The rawness of suffering

Suffering is universal but it seems that there are places where it is more prevalent, and also places where it is more present and more raw.  Today in particular I saw too many faces of suffering around Black Lion Hospital.

In the middle of the morning meeting and case presentation, my train of thought was interrupted by 5 minutes of the anguished wailing of multiple women that echoed up from the fifth floor to the sixth through the open staircase, down the hall, and through the closed door of the meeting room.  The presentation went on without interruption, and I tried not to show the distraction on my face.  It seemed that a baby had died in the NICU.

Incidentally, the case presentation (which is like our morbidity and mortality conferences for those in the know) involved a pregnant mother that I had some contact with about a week and a half before, when she was referred to Black Lion for fetal hydrops (meaning, essentially, heart failure of the fetus causing fluid build up in the baby's body), due presumably to Rh sensitization.  She was a G5P4000-- meaning that including the current pregnancy she had been pregnant 5 times, delivered 4 babies, and all of them had died.  This baby was showing dire signs of the same pathology, and on ultrasound it had fluid collections in the abdomen, scalp, scrotum, and a little in the heart.  I remember this case for the striking findings on ultrasound, but also the incredibly striking beauty of the patient, who came from some rural area not even speaking the national language of Ethiopia.  The baby was delivered by cesarean section a few hours after the ultrasound was done, and died 5 hours after birth.  In the US, this highly desired baby probably would have survived.

Ultrasound findings from the above patient showing thorax and abdomen: heart in right upper screen, abdomen in left lower showing massive abdominal ascites separating the two lobes of the liver and compressing the thorax so almost no lung tissue was visible.

Later on teaching rounds, we came to a 15 year old who had recently been admitted to rule out ectopic pregnancy.  Her mother had died of AIDS a year before, and ever since, she had been literally living on the street.  She had had multiple sexual partners, some consensual, and some forced, during that time.  As the huge medical team of 25 students, nurses, and doctors, most of them men, discussed her in English over her head, tears streamed down her face and from time to time she covered her face with her scarf, ashamed of her tears and her situation.

Anatomically correct dolls from the pediatric sexual assault clinic in Adama (called the Unit for Treatment of Children Who Need Special Attention) to allow children to demonstrate and work through their abuse

Thirty minutes later, we went to the "chemotherapy" ward (where they work up and treat non-surgical gynecologic cancer patients) to see a very sad case of recurrent ovarian cancer in a mid-thirties year old woman, who we determined to be inoperable.  As we were going to visit this patient, two women emerged from the next room sniffling and then promptly collapsed on the floor in sobs.  I was informed that the patient in the next room, who had been admitted for palliation of metastatic ovarian cancer, had just died.

Dr. D commented, "This is why I don't understand why they put gynecology patients with obstetrics patients.  On one side of the hall you can have good news, and on the other side, bad news."

And I said, "Well that is the nature of our profession."  And in my head I thought that one of the things that makes OB/GYN most rewarding is that we do get the great joys of taking care of healthy women, mothers, and babies to balance the sadness of the rest.

Courtyard of Black Lion