A Day in Admissions

(early February)



Today is my first day in the Admissions Ward.

It is a room with a bustle of different functions;
receiving patients who have started labour,
filling out the first set of information,
taking blood, doing ultrasound scans,
and also dealing with other gynaecological non-maternity related issues.


Doing the morning admissions are
two young doctors in colourful silk saris,
the patterns and silks peeking out from under their white pressed coats.
Their movements are swift and graceful,
turning and walking and purposefully spinning
from here to there.

With many folds of paper files clutched in their hands
like a Chinese fan dance,
their eyes flash at you, the delicate gold bindi between their brow glimmering with elegance.

There is a girl in a bed by the window, lying on her side.
She has fair olive skin and wears a tattered, old brown knit cardigan.
She covers herself with a family blanket, and looks up at me, in peace.
Her long thick black braid is hidden under her weary body as she lays, but she still is strong enough to watch us, to fix a silent gaze on the slightly stunned newcomers.

We must be quite a sight,
our non-brown eyes,
and our non-long hair,
and our non-brown skin,
our unnatural head-bobble.


I feel a little lost, my eyes search the big white room;
it has windows,
a few beds,
a green curtain,
an ever-changing row of women waiting in line for admission,
and a desk with a Sister sitting there,
balancing her heavily starched,
white, frilly nurse hat
that looks more like a pin cushion
atop her smooth, oiled, black hair.
She writes in the biggest book I have ever seen.

I scan the faces;
the different looks of
concentration,
timidity,
fear,
vulnerability,
tiredness,
strain.

There is a girl with a round face and light freckles,
answering promptly to the doctors questions.

Her eyes are like the shape of the moon, they glisten and wax wide,
having seen and beheld more in her short life than many have experienced.
She sits on the wooden bench,
holding a weathered walking stick,
and as she gets up I notice that she is severely bowlegged,
and cannot walk with out the aid of her tall cane.
She looks like she is from the mountains,
she looks young yet aged,
her eyes are hazel,
and she wears a woolen cloak wrapped around her shoulders.
It looks like it perhaps has never been washed.

If I had to guess her age I would say 15.
I wonder what her story is.
Where does she come from.
How did she get here.
What is her husband like.

The two doctors doing the fast file fan-dance
are at a desk on the far side and are frantically scribbling down notes, that we will later have to decipher.
They only pause their rhythm to ask short questions in Hindi or Telagu to their patient-at-present.
They are managing to get through the long line of morning admission patients at quite the rate!
Which I am impressed with,
because here, I have found,
at least they have a grasp on getting things done
quickly and efficiently... a quality that was lacking at Temeke.

I hold my blood pressure cuff in hand,
feeling a little awkward,
trying to figure out if and how I can get in there and help their already well oiled system.
I feel like the schoolgirl playing jump-rope, anticipating the perfect moment to run in to the already turning rope and start jumping to the same pace and beat.
I ask to deaf doctor’s ears if I can help, they seem to not notice me.
Finally I am asked to take a blood sample,
to the girl in the tattered sweater by the window.

Hello, again.
I tell her I am from Canada, her face grows into a bashful innocent smile. How could she have known that she would come to the hospital and be served by a Westerner?
I take the blood sample and transfer the rich red liquid to a glass vile.

There is another girl, thin, with deepset eyes, sitting on her bed also. She pivots on her palms with her elbows locked, and beneath her fuschia and yellow sari, it looks like she has a small bump of a belly.
At first I think the girls are friends,
but by her unsettledness,
I think she is just taking a seat and waiting for something.
Pieces of black hair fall from her braid, and she looks down, trying to compose herself.

Meanwhile, on the steel bed behind the curtain, the girl with the yellow and fuschia sari is now laying down on her back. She looks, I don’t know, defeated?
A doctor splurts some clear gel on her small tummy,
the bump only reaching the top of her bellybutton,
and turns on the ultrasound machine.
She swishes the wand around,
coating the belly with a glistening layer
and confirms what she already knows.

No fetal heartbeat.
3 months gestation.
Miscarriage.

The doctor asks me to get the Misoprostal tablets on the desk.
I break one in half and give it to her,
she takes it and places it inside, close to the cervix.
This tablet will “ripen” the cervix into dilation,
and the woman can deliver her tiny, formed child.

Katie and I stay with her.
We stroke her hair, hold her hands,
even sing over her.
She is 25 years old, this is her first child,
her name is Rizwana.
She lays still on the cold steel table,
drifting off into her own deep world of mourning,
not shedding a tear, not making a sound.

Her mother tiptoes her way in,
trying not to be seen by the white starched nurses,
and swiftly slips herself behind the green curtain.
She sees her daughter on the table,
she sees us by her side,
and she starts to break from the inside out.
A breathy heave starts in her chest
and travels up her throat
and then shatters on her face,
breaking her tense and sorrowed face
into an eruption of grief and audible tears.
Katie rushes over like a flood of love
and wraps her arms around her frail, hard working body.
Her sobs are born of a bone-deep sorrow,
for the little heart who
just
stopped
beating.

