Hold Your Eyes on God

The phone rings at 1 o’clock in the morning. The voice on the phone is that of a school teacher from a community seven hours away by fast boat or two days by peque-peque, a canoe with a motor on the back. We are informed that a pregnant woman with significant bleeding and her concerned husband are traveling down-river in their canoe to seek care. Their current location and estimated time of arrival to the nearest health post are critical pieces of information that are unavailable due to the remoteness of their village and the lack of reliable methods of communication. The midwife and I set out in the hospital’s ambulance boat to the nearest health post, the unknown looming over us like the unpredictable gray clouds in the distance, unsure whether it will pour rain or gently sprinkle.

As we approach our destination the steering mechanism of the boat comes loose. Unable to find a solution, the driver operates the steer manually from behind and the midwife takes control of the throttle. We move just quickly enough to overcome the current of the river, carefully inching forward at a speed similar to that of the peque-peque traveling somewhere out there in the distant jungle. We arrive at the health post in San Rafael, a community about three hours away from Santa Clotilde and wait nervously for the arrival of the hemorrhaging woman carrying her unborn (or newly-born) child. Various images cross my mind. I see a pale, lethargic woman holding her crying newborn child in her arms, umbilical cord still attached, his cries drowned out by the whirring motor at the rear of the canoe. I see a woman suffering from grueling labor pains, reclining and bracing herself on the shallow walls of the wooden canoe, unsure if the water in the canoe is coming up from the river, down from the rain, or out from the fluid surrounding her baby within her womb- her profuse bleeding makes the distinction indiscernible.

An hour passes and a peque-peque is heard approaching in the distance. A quick mental calculation tells us they have been en route for just over ten hours, ten hours in a hard, narrow wooden canoe amidst the starlit night’s barely-navigable darkness and the jungle’s threatening, mercurial weather. As it gets closer we see a barely-conscious woman lying under a wet blanket and her exhausted husband sitting at the rear steering the canoe. There is no sight nor sound of a baby- she is still pregnant. Reality quickly erases from my mind the previously-held images of a crying baby and laboring mother. A group of young men run down to the shore to hoist the woman on a backboard and carry her into the health post where we wait expectantly.

Information about the patient quickly unfolds before us…
Twenty-something-old woman.
Name? A person, not just a patient.
Alert and oriented.
Spontaneous breaths.
Palpable pulse.
Fast heart rate.
Low blood pressure.
Low oxygen saturation.

Now it’s time to act…
Quickly.
Intravenous access.
Oxygen.
Intravenous fluids.

We need more information…
Second pregnancy.
Eight months carrying her child.
Lower body garments soaked in blood.
Cervix four centimeters dilated.
Abdomen without any palpable contractions.
Not in active labor.

And the baby? Two patients, not one.
No name? Also a person.
Doppler ultrasound to confirm baby’s heartbeat.
Long, apprehensive silence.
Alive? Uncertain.
Last time baby moved? No answer.
Connect portable ultrasound.
Baby’s head pointed down.
Baby’s heart still.
Continued silence, now mournful.
Trace amount of doubt- just one more look.
Continued stillness, now certain.
Deafening silence.

Silence broken- voices.
“Hemoglobin level five!”
“Blood pressure dropping!”
She needs a transfusion.
Reminder- hours away from the hospital.
No blood.
Wait anxiously.

It’s time to act again…
Quickly and regretfully explain to the couple their unborn child has died in the womb.
Redirect focus to concern for saving the mother’s life.
More intravenous fluids.
Another point of intravenous access.
Tranexamic acid, a medication to counteract severe bleeding.
Continuous epinephrine (adrenaline) drip to maintain blood pressure.
Ready!
Update- boat still out of commission. Another boat is on the way.
Wait some more.
Hopefully the other hospital boat arrives soon to take us back to Santa Clotilde.

***

It’s a two-hour boat ride back to Santa Clotilde. IV fluids, medications, and tubing, secured with stretchy disposable gloves, hang from the metal poles that sustain the vinyl ceiling of the boat that protects us from the rain. Blood pressure, pulse, and oxygen monitors rest on my lap, occasionally disconnecting with the sudden jerks and accelerations of the boat as I check her vital signs every fifteen to twenty minutes. I welcome the cool breeze as sweat drips down my face and neck while the patient’s husband gently covers her cold, shivering body with the blankets they have brought along for the journey. Though we sit only a matter of inches from each other, I sense an invisible and insurmountable distance between us- how can I possibly understand his pain, his sorrow, and his fear. Just as near to him as I lie his dead child and dying wife.

I regret the circumstances. I worry about the outcome. I feel defeated by helplessness. What can I possibly do? Where can I look for answers? Easiest thing to do- rely on my own capabilities. Hardest thing to see- I am only capable of so much. Hardest thing to do- trust in Him and His plan. Easiest thing to see- He is capable of so much more.

What can I possibly do? To where can I look? Impossible rings loudly and incessantly in the depths of my ears, its hope-consuming doubt working its way into my mind and faith-destroying self-reliance piercing my heart. But then, I am reminded of the simple act of faith and hope: to hold my eyes on God and leave the doing to Him.

She survives to the next morning and we are able to evacuate her to Iquitos by seaplane where she undergoes emergent cesarean section with hysterectomy. She returns one month later to Santa Clotilde en route to her village. It is by no coincidence that as I go for my afternoon stroll, I see them waving to me in the distance. Only this time, their faces are full of light and life. And though much has been lost, we are grateful that He has made the impossible possible.

“Hold your eyes on God and leave the doing to Him. That is all the doing you have to worry about.”

~ St. Jane Frances de Chantal

Christmas Season JOY