This blog was originally written in June 2016 but due to raw emotions I was not able to share it. Today, I want to remember what God did in my life through this traumatic situation and share this story with you.
The ambulance raced through each little town and group of houses, sirens blaring and horn honking. The driver was serious, even when the other drivers failed to yield. Jay, her mother and mother-in-law and I held on through the wild turns and the lerching slow downs trying not to get car sick or jostled from our seats.
“Thud!” we barely decelerated as the second “Thud!” rumbled beneath us. Mother-in-law and I looked out the back window, “Patay!” she almost shouted. Dead indeed, the big dog never had a chance against the speeding tires of ambulance.
This was my second ambulance ride in less than a week. My Monday morning started somewhat unexpectedly as Jared came in my room to announce that we had patients. Rusty had been expecting an elderly man for chest xray and check up, but instead, Jared told it was a very pregnant woman and her mother.
Jay (not her real name) is mute. The story goes that “something traumatic” happened to her when she was young and after that she never spoke again. It’s hard to imagine the emotional pain that could steal your voice, especially once you spend any time with Jay. Her ever-present radiant smile seems to reveal a heart at peace and a joyful spirit. Now 30 yrs old old, married for six years and an adopted mother to a 3 yr old daughter, Jay leads as normal of a life as any woman in the tribe. For her, it is truly a quiet existence.
Pregnancy and childbirth are fairly routine events in the tribe. The ladies aren’t too big on prenatal care, though most of them are seeing the rural health nurse several times through the pregnancy. If they don’t have their Mother-Child Book from the rural health nurse the paperwork to get a birth certificate is much more difficult. A generation or two ago few of the families in the tribe bothered with the legality and consequently many of the over 50 crowd do know their birth dates. It seems implausible, even sad, to someone from the outside, but once you understand their cultural simplicity it’s easy to see why it wasn’t a big priority for them “back in the day.”
Even so, Jay came to me when she suspected she was pregnant. A check up and a simple blood test proved what she already suspected was true. Jay was going to have a baby. Unsure of her last menstrual period date, the doctor suggested we have an early ultrasound for dates. After the first of the year, we found out that Jay’s baby would most likely arrive around June 24.
Jay’s tiny figure grew as the months passed. By late April she already looked near term, but a second ultrasound indicated the baby, a little girl, was right on target for size and due date.
This Monday morning Jay and her mom, who I’ll call Lucy seemed a little excited. As her mother, who is very hard of hearing, excitedly explained what was happening I only caught key bits and pieces. Jay was having pain, they wanted to go to Baptist hospital, but they came here first. I quickly dressed and took them into Baptist.
When we arrived their the nurse started to fill in the bits and pieces I had missed with the fast exchange at my house. Jay and Lucy had already been to Baptist, but they were turned away. The nurse instructed them to get me, but the problem was there was no room in the OB ward. I wanted the doctor to check Jay, because while I didn’t doubt that she was having pain, I suspected she was only in early labor. But for some reason, the doctor refused to even examine her and sent us to a provincially funded clinic in a neighboring town.
Lucy wasn’t too keen on this idea. She kept saying that if they go there they won’t get good care and that the baby might die. She was really distressed and that’s very unusual for our indigenous patients. I offered that we could try the Rural Health Center in the town center and that seemed more agreeable to them, so off we headed for the 15-20 tricycle ride.
I had never had a patient to the Rural Health Center. Since everything there is supposed to be free, patients usually go on their own. The staff greeted us at the door and they were very friendly to both Jay and Lucy and to me. Quickly the midwife whisked Jay back to an exam room, and then shouted something out over the wall that I didn’t understand. I was to understand soon enough, the midwife thought the baby was transverse. I confirmed that the baby had been breech at the last ultrasound, but everyone had expected she would turn naturally as the time for delivery came. An ambulance was called and soon we were on our way to Kalibo.
