Physician heal thyself then will thou also heal thy patient. But what if you are both the physician and the patient? Who do you heal first?
I wasn’t ready to become an adult. Someone should have stopped me. Or at least paused the years. It was while I lay on my blue couch, curled in a fetal position, my favorite show running and my belly hanging over the edge of the seat that the memory came to me. Again.
Of her. Of a pain too fierce to battle. ‘Positive thoughts Swabra,’ I distracted myself as I peeled off the couch for a bathroom break.
I noticed the red on blue formless stain before I felt the warm fluid trickling down my thighs and all the positivity slipped away. Earlier on in this pregnancy, I had been diagnosed with Placenta Previa Type 4. A ticking time bomb. That’s why my days were spent lying down. Clearly that hadn’t worked.
‘Ok Swabra, act! Think!’ I pinched myself to action as I dialed my husband’s number.
“I have just gotten to work,” he said when I told him what was happening. Work in this case was miles across the city. He would need a time travel machine to get to me on time.
I panicked, got into our car — a stick shift — and drove myself to the hospital. The clutch was done by the time I screeched into the parking.
This was a hospital I was familiar with. I had worked there as a Medical Intern so I knew my way around and the staff knew me too. I waddled into the emergency room holding my under belly as if I was carrying a box of bricks. I met a medical doctor who introduced himself as the intern on call in Obstetrics.
“Ok. Doc,” I heaved, “my name is Dr Swabra Swaleh. I am a Medical Officer, 30 weeks pregnant with placenta previa type 4. I have called the consultant who is on the way. Also, I am bleeding.”
He took in my profile with the look of someone who was sleepwalking.
“Ok, erm, so, ok. Let me do a vaginal exam.”
My throat convulsed, “Nooo please do a speculum exam.”
“Yeah. Absolutely! That’s what I meant.”
I got on to the examination couch and started to draw my legs aside when he said,
“Shit! Shit! Shit!” The words ran out of his mouth, climbing over each other.
“Why are you shitting? What have you seen?”
“Blood! Lots of it!” then he looked at me as if waiting for me to say something.
“Doc. Just put in the speculum and tell me what you see. Can you see the cervix?” My tone was incongruous with the situation.
He took the shiny metallic instrument holding it as if it was going to hurt and not help me.
“Doc, how long have you been in the Obstetrics rotation?”
“It’s my second day.”
I wished I hadn’t asked.
“Ok, how about you ask for help from the intern who just finished the rotation?” I started to feel dizzy.
“He is in the surgical rotation and today they are in theatre.”
“Ok. Is Sister X around?”
Sister X was a super nurse. The black panther of nurses. She was the one you wanted by your side when you felt like you were losing your vertical hold.
“Sister X is not on duty today.”
So much for black panther.
“Ok. Just put in the speculum.”
He put it in and said, “Oh shit!”
“Call anyone and everyone you can. Theatre! Let’s go to theatre.”
He sprung to action and wheeled me himself.
In the OR, they prepped everything fast and in no time the intern— who had only just observed these surgeries — was cutting through my abdomen. He knew what to do, but I could hear the nurse talk him through nevertheless. I remember her saying, “When you open the uterus, you will not see a baby at first. You will see the placenta. Go through it quickly and get the baby out!”
What she didn’t tell him was that blood would be a curtain raiser to this event. He cut the uterus open and then I heard, “Waa Shit!”
Then the nurse shouted, “Suction!”
There is nothing as scary as hearing the sound of your blood being sucked into a machine. I craned my neck to the side to catch a glimpse of what was happening. I saw the nurse hand over the baby, pale as a sheet, to another nurse who quickly put him on the resuscitaire. ‘C’mon, c’mon, c’mon cry,’ I whispered, ‘please God not again. Not again,’ and I extricated myself mentally from that room.
You see, when I was 22 years old and a second year in Medical School, I got pregnant. It wasn’t an expected pregnancy but it wasn’t unwanted either. We were in love. My partner and I.
We seemed to be the only happy ones though. Members of my family were not. I come from a family with a cacophony of religion. My dad is Muslim. My mom was Christian. I was born Muslim but raised Christian though I am Muslim and married to a Christian.
So you can figure out why my family was displeased. Not only was I unwed and pregnant, it was with a guy who was as welcome as a wet shoe.
Still, we carried our human with glee. As much glee as two broke university students can muster. The pregnancy progressed beautifully. I couldn’t get enough of the experience. Whenever I had a chance I would get into a dark room and ask whichever sonographer I found, “Please I want to see my baby. Just a quick scan please.”
In total I had ten scans. Ten! Just because.
The year went by fast and I was able to sit my exams and pass. Then labor came. Such a considerate baby. She waited for me to be done with my papers, then she came knocking. Yes it was a she. Tamar. Born weighing 2.6 kg. A shining angel.
