Haitians drive like Jamaicans? with no abandon?
4:36 PM me: no, more careful driving than that by the hospital staff, but didn't I tell you the other day about the lady who got crushed right by a tap tap (bus) right in front of the hospital and needed an emergency amputation? the thought did cross my mind today…
anyway, the clinic is barely a building. one of these places that looks like it could serve as a medical facility in the bush somewhere. or a place in a movie or on the news where prisoners are taken in some foreign country to be tortured and disappear if you know what i mean. It does not have 4 walls…
tracyromm: got the pic, yup
4:37 PM me: anyway, we get there and it's ME doing to the clinic. I get taken into a spare but clean exam room, given the big old leather chair behind a large old oak desk, some charts, makeshift scraps of paper to write scripts on, and the interpreter talks me thru the prenatals. I taught the young nurse how to do a basic prenatal exam.
ok, then the pickup which had gone off with the nurse and driver to get some unesco or unicef “pudgy packs” which are these calorie and protein dense packets of peanut butter mixed with nutrients, returns for us. These nutrition packs are important. There is kwashiokor here, tracy, HERE, just offshore of Florida!
So in the backseat of the pickup they've got this mom whom they found by the side of the road with a baby in her arms and they want the doctor to take a look at the kid. Ok, so that's me, right?
4:39 PM tracyromm: getting more involved by the minute, or keystroke
4:40 PM me: oh I forgot one part. you'll need the comic relief later, trust me. on the way before even getting to the clinic in the middle of NOWHERE Haiti we are stopped by 3 guys who are using a branch as a make shift road-block. they've got this big branch across the dirt road and said the government won't fix the road so they are and they want people to pay money to pass. all the Haitians in the front seat have no money and are just sitting there like whadda we do. so I asked James the interpreter how much and he said a dollar so i gave the guys a dollar. (that becomes part of the story later on the return when I also gave a dollar)
tracyromm: wheee. welcome to Haiti. reminds me of my first trip to JA except that was a real roadblock. one dollar. geez.
4:42 PM me: anyway, I get in the back of the pickup next to this gorgeous young 19 yo Haitian mom of 3 kids – her oldest being 7 years old i think she said, or was it 5 yo, anyway, either way the math is simple and astonishing.
so I take a quick look at this way too itty-bitty 18-day old baby. the mom pulls off the baby's hat and I am looking at a funky crushed infected skull base and I'm thinking, shit, I'm in way over my head. I wrap the timon (= baby/child in Creole) and give her back to her mom, with reassurance that we are going to help. As we start driving and I call Geoff and we get to the road block on the return trip I tell him “Hold on we're at a road block and I have to pay money to get through” and later he tells me he thinks “Oh shit, my resident is gonna get kidnapped because I have diarrhea!” I laughed fit to split when he told me that 'cause I wasn't in peril at all!
I tell him whazzup, and mind you I've not eaten yet that day except a few almonds and raisins and we have no water with us and by now it's like 2 o'clock. we get back to the hospital and do a thorough eval of this baby and get more of the story now that I'm not in a pickup on a bumpy road and can hear the mom talk and have the interpreter near me and her not in the front seat as he was.
tracyromm: I hope you are high tailing to the hospital. why call? to get him ready?
4:45 PM me: oh, I called Geoff to make sure he would be able to help me and not too sick and so he'd have his thinking cap on by the time we arrived and so that he'd be ready to meet me at the pedi part of the hospital. we actually stop to pick him up and the nurse grabbed a coke for me at base camp so I could hydrate a bit….
so the story is that this 18-day old baby was actually born at 7 months of pregnancy. the mom tried to get to the hospital on a motorbike when she realized she was in labor, but ended up delivering on the motorbike and isn't sure if she hit the baby's head when it was coming out. It is really hard to get to the hospital here; remote, few cars, few phones…
so now we're thinking infection? burn? Giant lymph nodes: mumps? Tropical infection? The baby also has a giant birthmark all around the area and it's not normal. so maybe cavernous hemangioma has ruptured?