The ambulance came with a nurse and delivered us back to the village so that the hospital bag could be gathered. This took a little while, because despite having already gathered the baby’s things, they weren’t packed and no one had thought about packing a bag for Jay or her helper at the hospital. The family borrowed a backpack to pack the things in while I made Lucy a list of kitchen wares they’d need to bring for the hospital stay: 2 plates, silverware, 2 cups… at the very minimum. I forgot to remind them to bring bedding, blankets or sheets and pillows. After what seemed like a long time the drivers helper came to hurry them up and after checking that we had all the necessary papers for PhilHealth, we were off to the provincial hospital.
On arrival I was given a list of things to buy at one of the pharmacies across the street– two adult diapers (to be used as chux pads) and a shaver. I was also advised that there were no available beds, so I would need to purchase a folding bed for the mother and the child (rooming-in!). Within an hour of our arrival Jay had been checked by the OB doctor on duty, a well-dressed, soft spoken middle aged woman. Since Lucy decided to stay at home and send the mother in law, I became Jay’s voice.
The doctor wanted to know who determined that Jay was in labor. She was fingertip, less than 1 cm dilated and as I had observed in transit, not having regular contractions. I reported the events of our morning and the decision of the Rural Health Center. “Transverse?” the doctor asked surprised, “Well, let’s get an ultrasound and find out!”
Shortly the ultrasound revealed a healthy, nearly term baby that was in the proper, head-down position. By now it was mid-day shift change, so amidst the changing of the guard, we negotiated the “what now.” The doctor felt that Jay was not in labor, perhaps early labor, but possibly days from delivery. She offered to keep her, but knowing how crowded the ward was and how uncomfortable that was, I offered to take her home.
“There’s no reason to come back,” she said, “she has a healthy normal pregnancy, just have her deliver there in Malay.”
We headed home, somewhat disappointed as every late term Mom with a false alarm can understand, but assured that everything was fine… it was just not time.
Throughout the week we checked on Jay and the pains had quieted. Rusty and I had made plans to make a last minute run to Iloilo, a large city more than 7 hrs away by bus to deliver paperwork for the tribal preschool and to purchase a new sound system for the church that had been donated by a donor at home. I secretly suspected that Jay’s baby might decide to arrive while we were gone, but was assured that like most deliveries in the community, it would go just fine without me.
Sunday morning dawned sunny and fair. Our family attended church together with a faithful band of believers in the tribe. It was a beautiful morning of sharing testimonies and hearing a salvation message shared by the young indigenous lay pastor. After church we greeted several people and explained again about our short trip to Iloilo. It was just beginning to sprinkle rain, when Lucy came running out of the village to get me. She said that Jay was having pains for three days and needed me to come. As we crossed the small dirt path to her house the rain began to dump. Jared and Mark hid in a little shelter, an open air living room area built off the side of one of the neighboring bamboo and grass houses. I went to Jay’s house and as soon as I saw her face, I knew “this was it!”
I entered the house, first by sitting in the raised doorway, then swinging my legs inside. We sit on the floor in these simple homes, though Jay was pacing, clearly in labor pains. I explained that we should go to Baptist and Lucy and mother in law began re-packing a bag from Monday’s false alarm. We were mostly waiting for the rain to let up, and while we waited Jay had a bit of rice and a dried fish to eat.
The fast falling rain only lasted 15 mins, but had quickly made a slippery yet sticky mess out of the paths in the village. As we carefully navigated out of the village I prayed that we could find a tricycle. Jay was in no condition to walk the half mile to the main road. Before too long a tricycle came back to deliver another person home and we were on our way to the local hospital.
This time we entered through the Emergency department since it was 11 am on a Sunday morning. The same doctor from last Monday was on-call again, which is fairly unusual given the quick rotation of doctors at this rural hospital. I explained that Monday had been a false alarm, that she had an ultrasound that showed a healthy, head down baby and that I had personally observed contractions at about 4-5 mins apart for about an hour and half. Reluctantly, he examined her and said she was 7-8 cm, but noted there was swelling which he felt was because she had been in labor a long time. He seemed to already have his mind made up to send her to Kalibo and I was frustrated because I couldn’t understand why he wanted rid of her so bad. Was it because she was Ati? Because she’s mute? I put up about as much of a fight as I could and keep the valuable relationship with this fairly new doctor to our chief medical facility in the area…. He made a phone call and an ambulance was on the way. Again.
