breech

32 years ago today, my mom produced.  She was 26 years old.  It was before malpractice insurance was sky high for obstetricians, before childbirth and parenthood and access to information were what they are now.  But my mom had been around the block.  Not only had she produced (the african version of "given birth to") me 20 months before, but she was working as a Labor and Delivery nurse at the time...so when the nurses told her that the baby she was in labor with had turned since her last appt. the week before (which "they" say never happens) and was presenting in breech position, she knew a few lives were at risk, both hers and the baby's. 

She was less than two miles from home (a 7 min. car drive away according to Google maps - about right from experience) in a teaching hospital, not only with experienced doctors, but a host of doctors in training (residents) and medical students and, of course, nurses.  One of the residents came into the room, intending to deliver my mom's baby, but my mom knew better.  My mom, who is never rude to people she doesn't know and bends over backwards not to appear to be so, said to the "youngster" - "Don't take this personally, but I'm waiting for the attending."  And she did.  Although I'm not sure how long.  I'm also not sure how to spell the Dr.'s name, but from the stories it's pronounced "Toddy."  She knew Dr. Toddy had been around the block too, and she knew that the difference between experience and lack thereof in this situation could be the difference between life and death.

Dr. Toddy came.  The first of the baby to come were the feet.  They were blue.  My dad started to cry.  It wasn't until Dr. Toddy skillfully delivered the rest of the baby boy's body and he began to cry that the tears turned to tears of joy.  They named the 9 lb. 13oz.  bruiser, Jeffrey Kurt. In Lutjens fashion the boy's middle name was that of his father.  It was December 14, 1980 - St. Louis, Missouri.

The rest of the story goes that when my dad went home to look after me and brought me back to the hospital, I looked a hot mess waddling down the hall dressed in red corduroys with a pink sweater and spaghetti sauce all over my face...but I digress...the story's not actually about me for once...

Fast forward 32 years.  It's 7pm on November 28th, 2012 - Mbari, South Sudan.  Citi is 23 years old.  She has just begun laboring with her firstborn.  Her husband is around and is active in the community as a Community Based Distributor (CBD) for first tier basic community medicine interventions. Citi's mom, the grandmother of the baby, is a TBA (Traditional Birth Attendant) and is present to deliver her grandchild.  Citi labors at home, in a mud tukul with a thatched roof.  It comes to 10pm and the baby starts to come - the bottom is first...eventually the feet come...but everyone knows there is a problem.  The rest of the baby won't come...hours go by.  The phone network is poor, often calls are dropped or the reception is close to un-intelligible.  Mbari is what you call "the bush." Attempted calls are made all night to reach anyone who could send a vehicle to get Citi and the baby to help.  No one can find anyone with a vehicle to come.  Someone gets a hold of James.  

James is Citi's paternal great uncle.  His late brother was Citi's father, so now James is the one "responsible for" Citi and her well being.  James is a primary school head teacher and a pastor in the Episcopal Church of Sudan.  James lives near Mundri, where the phone network is a bit better, and knows Bishop so he manages to get through to him on the phone to request use of Bishop's vehicle to rescue his "granddaughter." It's now 7am.  Citi has been in the process of delivering her firstborn for 12 hours now.  Bishop is on his way to the bus park, headed to Juba.  Our teammates drove him to the bus park and he passed along the request for vehicle assistance to the teammates who gave him a ride.  Bethany knew James and John was willing to drive, so they set off, not know what they would find when they arrived at Citi's house.  They knew she was in trouble, that the baby was breech, but that was it.  Both Bethany and James are brilliant individuals, but neither has a lick of medical training, and with both the mother and baby's lives in jeopardy, they were wisely feeling outside of their comfort zones.

When "Brown Sugar" our beloved passenger Land Cruiser reached Mbari, Bethany went inside the tukul and there were 25 people standing around Citi, who was laying with a gray baby laying between her exposed legs, head still inside her body.  A dead, not yet fully delivered baby.  Not something a nurse sees everyday, let alone a teacher/counselor and a water engineer.  Bethany and John's instinctually accurate fear told them they needed to get moving, if the mother's life was to be saved.