tracyromm: that is a devastating story
4:48 PM me: Yeah…you do and you don't get used to them here…
So while I'm holding this tiny little baby girl – her name is chiffi – and trying to be oh so tender to her, and trying to get her a spot in the hospital, Geoff goes to find this neonatologist who is visiting for 2 days and he comes over and confirms what I'd said in the car that we were looking at open skull (and adds that the fluid that was coming out was CSF), and as I speculated to Geoff and he'd concurred, that maybe this was a ruptured cavernous hemangioma now superinfected into the skull and possibly brain. The neonatologist says nothing can be done, even if we were back in the states, “the baby's a goner” he said. so I wrap the baby and take mom and baby outside to sit somewhere more private. rick, the neonatologist is clearly overcome emotionally and just devastated and shocked at what he is seeing here in this live action moment.
I give the mom my coke and rick goes to get one of the interpreters so I can give her the news, which I've been asked to do and which is appropriate. I'm a mom, I brought her in. she knocks back half of the coke like someone who hasn't eaten in awhile (during the ride to the hospital she'd confided that she had no food at home for her children) and while she's chugging I have this weird screwed up ironic mental image of being in a Coca Cola commercial, you know “have a Coke and a smile” – the nice white doc giving a Coke to a poor Haitian mom only it's over me about to tell her that her baby daughter in going to die in the next day and there's just absolutely nothing to smile about in this situation.
the neonatologist comes back with the interpreter and walks away because he's really sad. Geoff comes over and stands by where I'm sitting with the mom and her baby, whom she is now tenderly dressing back into her little tiny clothes. and I am telling the interpreter what to say and he just can't believe it and he tells me he cannot tell a mother her baby is going to die. and I said we have to and I don't speak enough Creole so I know this is so hard but I really need him to tell her so I know she understands. The mother is clearly not getting that there's nothing we can do to help her baby. Finally she starts to get it. It sinks in. But true to my experience of Haitian patients her countenance remains cool, calm, stoic. There's some mixture of denial and resoluteness.
4:57 PM tracyromm: you ok? can it get sadder than that?
4:58 PM me: Sadly it can get sadder than that here. We've got a premie in the NICU we've been taking care of. His mom died in childbirth…This Haiti. It seems it just keeps getting sadder!
Interestingly, it is clear that this young mother does not want to see or hear our sadness for her situation because in her mind, God can save this baby if God wants to. So through the interpreter I honor her belief by saying, “It's in Gods hands,” which is how Haitians seems to accept things going one way or the other; it allows hope and it also allows acceptance. Not my religion or language, but really important to support.
Geoff gives her money from his pocket as she has literally nothing, and otherwise there is no way for her to get the 45 minutes back to home. Another woman appears from nowhere. It turns out it is her sister (whether literally I don't know, but I'm just so glad she's not alone). We didn't want to just have her go 45 minutes home alone in a tap tap! The other woman just happened to be at the clinic that day. She might be pregnant. Couldn't tell for sure.
The momma has the remaining coke in her hand and turns to give me the rest for me to finish and she thanked us very much. I told her to keep the coke and she handed it to her sister who began to drink it as they walked away….More Coke commercial images give me this sense of irony that blunts my sadness for the moment…
5:00 PM tracyromm: resilience, or resignation?
me: It's both, T. How the hell else do you survive in a place where middle class means that you have a roof over your head – literally even if you have nothing else – just the roof!
5:14 PM tracyromm: gotta run. maybe we can connect later.
5:15 PM me: yeah. we might go to deliveries, but if not let's catch up around 9:30 ish. want to tuck in earlier and read this evening. Family medicine is amazing, eh? Truly cradle to grave medicine, though sadly in this case that only encompassed 18 days for this tiny girl. So glad to be a family doc and midwife. It's an amazing combo in a place like this…Anywhere, really.
5:16 PM tracyromm: indeed. xoxox
me: ciao! xxoo
All photos in my blogs from Haiti were taken and shared with permission