Rizwana still stares at the ceiling,
but now with her mom’s raw,
honest presence,
a small stream of tears makes a glimmer on her skin
as they silently blaze a trail down her face.

All I can offer is to be there.
To choose to not walk away in this moment.
And this is enough.

To offer comfort. Presence. It’s the most we can do, and the least we can do.

A little while later, we need to go for lunch.
Rizwana still lays there, unmoving.
We slip away for a quick bite to eat,
and arrive back
to find a small,
6-inch long baby laying on her cotton sari skirt between her legs.
Only three months old,
but every limb and finger and joint is formed,
thin and delicate.
A little boy.
His little eyes, little face, little mouth.
Just 6 months too soon.
About half an hour later, a tiny placenta delivered.

But no one attended to her,
behind the green curtain you can be forgotten.
There Rizwana lay in her blood,
with her firstborn child between her legs,
unfit for the world beyond the womb.
She cannot escape this moment, even if she tried.
Her wet sari, the increasing coldness of her blood on her skirt, the unforgiving flatness of the steel examination table,
are constant reminders of why she is here at the hospital.

We get a daima’s attention and she finally comes over to clean up.

***

While Rizwana is getting tended to,
another young girl with a tight, full belly in a blue dress
is writhing on the examination table.
She is 18 or 19 years old, first baby.
Upon examination, she is fully dilated and the baby is making its descent.
Labour is driving her wild,
her eyes roll back,
her hair that has been unkept is starting to mat and loosen
from the thick black braid down her back.
She is clearly exhausted,
she falls almost asleep and then awakes with a rush of delirium
for the length of the contraction,
then she falls back into a state between consciousness.
As she flails her hands and tries to grip the edge of the bed,
it is then that I notice
that she only has a nub of a pinky on her right hand.
...I wonder how that happened.



Then, another girl enters.

She wears a black sari top and a thick bunched bright blue skirt.
She is having strong contractions
and her eyes flash with pain everytime one comes on.
Beside her is her mother,
and she is fascinating and gorgeous.

This mother and daughter are Banjara women,
like Indian gypsies.
Her mother’s black hair is parted
and fastened with chunks of elaborate silver spheres
dangling by her cheeks.

Pierced into the side of her nostril
is a large brass hoop with dangling brass and red beads.
The ring is so large that it rests on her lips
and moves when she talks.

Her shirt has three large mirrors etched in fabric
and placed over her chest,
and she has a vibrant bunched orange skirt
paved with mirrors and silver embroidery.
Over her hair is a green and orange patterned head covering
that extends down to past her hips.
Behind her cape is her bare back...
Banjara shirts only cover the front.

Ten to twelve chunky angular cream-coloured bracelets
cover the entire space of her forearms.
They creak and shift like tectonic plates
as she moves her arms to and fro, attending to her daughter’s pain.
Her fingers and toes are dripping with rings,
and as she walks back and forth,
everything on her jingles with each barefoot step.
Her ankles are encased with thick brass scalloped metal hoops that look like shackles,
and they peek out between the swish of her bright orange skirt.

There are two other Banjara women waiting in the hall,
all barefeet,
all colours,
all mirrors and silver and gold.
All looking out of place.
Their distinct, frivolous look contrasted with the
plain,
practical,
white tiled environment they now find themselves in.

The three old Banjara women look afraid.
The setting is new to them,
and the gorgeous mother of the pregnant girl finds herself spinning,
and bumping into people,
and sometimes grabbed the arms of ward boys
and forcefully ushered out.
She looks as though she is a paper bag
being blown to and fro by busy traffic.

Within the frame of the mother’s colourful head-scarf,
the straight black hair parts and reveals her fearful eyes.
She is confused,
unknowing,
trying to be a mother,
but not knowing her place in this hospital rank.

Doctors are quickly scribbling things and not being quick to get the young Banjara girl to the labour room!
She is getting liquid drugs into her IV line
and I finally ask what is going on.
They tell me she has mitral-valve stenosis.
The narrowing of a valve in a chamber of your heart.
So it’s a heart condition that can lead to
cardiac arrest,
postpartum haemmorhage,
and even death.

They said they would have done a C-Section if she came earlier,
but now she’s minutes away from delivering the baby,
so they need to do some paperwork and figure out some things.

Sangeetha is her name.
And she’s sitting in a wheelchair now,
waiting to be wheeled to the Labour Room.
She’s making a concentrated, determined face,
probably trying not to push
though her body is telling her to.

Her mother’s face is sinking,
and her kohl-coloured eyes are wide and despairing.
She looks to me,
she looks to the doctors who are not looking up from the paperwork,
she looks to her daughter
who is clenching her fingers to the armrests and holding in her contractions.

