Hindsight

Justina spent the day at our house, sobbing and sleeping. She is exhausted what with just giving birth 6 days ago and then spending 2 days in the hospital with an infant hovering between life and death. As I held her in the morning, she kept saying things like, "Is this life?" She's walking through one of the most painful things a parent can experience.

In the evening I sat and reflected with the parents about what happened. Baby Joshua's death seemed preventable to me. I started asking more questions about her medical care at the hospital that she chose to attend. To my shock, I discovered that she never saw the same doctor twice during her prenatal appointments, delivery, and discharge. Yes, there was a written record that followed her, but there was no one who personally recognized her and knew her case.

The day before she delivered, she had shown me the lab result for her yellow eyes and dark urine. I saw numbers and acronyms, but none of it was familiar to me. I told her she would have to ask the doctor what it meant. Well, she unexpectedly delivered the next day. I asked her if she ever showed the doctor that lab result. She said when she went to the hospital in labor, she kept trying to show it to him, but he was very busy writing, writing and never looked at it. How I wish the parents had been more assertive and the doctor more attentive. There could have been a very important connection between the lab result and the baby's sickness.

Since the baby was born 4-6 weeks early, he should have been checked much more thoroughly before being discharged. If the jaundice had been detected at that point, he would probably be alive today.

I asked the husband if he ever went with his wife to her appointments. He told me he did go to some of them, but husbands had to stay in the waiting room. There are literally hundreds of women who come for their prenatal appointments every day--I guess it's kind of a classroom setting and men are not allowed inside. I urged them to register as a private patient next time--so they can see the doctor together and be sure that all of their questions get answered. They will need to pay a little more, but they should get more attention.

I even chide myself for not being more observant on the baby's second day of life. Why didn't I open up his clothes and take a good look at his body in the sunshine? Why didn't I press my thumb into his skin to check for yellow hues? Why didn't I ask more questions about his response to nursing?

When I took a good look at Justina's eyes today, I could still see some yellow. I'm going to ask them to go back to the hospital to follow up on her own health concerns. Through this very painful experience, I know the parents will be much more assertive when they seek future health care.

There are many, many excellent doctors in this hospital and throughout Nigeria. I think Justina and Baby Joshua just slipped between the cracks of an over-crowded system.