By 12 noon we were off. This time there was no nurse. I prayed out loud as we headed through Caticlan, for safety and no delivery until we got there! In 32 mins we were to what I’ve always considered the mid-way point and in only 1 hour, a trip that almost NEVER takes less than 1 hr 35 mins, was over.
The ER nurses recognized us right away. I gave them the update as they gave me the order for two more adult diapers and another shaver. We were starting all over again.
Before too long, the doctor arrived and determined that Jay was still 7-8 cm. Her contractions had remained consistent at 4-5 mins throughout the entire transit and as she lay on the uncomfortable exam table in the back, alone, waiting for the doctor. This doctor was young and sharp. She was kind to me and understanding to Jay. She decided to send her to the Labor Room and I processed the admission paperwork. Lucy and mother in law waited anxiously and unknowingly outside the ER exam room and then followed as the nurse wheeled Jay back to the Labor Room.
At the provincial hospital everything but the surgical suites is public domain. And by public, I mean, a lot of people. Patients must have at least one family member with them at all times, and most people have 3-4 despite what the signs say about one “bantay” (watcher or helper) per patient. The OB ward is always overcrowded in the free to very inexpensive public hospital and this day was no exception. The ER nurse asked if I had brought the folding bed that I had purchased earlier the week. I explained how it was left at home, (we were planning to have this baby in Malay!) and soon another nurse from the OB ward ushered the two grandmas-to-be to a tiny narrow wood bed in an area that was designed to be a hallway. There were beds all along the wall of this hall way and three in a L shape in the center. No one is allowed back in the Labor Room, so Rusty and I took this opportunity to get some much needed supplies for the family.
With the spare wooden bed, we knew we needed to find sheets, blankets and a pillow or two. We started out at an “ukay-ukay,” a Philippine second hand store that has mostly goods from the US or Japan. I wasn’t happy with the limited stock of twin size sheets (the bed was only about half the width of the US twin anyway!) and there were no pillows. Plus I knew the staff would be asking for the traditional Filipino layette, which includes a white side tie shirt, booties, mittens and a cap, plus a hooded blanket. We haven’t had much experience with birth in the hospital here, but had already seen the way the nurses tend to look down their noses at mothers who don’t have what are considered the absolute basics for their newborns.
So Rusty and I went to the mall and I bought the traditional layette for Jay’s baby girl. I even went “cute” and got a pink printed hooded blanket. We got a pack of newborn diapers and I found a great deal on a set of small pillows. I gathered up some sheet fabric and a new bath towel, too. On our way back to the hospital we got food for the grandmas who hadn’t eaten all day.
It was after 5 when the nurse moved the grandmothers to a newly vacant bed in the inside of the ward. There are 5 beds down each side wall and four on the short end walls. But the beds are all new, matching hospital beds, with nice step stools, a plastic matching dresser and a bedside table. This is a huge improvement over the old metal with no mattress beds that the ward used to have, where the mothers would grab up cardboard boxes to give protection from the metal springs.
Along the way, Rusty and I had made a change of plans regarding our trip to Iloilo. We still needed to go there, but now it was late and we wanted to make sure everything was OK with Jay and the baby before we left. We explained to the “lolos” (grandmothers) that we still needed to go to Iloilo, but that we would stay here in Kalibo tonight and be back first thing in the AM to see the baby and check on things. Knowing that birth can take a while, and seeing how tight security was around the labor room, we decided there really wasn’t much more we could do. Plus the crowded OB ward didn’t need two big Americans standing around looking stupid. 🙂 So we dismissed ourselves for the evening, left the grandmas with some cash, “just in case,” and promised to return to them first thing in the AM.
It’s always a stark change of realities, leaving the hot, crowded provincial hospital and traveling across town to a “tourist” style hotel. It used to really bother me. I could not find peace in the disparity and injustice. But as we’ve transitioned to a more “long term” mindset here, I’m more comfortable with the odd-synergy of the two worlds I live in.