Citi and her not yet delivered baby, still on the mattress she was laying on, were carried outside and laid into the back of Brown Sugar.  Her mom climbed in next to her along with another female relative.  Citi's husband, James, Bethany, John and another male relative, climbed into the front 2 rows of seats and took off towards help.  John was at the wheel.  Bethany was manning the phones - hers and John's,  trying whichever would get the best signal at any given time, on whichever network happened to be available at that given time.  She managed to get a couple calls through to Scott, the PA, but the reception was terrible and he couldn't understand much of what was needed other than the question of whether the Mundri Health Center would be able to help Citi or if they needed to drive further on past Mundri to Lui Hospital where there is a doctor.  Scott decided he was pretty sure Mundri would be of no help, that unfortunately Lui was the closest place Citi could find the help she needed and that was about 45 min. past Mundri.  He also decided the 2 of us could be of help once they came through Mundri, and after asking if I was willing to go, which I of course was, he gave me instructions as to what supplies would be good to have on hand in the vehicle...IV start supplies, and IV fluid supplies and where I might be able to find them in the house.  He went to confirm at the Mundri Health Center that Citi needed to go to Lui, and I hurriedly gathered supplies...thinking of a basin at the last minute in case there was a lot of blood and the baby was going to be delivered in the vehicle so that we could try to limit blood spread and have something to put the dead baby in.  Thing is, I had just set my laundry to soak in my basin, intending to wash it sometime that day (obviously that plan was slightly waylaid at this point), so I ran by Andrew's tukul asking for his, so he dumped his dirty laundry out and off I went with a basin full of IV fluids and needles and syringes and tape and such.  Scott went of to find more fluids and we met at the roundabout where I'd told Bethany in a very crackly phone call that we'd be waiting when I confirmed with her we would need to go on to Lui.

Brown Sugar rumbled down the road towards the roundabout with dust flying behind.  Scott has one of the women in the back re-locate to the front to make room for us next to Citi.  I climb in first to be closer to her arms, and Scott climbs in after me, positioned to examine the baby and the rest of Citi to see how dire the situation was.  We were told Citi was in and out of consciousness along the road, which worried us, but other than that, we knew nothing.  As we were arranging in the back, John got out to return to his work, and Bethany took over at the wheel.

I started opening cannula packing and putting gloves on to put a couple IV's into Citi veins for fluid replacement since we knew that in 12 hours she had to have lost a LOT of blood.  Scott lifted up Citi's skirt, and we both got a look at the gray baby girl basically hanging out of Citi's body.  There wasn't any bleeding currently, thank God.  Deep breath, and I went back to my task of IV insertion, knowing I was just wasting precious time by looking/pausing.

Now, if any of my nurse friends are still reading, they will gasp or laugh at the fact that I was the best choice available for the person to put in 2 emergency IV's in a severely dehydrated woman while bumping along a TERRIBLE dirt road in the back of a vehicle!  Venous sticks are NOT my strongsuit.  Never have been.  But today was a day for prayer.  I learned from Michelle K. back at SLCH the short prayer of "Sweet Jesus, please!" when a patient really needed an IV and veins were few and far between.  Citi's were TINY.  The "Sweet Jesus"prayers began as I wrapped the glove around her forearm as a tourniquet.  (Scott told me later he was praying like crazy too!)

The few IV skills I do have work best when I can see the veins really well, so I asked Bethany to stop the car for a minute and in I went into her left hand with a #20.  I didn't think I'd be able to get the #18 in the tiny vein.  The first vein was shifty, but eventually by God's mercy (and it really was His mercy alone), I got a blood return and threaded the cannula in successfully.  Bethany started driving again and Scott had hooked up the fluids line while I was putting the IV in and so the water started dripping.  I held the bottle while he listened to Citi's heart.  She was tachycardic, which was good, so I went back to attempt the insertion of IV #2.  Bethany had to stop again for me to be able to get #2 in without poking Citi's eye out with all the bumps.

