Thursday, February 8, 2018

Maternal death hits home

A week ago tonight after we were in bed awhile, I heard the big metal door slide open and the Land Cruiser leave the compound. I remember thinking, "Who gave permission for someone to take the Land Cruiser- at this time of the night?" I forgot about it until maybe 30 minutes later when there was pounding on our door.

It was Stecy, our volunteer coordinator. She said with urgency, "Dr. Steve, Perrine needs you at the hospital. Someone is seizing." Steve dressed quickly and hopped on the moto with Judnell to go to the hospital. I was thinking that Perrine knows what to do about seizures--MgSO4 injections and hydralazine--- so maybe it is worse than usual and the patient is not responding. But seizures  themselves don't usually kill women. It is the organ failure from the excessively high blood pressure that kills them. The brain swells, the kidneys stop functioning, and the lungs fill up with fluid. I felt that Steve would have good suggestions about what steps to take to reverse these and fell back to sleep.

Some time later, I woke and wondered why he was not back. I heard low voices in the kitchen so I opened my door and saw Steve and Phu sitting at the kitchen table. I walked out to see why they were still up in the middle of the night. Steve looked at me and said, "She died." I could see he was upset. I asked, "Who?! Why?"

The story of the death of our student, Guerline Adeka started way before that day. She was pregnant through most of the last 9 months of the class and due two weeks after graduation. But for some reason, she spent about 4 days the week before this night in the hospital with ineffective labor pains-meaning she was not dilating. So a doctor did a C-section. All seemed well. She and the baby went home. A postpartum visit was done. All seemed ok.

Monday and Tuesday were review days for the class. Guerline did not come but everyone understood. Major surgery 3 days before would not make sitting in class for hours very comfortable. But she did come for the exam Thursday morning at 8 am sharp. She was determined to put a lid on this year's work. Determined to graduate with the exam behind her. Perrine, our clinical director, asked her how she was doing. She told Perrine she felt short of breath the night before. Perrine said to call if she felt worse.

So she did. She called Perrine about 10:30 pm. Perrine took the vehicle and went about 2 miles to pick her up. Guerline was in respiratory distress and kept saying she could not breathe. She was panicking and Perrine stopped on the way to the hospital to get some money because she knew oxygen would be needed and one has to pay for that. Within minutes of walking in the hospital, Guerline collapsed and was gone. Perrine started CPR, anesthesia intubated her so they could get good ventilation. When Steve arrived he could not find a pulse but he helped Perrine do CPR longer. Perrine had the desperation one feels when you know and love your patient and when you are saying, "This CANNOT happen! NO! It did not bring Guerline back.

No one slept much the rest of that night.  As medical people do, we discussed what happened to Guerline. Probably a Pulmonary Emboli happened. Its a risk of any surgery, thankfully rare. And here in the U.S. we also lose mothers after C-sections due to PE's. There was some discussion about heart failure from cardiomyopathy but that probably would not have taken her in an instant like a PE can. And was it a necessary C-Section?

I woke in the morning to wailing. As the students started arriving to review the exam with Cindy, they learned that their friend and colleague had died. I have never heard such wailing by so many people at once. It was heartbreaking. It went on for hours. It was so so sad. We gave hugs, served coffee, held each other. Later in the morning, some students started singing. Mixed with the sobbing, it was sweet and comforting.

I thought about how Haitians know how to grieve. There is no hiding how they feel, no burying their emotions. The grief is there for all to see and hear. I also wondered if the weeping encompassed all the sad things, all the losses, all the injustices they had ever experienced in their lives. Grieving is the only way to get to the other side. And we never quite arrive on the other side. We are never the same when we experience great loss. It marks us for life. It changes us.

One of the most striking things about Haitians that anyone learns when they spend time with them is that they are some of the strongest people I know. They have an incredible ability to feel deeply, to express themselves vividly. They know how to live in joy regardless of their circumstances. They can dance and sing with grace and skill and beauty.

That is why, later in the afternoon, the maestro led the students in practicing their singing for the graduation ceremony. It was a bit more subdued. He could tell it was not easy. But sing they did. Life must go on. They were graduating from a difficult course of study and work. They had spent hours in the hospitals and birth centers learning from women. They had sat through days and weeks and months of classes. Graduation would bring a new life for them and their families.  The work they were called to do will save lives. They know that deeply. They will do it for Guerline.

And they would sing. They deserved to sing. They needed to sing.

This is why I love Haitians. They get me in the heart and soul every time.


  1. Thank you for sharing this heart-wrenching tale. The singing is beautiful. Those who hear it, will be singing along for a long, long time.

  2. Thank you, Nadene, that was very eloquent. We are still feeling the sadness, but hopefully it will make our graduates even stronger.