Finally, finally,
the ward boy gets the word to wheel her down,
and the trio of old banjara women and I follow.
Squeezing between masses of people on both sides of the halls,
we turn corners and through doors.
But at the last set of doors,
only the hospital staff enter.

The rest get left,
the three old ladies
shocked and horrified that this is where they stop.
I sweeze the mother’s hand,
as I go onwards and she stays back,
and try to look comforting, like “everything’s gonna be okay”.

Off wheels the daughter in the flood of a contraction,
and none of the family can be there with her.
They stare through the dirty glass window,
unable to go any further,
down that mysterious hallway her daughter was whisked off.
I can just imagine all the unknowns
that must be piling on top of each other in her mother’s head right now.
And she can’t do anything about anything
but just crumple down the wall and sit on the dusty floor, waiting.

Meanwhile, we get Sangeetha on a bed and I let the doctors know about her Mitral Valve Stenosis.
“Where is her case sheet?”

The ward boy dropped off a pile of papers on the desk,
but none of them are hers.
How does this happen!!
I go racing back through the halls and doors,
passing the mother who has now resorted to tears and
weeping in a heap on the floor by the door she is not allowed to enter.
I comfort her for a moment and try to say that her daughter is okay.
I bounce from ward to ward trying to find her file,
which has been passed off to some medical officer,
and when I finally end up back at the Labour room, it is there.
Ah. Finally.

So I get back to my ward and give an at-ease look to the mother
yet again on my way out.

...

Life goes on in the Admissions Ward, cannulas, blood pressures, ultrasound scans...
Rizwana,
the one lying on the table by herself with her crying mother,
has now got cleaned up and has left the hospital.

It is around lunch time,
I feel like I should just go and check up on Sangeetha,
see how she’s progressing,
and see if I releive any confusion from the distraught trio of Banjaras.

I enter into the Labour Room, and it is such an eerie sight.
Everything is quiet,
the lights are dimmer,
there is only one doctor
and Sangeetha is hooked up to an oxygen mask.
No bustle of nursing students, no flurry of the masses.

Is everyone taking a lunch break?

There is a yellow incandescent glow
shining on Sangeetha from the suturing lampstand,
and as I walk in quietly,
her scared eyes shift to recognize me.
She is trying to push, but nothing much seems to be happening.
She’s still wearing her black fitted sari top which is so tight it looks like it could burst at every seam.
This must be such an uncomfortable thing to labour in!

I’m pretty tense,
I watch her breathing,
and take some comfort in that it is steady...
I just don’t know the severity of her case!
or what could tip the scales to put her into cardiac arrest!
There is so much unknown!


There are two steel clean forceps
that look like extreme salad tongs
laying starkly in the harsh light, casting sharp shadows on the steel stool.

I walk to her bedside, and the masked doctor with the bright, jovial voice greets me and pleasantly asks for my help with the delivery.
She cuts a very deep episiotomy, (I don’t think the syringe with anasthesia went that far in)
and the already-in-pain Sangeetha enters a new threshold.

Uh..
I wasn’t planning on helping with the delivery,
but what am I supposed to do? She’s all alone! What if something happens??
I’ve never seen a forceps delivery before.
The doctor grabs both tongs and fiddles with them to see how they link together. They make a dull, metallic clang, and the sounds stand out among Sangeetha’s breathing and the whir of the ceiling fan.
They pivot together like scissors, and clamp tight... to form a space that I think looks too small for a baby’s head!!

In goes one, sturdy, steel counterpart,
and in goes the other.
Clink. Clamp.
Ouch.

I timidly yet firmly place the clean gauze pad at the base of the freshly cut episiotomy. And press hard so nothing more rips.

At this moment, my tutor walks in,
and the masked doctor, pleasantly surprised to see her, joyfully asks for her to stand behind her...
in case she pulls so hard on the forceps that she loses grip and falls backwards.
Oh
my
goodness.


Well she pulls
and I hold the gauze
and she pulls and pulls
and Sangeetha is still awake and feeling every inch of this
and she pulls
and out comes a perfect little girl.

Praise the Lord.

We all sigh.


And Sangeetha’s alive,
she’s not going into cardiac arrest,
she’s not bleeding profusely,
she’s breathing well,
and being amazingly strong.
She’s 19,
first baby,
and she just had a ridiculous episiotomy and a forceps delivery.
And she wasn’t even with her mom.
What a champ.


I go out of the Labour Room and look for the Banjara mother on the way to Admissions.
I’ve been gone for longer than expected,
so I’m quick to get back to my posting... but I see Sangeetha’s mother
and my face lights up,
I make a cradle with my hands
and lots of positive face expressions to communicate that she had the baby and everything is fine!
Her droopy once-sorrowed eyes
become glistening and clear,
and she motions with her hands to say thank you.

An onlooker translates, and the mother is asking,
Boy or girl?


But it’s not my place to tell, nor would I,
soon enough she’ll see for herself,
and behold her new, beautiful

granddaughter.