Who didn’t cry at birth.
When I pushed her out, she had this blue tinge. The nurses took her and started working on her. They wrapped her in a warm blanket and placed her in the resuscitaire. Someone picked an ambu bag and placed it over her mouth. I heard them counting, “ One and two and three and..”
While someone else said, “Call the pediatrician.”
The Pediatrician later burst through the doors as if she had been eavesdropping all along. She came in and placed her stethoscope on Tamar’s chest. And I saw her countenance fall.
“Put the baby on oxygen. Let’s get an ECHO done ASAP.”
“Doc, what’s up?”
“Something does not sound right Swabra. Let’s just perform an ECHO and then I will come and explain everything.”
That was the longest wait of my life.
When she eventually came, she told me, “Your baby has three heart defects.”
‘That can’t be right,’ I thought. All the ten ultrasound scans showed everything was ok.
“But the scans I did didn’t..” I trailed off knowing speaking of the past was in fact just wasting time.
“Ok. What does this mean doc?”
“It means we need to monitor her. She will need to be on oxygen and then we will observe to see whether any of the defects close spontaneously.”
In a few days, Tamar picked up. None of the defects closed but she was a fighter. She remained stable and at some point was even taken off oxygen. I would stare at her, greedily drinking her in. We were eventually discharged with instructions to come back in two weeks for a repeat ECHO.
Going home though was an episode in 1000 ways to be anxious. I wanted to hold her all the time and did everything for her with military precision. But she surprised everyone. She was able to breastfeed well without becoming breathless or turning blue and apart from what we knew, she behaved like any other baby would.
Two weeks later, we went in for the appointment. The ECHO showed the defects were still present and had not changed in any way so a decision was made to operate. Tamar was also started on meds to reduce the burden on her heart. The surgery was scheduled for two weeks later when she would be a month old.
In that time Tamar gained weight and became the joy of our simple home. On the night before she was scheduled to go to theatre, I breastfed her as usual, burped her and put her to sleep. Something woke me in the middle of the night. I got up and checked on her and found that she had brought up some milk. I changed her clothes, fed her, burped her, then put her back to sleep.
The rest of the night passed unbroken.
In the morning I got up, startled that we had slept that long and went to pick her up. I took her out of her cot and her body arched backwards like a comma; her hands floating undisciplined by her side.
I touched her fingers and recoiled! They felt like she had spent the night outdoors. It took a minute to hit me and when it did, it didn’t.
Acid rose in my throat and I could barely speak when I woke up my partner and told him, “Something is wrong. Let’s go to hospital now!”
In the car I remember checking her pulse over and over and performing CPR on her. I continued the CPR all the way into the Emergency room until the doctor who attended to us said, “She is gone. She was gone when you got here.” I saw the words BID on her form and that is when the reality slapped me splintering me into pieces.
Her Pediatrician was called and I barely remember what I said to her but I am told I kept saying, “She was ok. I fed her, burped her, changed her. Did she aspirate? I fed her. I burped her. What time did she die? I burped her. She was ok.” That’s all I told anyone who tried to tell me my Tamar was gone.
There should be a stronger word than regret. Have you ever felt like you are the end of your own happiness. That is what I felt.
Three days later Tamar was covered by earth.
Grief is not when your baby dies. It is not when she is buried. It is when everyone leaves and you are left to pack away her clothes and fold away her cot. That. Is. Grief. It is animal pain.
It hit me so hard, I was unable to metabolize the feeling. I dropped out of medical school. How could I go back? To do what? Learn medicine that had failed me?
Food tasted like chalk. And in no time my flesh started to sink beneath my bones. I would sleep all day but the only thing it would do, is reset me and on waking I would reconstruct the events of that day. Worse still, the relationship with my partner turned gangrenous and eventually sloughed off.
I decomposed at home for six months until my grandmother insisted that I go back to school. I fought her but eventually went back a shell of my former self. I had folded into myself so much. The school community was small so everyone knew what had happened to me. I could see them whisper as I passed by. Being around people was good and bad. I hated it and I loved it. Going back to the wards was even worse. I tried to bandage myself but I couldn’t. I didn’t know it then but I needed help.
Now you understand why, when my second born didn’t cry at birth, I lost it. I was not ready for another 28 days. And worse still with a preemie.
As they resuscitated him I kept thinking God if he is going to die let him go now. I can’t go through another 28 days.
But he didn’t die. He grew past 28 days and beyond. The guy is now 7 years old and he has a younger brother. It has taken lots of therapy to overcome the need to watch them all the time. Sometimes I feel like a tennis player playing on both sides of the net and with each pregnancy the fear comes back. But allowing the fear to overpower me is not to live and not to love.
So I have chosen to live, to love and to trust.
In remembrance of Tamar.
This is Dr Swabra Swaleh - an amazing soul and obstetrician gynecologist.