Bethany was a great driver.  It was a tricky ride, she knew Citi needed to get to the hospital ASAP - so she needed to drive fast.  She also knew that we didn't want the baby to come out while we were in the vehicle so she couldn't go too fast in fear of jolting the baby out and the mom bleeding to death in front of our eyes.  Bethany balanced all the factors with expertise, weaving all over the road to find the best path.  We decided on this trip to coin a new term.  Instead of "the grass is always greener" on the other side the South Sudanese equivalent should be "the road is always better" on the other side...it's a tricky business this driving in Africa, and Bethany totally rocked it!

An #18 IV went into Citi's right hand with relative ease and then all we could do was wait.  Scott held the 2 bottles of fluids dripping "wide open" into Citi's veins trying to giver her the water and sugar she needed to stay alive until we reached the hospital.  I had gotten motion sick as I focused on Citi's hands in the back of the jumping/bouncing vehicle, so I finished taping the IV and promptly stuck my head out the window and vomited several times.  I felt like a wimp, vomiting from motion sickness when this woman was lying here, no doubt in excrutiating pain, without making a peep. Scott asked Bethany to stop so I could shift to the front and in minutes I was nausea-free.  

Citi was alert and appropriately responsive throughout the whole trip from Mundri to Lui...about a 45 min. drive.  Can you imagine?  Riding in the back of a vehicle, with your firstborn child dead between your legs, who not more than 12 hours ago was kicking in your stomach, trying to let you know it was time for her to come out, with 2 strange white people hovering over you poking you with needles and looking between your legs with downcast faces...I can't.

As we were driving, as I was trying to look for the best vein, I heard a couple phrases of a song playing from Bethany's iPod up front:

"You make beautiful things

You make beautiful things out of the dust

You make beautiful things

You make beautiful things out of us" - (Gungor)

It was a song I'd heard for the first time just a few days before, when our teammates John and Andrew had done a harmonized duet of it at our retreat.  The first time, I'd been more ready to believe it's truth, this time, in the back of a vehicle with a laboring first time mom and a dead baby, I wasn't quite sure but was holding on with a white knuckle death grip that it could be.  That if there were to be something beautiful to come of this: God would have to be the one.  Please Lord, I silently prayed as the song played on, please make something beautiful out of this.

We reached the hospital - a 2 hour journey for Citi and her family, a very kind midwife met us as we backed the vehicle up to the delivery room porch.  Several people lifted Citi & Baby with their mattress onto a stretcher which they then pushed into the delivery room.  Scott and Citi's mother went in with her and the midwife, then the doors were closed.

Bethany and I waiting outside with the rest of the family.  At one point, the family said "the baby must be out, Citi made a noise and now she is silent."  A white doctor went in and out of the room a couple times...Dear Father, spare Citi's precious life, I prayed.  Bethany and I talked about loss and death in this place, the reality of women here and the reality of childbirth here...the distance from health care, the lack of vehicles, the public exposure of your body in such a situation as Citi's and in such grief, how Citi and her baby girl put "faces" to the numbers of "infant mortality" statistics, and the risk factors for pregnant mothers in this country...

We waited until the baby was delivered and brought out in a small cardboard box to be taken home for immediate burial.  We waited until we knew Citi was a bit stable and with her mother and the rest of us left and returned to Mundri by the same road.  We sat and mourned with wailing women who greeted us when we arrived with the box carrying the nameless baby girl.  We sang, we prayed as the small hole was dug.  We were served tea and we said our goodbyes.  Bethany and I took a couple people back 4 days later for the final prayers, an ECS burial tradition.  Everyone was so thankful to us for the help we provided, and we tried to re-direct the thanks to God - afterall it's His vehicle, His supplies, His  gifts in the skill sets we have.  I've heard Citi was to return home from the hospital this week, hopefully physically stable enough to have the freedom to do whatever remaining grieving she needed to do.

God made my wonderful brother out of the dust of fear my parents had 32 years ago, a beautiful thing indeed.  

14 Dec. 1981 - 31 years ago - Jeff's 1st birthday (as I look on)

Now my prayer is that he would make something beautiful out of the dust of the loss of Citi's baby girl...the dust of the disparity of resources in our world, the dust of death.