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  • Kacie

From Breath to Life

I pull up in my van and see my son running out the front door to greet me. But he knows not to hug me. I’m still in my scrubs.

“Hi mama,” he says, putting his arms out. “Don’t worry, I won’t touch you.” He hugs the air instead.

He can’t see it but I’ve got fluids from at least two different people’s bodies on my clothes. Blood and amniotic fluid.

Blood from that first delivery where the student forgot to put a cotton swab over her failed IV insertion. I stood by the mother’s side while she pushed with each contraction, her arm dangling behind me unknowingly dripping blood down my clothes.

The second, a breech delivery.

“What is that?” I ask, accustomed to mostly seeing the tip of a hairy head come out first.

“The feet,” the midwife says.

Two very white feet. Then, the baby’s legs, pressed together like he’s twisting down a water slide. The midwife wiggles her hand inside the mother and pulls one arm down and out, then the other.

We wait patiently for the head to emerge. I have my bulb syringe to suction and a bag and mask ready. That’s all you get around here to save lives in the land of no oxygen or electricity. But what I keep finding out- it’s usually all I need.

A Ugandan pediatrician who works in Kampala recently said to me, I think some places receive extra grace from God because of how difficult the circumstances are. She was at our hospital when she said this.

Some days I believe this too. Other days it feels like we’ve been abandoned. But the truth? God’s in all of it, all the time.

I glance around the room, taking stock of the team. As each second ticks past, my patience feels more like I’m digesting chili peppers. My gut is hot with doubt.

Will this baby come out?

And if he does, in what condition?

Please, alive. I pray. Please. Alive.

Across from me is Susie. A student nurse from America. It’s her second day at the hospital and she is a sponge. A joy-filled, sponge.

To my left is Lydia. A newly hired midwife.

Between the patient’s legs is Juliet. I’ve been working with her for two years now.

Juliet wraps a towel around the baby’s body and pulls his feet up directly towards the sky.

The mother arches her back and comes up and out from the edge of the delivery table, holding on to Susie and twisting that way.

The baby comes out, along with a tidal wave of amniotic fluid.

“It’s gone in my mouth,” I hear Juliet say. She lays the baby on the mother’s abdomen and runs to the sink. Lydia follows her.

I look at the baby. Blue. Limp. Not crying. No grimace. No movement. Nothing.

“We have to resuscitate here, now” I say to Susie. The baby’s umbilical cord is still attached, and there’s no time to waste.

I dry and stimulate the baby’s back. His body jiggles.

No response.

I suction his airway with the bulb syringe.

Then I put the mask over his mouth and nose, make a nice tight seal, and push a breath in.

This is so awkward.

I’ve never resuscitated a baby directly on his mother’s stomach before. His legs are draped over Susie’s side, and I can’t tell if the breath I’m putting in is good enough.

“Can you hold his legs straight?” I ask her.

My hands are shaking a little, from all the adrenaline.

I see the baby’s heartbeat through his chest, and it’s fast.

I give a few more breaths in rhythmic fashion.

Nothing happens.

The mask is slipping across his face and I can’t see his chest rise, which is supposed to mean what I’m doing is effective.

I reposition the baby’s head, exposing his neck upwards a little, hopefully opening his airway.

But my next breath doesn’t give me the fullness I expect.

I lean backwards and grab the smaller mask out of a silver tray, and switch it out real quick.

The mom looks down at her baby, with fear in her eyes.

And I try again.

I squeeze the bag connected to the mask and I see the artificial breath course through the baby’s body because his chest lifts. It’s barely recognizable, but it does. I keep going… breathe-2-3-breathe-2-3-breathe-2-3…breathe-2-3…breathe-2-3…

I do this for what feels like forever, but in reality is no more than two minutes.

His face grimaces. He coughs a little. Turns away from my mask and kicks his legs out.

I keep going until he let’s out a cry. It’s not a long, loud, robust cry, but it’s there.

I take the mask off and see what he can do on his own.

He’s breathing, enough breaths a minute that I can say he’s been successfully resuscitated. He’s pinked up. He’s blinking and looking around.

The mother looks at me and with sparkle in her eyes she says in a weak little voice, thank you.

I’m still totally caught up in the moment, the high-risk delivery, the baby, all the steps, that I forget to respond. I just stare back at her, through her.

When I get home later that day, I throw my scrubs in the wash, take a shower, and find Boston to give him that hug we both wanted. After my kids don’t need me anymore, I retreat to my room. I like to give myself an hour of doing nothing.

The problem is, this hour isn't restful, instead I am rehashing everything I could have done better. Thinking that if I were just a little more type A, more linear in my thinking, a little more analytical, or better at remembering all the details.

I forgot to check the time of when I started the resuscitation. Fail.

I never said thank-you to the mom. Oops.

I didn't give Susie good enough answers. I was so tired and hungry.

“But did you ever stop to take in the fact that you saved a life?” my counselor asks me. “That’s remarkable.”

It’s hard to hear her say that. I can barely believe it myself. I am stuck in the details, unable to see the big picture.

The American nursing culture is a culture that strives for perfection. (unattainable, sure, but still a high value) The Ugandan nursing culture is a culture of necessary and constant improvisation. You will never hear an American nurse say what every single one of my Ugandan co-workers have said, "Improvise, improvise, improvise." Yet in all the improvisation, I feel that I am somehow failing, not measuring up to standard of care. But standard of care in a place that feels like civil war nursing, is impossible.

“I don’t think that mom cared that you forgot to check the time you started your resuscitation. She left that hospital with her baby in her arms.”

This is why I have a counselor. I need to be walked closer to the truth.

The next week at work, I resuscitate another blue, limp baby back to life. Susie says “You’re always in the right spot at the right time. You always know what to do. You’re a beast. I’m either gonna call you a beast or a baddy. You choose.”

We’re walking out to my car. “What’s a baddy?” I ask.

“It’s the polite way of saying bad-a**,” she whispers the word.

I think about it for a moment.

“Call me a beast,” I say, laughing at the incongruency between her perception of things and mine.

I drive back home, a woman on a quiet mission.

I want to get out of this rut of only seeing the crushing parts of my work. I want to see the wins too. And I want to believe what the pediatrician from Kampala said about the extra grace in this place.

It's going to take work.

*This is a post originally written in summer of 2022. I have since "done the work" and am in a much kinder place. I have learned a lot about a term called moral injury which international healthcare workers often experience in their work environments that differ so much from the developed world. This isn't a post to brag about anything, it is a post to share the struggle of that experience.

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