The next morning we were to the hospital right at the 7 am shift change. Jay was in her bed, with only Lucy there, who explained very quickly (as in super fast Malaynon) that Jay had an operation. I heard the word “patay” but only once and I thought I understood her to say that they had to do the surgery so that the the baby would not die. She was calm and even though in physical pain, Jay gave me a big smile. The mother in law was missing, but Lucy explained that she went home, which wasn’t all that unusual either.
I went to the nurse station to get the rest of the details and to advocate for the much publicized “Mother-Child friendly” practices of rooming-in. The nurse at the desk said that they didn’t know anything about Jay’s case because her chart was with the doctor. Again, I didn’t find this unusual, cesarean deliveries require extra levels of care and I know that I’ve observed c-section babies spending the first day in the ICU just for observation. Rusty waited in the hall and I went back in the ward to wait with Lucy and Jay.
After about an hour a nurse came and got me. She asked if I would speak to the doctor. She led me to the female doctor’s quarters, where the young doc I had met the day before greeted me. She began to tell me the story of the delivery. She said that Jay had labored for a few hours and was ready to push. The nurses and even the doctor herself had instructed her about how to bear down and she had pushed for about an hour, when the baby’s heart rate became bradycardic (slowing down). The doctor said she immediately ordered for a cesarean delivery and that there was no delay in assembling the surgical team.
She explained that upon her first incision, before cutting the uterus, there was blood pooling out of the abdomen. Jay’s uterus had ruptured, literally top to bottom. The doctor explained that they got the baby out, but she was already dead. They attempted to resuscitate her, but it was too late. The doctor showed me a picture she had sketched of the rupture and explained how she discovered that the round muscle on that side of her uterus had also torn. She called in the general surgeon to make those repairs and they placed a drain through the abdominal wall to aid in the healing process.
I stood there almost dumbfounded. I thanked the doctor, who genuinely seemed sad to have to tell me this news. She assured me they did everything they could and that she really wasn’t sure what could have caused such a traumatic rupture. She also said that she was able to save the uterus, but any future pregnancy should be monitored as high risk and a cesarean scheduled well before labor begins.
I walked back the hallway, lined with folding beds holding new mothers and tiny babies, and found Rusty. I said, “they lost the baby,” and he said, “What?” and I explained what the doctor had told me. We both looked at each other with kind of a “now what” expression. We had never had a hospital loss before. For a few minutes we talked about what might need to happen to get the baby’s body released and decided to ask for a social worker at the front information desk. As we walked back the hall I felt the grief wash over me and told Rusty, “You’re going to have to do the talking. I am going to cry!”
Soon a kind social worker was walking us through the paperwork, first by looking Jay up in the computer. She offered to go back the OB ward with us, she wanted us to get the husband to come bring the baby home. It was then I we learned that in the early morning hours, the mother in law had taken the baby in a cardboard box back to the tribe with the money we had left them the night before. By now, word would have already reached the village and the husband would meet his daughter, in a carton, hand carried by his mother, home to her final resting place.
I am taking this loss much harder than I thought. The first two days were the worst, I’d be going about my business and suddenly a picture of her tragic delivery and that awful moment when everyone realized she was gone… would flood my mind again. There were plenty of “what ifs” and questions if we had done the right things. Knowing that this kind of thinking is faithless and maddening I again turned the Lord for my strength and comfort.
Today, Jay is still recovering at the hospital, 2 hrs from home. Her husband buried the baby alone on the mountain. Our lay pastor offered to go with him but he said he needed to do it alone. In tears, he laid his daughter to rest along side the others from the tribe in the mountain cementary.
After we got back from Iloilo, another elder in the tribe came and told us another part of the story. A few years ago (no one is sure when but probably 5 yrs ago) Jay and her husband lost another baby. I was dumbfounded again when we learned this information. How could we have cared for this woman through all her prenatals and ultrasounds and not known this piece of relevant information? Often what we deem as relevant, they do not see as important. It’s not a language barrier, because we’ve seen it with dual language, educated people who’ve doctored with multiple doctors yet failed to share important, relevant facts. We strive for excellence and its hard to know that we don’t always have all the information. With this, like so much here, we must trust that God has a plan and His good will never be thwarted.