Some rather icky content in this chapter. Sorry, I didn't make it up. Really.
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He'd been there barely two hours, and already the old, too familiar, helpless feeling was coming back – the downside of working in places like this. For every life he saved, every patient he treated, there were five others for whom he could do nothing because he had too few supplies, too little equipment, or the patient had arrived too late.
He handed the infant back to her mother; the little body as frail as a bundle of twigs, as light as breath. He couldn't even guess how long the child had been dead. How long had the mother waited so patiently in line? It didn't really matter. Even if she were still alive now, Luka could have done nothing for her. Water was scarce, rehydration salts were scarce, and an infant as far gone as this one wouldn't have been eligible for treatment. Perhaps yesterday, or last week, but not today.
Luka found himself feeling almost glad that the baby was already dead. He could mutter his condolences through the translator and move on to his next patient. He didn't have to try to explain to the mother why he couldn't help her baby. He didn't have to explain death. This mother understood death; was more familiar with it than he would ever be.
A sudden commotion outside. Shouts and a woman's voice wailing in pain. Carter was already moving, and Luka followed him out the door. Three women were approaching, half-carrying, half-dragging a fourth woman. Or girl. It was hard to tell. Her face was streaked with sweat and dust and contorted in pain, but she couldn't have been more than 15. Her bright green robes were stained below the waist with bright blood; more blood made a trail in the dust beneath her. Her wails were already fading into moans, her eyes going glassy with shock.
Luka's long strides took him to her side in an instant, and he picked her up. One of the other women started to protest, but she was hushed by her companions. Luka didn't understand the words, but the meaning was clear. They had brought her here to be treated, and she would be treated. By anyone. Still, as Luka started to bring the girl inside, he knew in his gut that this patient too was beyond help. She was bleeding to death, and the hospital had no blood. Unless they could stop the bleeding quickly, there would be nothing they could do.
By the time Luka set his frail burden down on the exam bed, she was unconscious; eyes rolled back in her head, breath coming in faint gasps.
Carter had joined him, and the grim look in his eyes told Luka that he knew the prognosis too, that he had seen this too many times before. Still, they had to try. Grabbing a pair of gloves, he pulled the curtain around the bed and turned back the blood soaked robes. The stomach muscles were loose and flabby. She had just given birth. This was a post-partum hemorrhage. A flicker of hope. If they could just get her uterus to clamp down …
"Do we have any Pit?" he asked Carter. Pitocin would help stop the bleeding and then, maybe they could keep her alive long enough for her body to replace the lost blood.
"We do, but it won't help." Carter spoke quietly.
"We can try!" Luka snapped. Then he fell silent. He was kneading the girl's abdomen, expecting to feel a uterus as flabby as the muscles around it, but it was hard, just as it should be. Maybe the bleeding was from a vaginal laceration, even a torn cervix. He'd never seen those bleed this badly, but maybe that was the problem. Pulling up a stool he sat down and separated her thin legs … and felt his mouth go dry. Carter was watching him impassively.
Luka had seen plenty of traumatic deliveries in his time, but never anything like this. She was torn open from rectum to pubic bone, but it was more than that. The genitalia just looked … wrong.
He looked from his patient to Carter and back again. Carter finally reached over and pulled the bloody robes down to cover her.
"Welcome to the wonderful world of infibulation," he said quietly. "We see two or three of these a week, and probably three times that many bleed to death out there." He jerked his head toward the door. "These women are nothing but scar tissue and when it tears, it really tears."
Infibulation. Luka had heard of it. Female circumcision, female genital mutilation, call it what you liked. He'd even seen the occasional patient with less extensive cutting come through the ER. But he'd never seen anything quite like this. What had he read about it, long ago? They removed all the external genitalia from the girls at the age of 5 or 6, using razor blades or glass, then sewed together what was left, leaving only a tiny opening for urine and menstrual blood. It was supposed to keep the women chaste. Assuming they survived.
Swallowing hard, Luka stripped off his gloves then scooted his chair around to the side of the bed. He couldn't do anything for her, but he could allow her a little bit of dignity in her last moments. He stroked her hair and waited, but not very long. The last moments came quickly.
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Dinner was mint tea and millet porridge by lantern-light. Not that Luka was hungry. He'd been without sleep for too many hours. He'd seen too much.
"Having second thoughts?" Carter asked.
"No, it's just …"
"Different than what you expected," Carter finished for him. "Darfur, also known as Hell-on-Earth. It was different from what I'd expected too. The irony is that this is a pretty well organized relief effort. We've got a dozen different NGOs working out here. But there are just too many people in too small a space, trying to survive in an absolute wasteland. There's only so much we can do when everything has to be trucked in. Water and food take priority. Medicine is a distant third and things like generator fuel get tucked into the odd spaces left over. A couple hundred people die here every day, and a couple thousand more arrive every week to replace them. But we do make a difference here, Luka. We save lives. Not as many as we'd like, but some." Carter managed a tired smile. "And I am glad you're here. And you might be glad to hear that I'm trying to convince Gillian to come."
"Really?" Luka managed to feign interest.
"I haven't quite talked her into it yet." Carter's eyes twinkled. "But now that you're here, I'm sure the balance will tip in our favor."
"Don't bring her over on my account," Luka said quietly.
"I thought you and Sam weren't together anymore."
"We're not."
"But there's someone else." Not a question.
"Yeah."
"Anyone I know?" Luka just sipped his tea and stared into the cup and Carter raised his hands in a gesture of surrender, "Ok, none of my business. I can take a hint." Then more soberly. "Seriously though, what we really need here, more than nurses, are more female doctors. There are three medical stations in the camp, and only 2 female doctors between them. Most of the women here won't let themselves be treated by men, not for anything gynecological or obstetric anyway. If we could get more of these women in here before it was already 20-minutes-past-too-late – if they knew that there were female doctors available to treat them, we might do better."
"Sounds sensible," Luka agreed tiredly. It was getting hard to keep his eyes open.
"What I was thinking was … do you think Abby might be willing?"
"No." Short.
"She's not an OB, but the combination of OB nursing experience and ER medicine would be perfect here."
"She can't come, Carter."
"How do you know? Look … I know things have sometimes been a little awkward, but …"
"It's not that." Luka sighed. It was going to have to come out eventually. "She can't come because she's pregnant."
"Really?"
"Really."
"That's terrific! If it's any of my business … who?"
"Me." Despite his fatigue, Luka couldn't keep the smile from breaking through. A smile that Carter matched.
"Wow, that's really great, Luka. I'm happy for you. When is she due?"
"August. Everything's going great; with the pregnancy and with us."
"Don't worry, we'll have you home in time to cut the cord."
"Damn right you will. Now …" Luka pushed his half-full bowl away. "As delicious as this … stuff … is, if I don't get to bed, I'm going to be face down in it in another minute." He rose. "Oh, John, what's the communication set up around here?"
"With the real world, you mean?"
"Yeah."
"Crap, like everything else. No cell phone reception. Computer's available in the admin office for personal e-mail one hour a week. You can send Abby a love note on Friday at 3 p.m. Now go to bed. We're up with the sun."