Worlds Apart

I felt my Irish skin sizzling as I sat in the back of a tap-tap. I heard a chorus of “blanc! blanc!” coming from all around me. The stench of animal and human defecation, burning trash, and rotting food and flesh filled my nostrils. Billy knocked on the window to get my attention and said, “okay? okay!” He stepped on the pedal, and off we went.
***
“‘elp me?” An aged woman pulled back a blanket to reveal a tiny face, no more than a few hours old. I gasped, horrified, and waited for Sadrac to translate the full story.
“Her neighbor has five babies. HIV. No food. Baby in the trash,” Sadrac told me. I felt breakfast coming up my throat.
I rushed the premature and starving baby in to see Dr. Carter. The clinic had been set up just a week before with HIV testing facilities. Half an hour later our fear was confirmed. She needed care that our little clinic could not provide. In the US she would have been airlifted to the nearest major hospital, but in Titanyen, Haiti, she was bussed and taxied to the only major hospital. Jennifer, a volunteer nurse, a soft-spoken southerner with kind blue eyes and the prettiest blond curls, was sent to accompany the baby on the half-day’s journey to the hospital in Port-Au-Prince.
***
At 5:30 AM the fan in our room turned off, and I woke up instantly when sweat started to pool all over my body. Mosquitoes, no longer warded off by the fan, swarmed around my face. I climbed out of my top bunk and went to get some breakfast. Dr. Carter was sitting at the table talking to Jennifer, who had enormous black circles around her red-tinted eyes.
“What happened?” I asked anxiously.
She looked at me and spoke. “She…,” Jennifer choked on that one word and gasped as tears poured out of her eyes.
Dr. Carter finished for her. “She didn’t make it through the night.”
***
Anitha enunciated every consonant and puckered her lips as she spoke through her thick Creole accent. “Sawah, what do you do at home?” She sorted vitamins on the counter of the Mission of Hope’s pharmacy.
“I work at Starbucks.”
“Eh?” Anitha stared at me, raising her eyebrows in wait for me to actually answer her question.
“I work at…,” Sudden realization must have flashed across my face. “I work at a coffee…,” My eyes looked away as I thought hard. “I sell coffee. And food. Breakfast.”
Anitha nodded. “Oh! You like?”
“Yes… yeah, I like it.”
***
“Can you just drop off these de-worming meds on your way to the beach?” asked Dr. Carter, a wrinkly, retired, seventy-three year-old man with a thick southern accent who spent two weeks every other month volunteering at the Mission of Hope Haiti.
“Sure can!” said Andy, a pudgy New Englander who was, like me, on his first visit to a third world country. On the last day of our trip, our guilt-ridden beach day, Andy, the rest of our group, and I stopped at the same orphanage we’d visited a few days before. We were armed with a Ziploc bag of little white pills, and a party sized bag of Dum-Dums. At their teacher’s command, 45 orphans age 11 months through 14 years lined up for candy. The little ones cried when the medicine touched their taste-buds, but lit up when the flavor was put out by a Dum-Dum.
***
“Sarah! Get in here!” yelled Dr. Carter from the patient examination room.
I poked my head in the door. “Yes?” I asked expectantly.
“Here, take this. You’ve given shots before, right?” He extended his arms, and I saw in his hands a large syringe and vile filled with red liquid.
“What! You’re kidding! You do it. I don’t know how to give a shot.” I held up my hands in protest and started to back out of the room.
Dr. Carter laughed and said, “you have to learn sometime if you’re gonna be a nurse!”
“No I don’t! I’m not even sure I wanna be a nurse!” My eyebrows were raised sternly. “Oh, get over here. It’s easy.” Dr. Carter smiled and beckoned me into the room. Billy, the translator, spoke in Creole to the confused man sitting on the examination table, who laughed. He had yellow teeth and orange hair, a look that meant malnutrition. I stepped into the room, and Dr. Carter handed me the syringe and the vile. “Like this.” He motioned with his hands, and I reluctantly obeyed. I filled the syringe with Vitamin B12 and stabbed the needle into the Haitian man’s bony arm. He covered a wince with a gaping smile and a loud “merci!”
***
“What color is the discharge? And is there any burning or itching?”
Vena had a quick Creole conversation with the young patient, who had the saggiest A cup I’ve ever seen. “Yellow. Itchy.”
I inhaled quickly at the visual in my mind. My nostrils were greeted by putrid body odor. I wrote on my notepad and said, “anything else the matter?”
Vena again spoke to the old woman. “Diarrhea. That’s it.”
“Okay. She can go wait in there and then somebody will come get her.”
***
I wheeled my suitcase around a pile of cow dung and up a steep ladder. The stewardess smiled. “Do you need any help finding your seat?” I shook my head.
***
“I’m starving,” said Andy.
“Chili’s. I want Chili’s,” I said as I stepped into Miami National Airport.
Another member of our team said, “I don’t care where we go, as long as I can get a Bloody Mary.”
***
“Thank you for choosing Starbucks! This is Sarah. What can I get for you?” I spoke into my headset in response to the DING! in my ear.
“Ah, yes, I’d like a Venti Java Chip Frappuccino with whipped cream and extra chocolate drizzle,” said a sickly obese woman from her front seat.
“I’m very sorry, but we’re all out of Java Chips right now, so there won’t be any chunks in your Frappuccino. Is that okay?”
“What do you mean you’re all out of Java Chips? This is ridiculous. Never mind.”
I heard tires squeal, and she was gone.

Let's Talk about HELLP

            In general, it’s true that you can’t spend your life wondering, “what if?” But… what if you could?
            My experience with Pre-Eclampsia and HELLP Syndrome was much similar to that of other women: completely uneducated. My experience was different than that of other women in that both my daughter and I survived, more or less without harm.

            HELLP is an extremely rare variance of Preeclampsia that can happen with or without previously occurring Preeclampsia symptoms. It stands for Hemolysis (the breakdown of red blood cells), Elevated Liver function, Low Platelets. Since it more often than not occurs in concurrence with Preeclampsia, doctors don’t generally do a blood test unless there are other non-HELLP preeclamptic symptoms occurring. There are no risk factors, no known causes, no known reason for this complication to occur. Of the women who develop HELLP, more have Preeclampsia than not. More have Gestational Diabetes than not. More are Caucasian than not. More are over the age of 30 than not. And yet within those categories, there is no increased risk of developing HELLP, since it is still so rare. And any link between those categories and the occurrence of HELLP is completely unknown.

            HELLP Syndrome can happen anytime during pregnancy up until 72 hours after delivery. The onset is generally sudden, and symptoms severe. HELLP Syndrome was identified by Dr. Louis Weinstein in 1982. Prior to 1982, HELLP was a silent killer. You know in all those old books and movies, when a character would ask about someone’s mother, and be told “oh, she died in childbirth…?” HELLP. Seizures, bleeding to death, a shut-down liver. Dead. Oftentimes both mother and baby, in a matter of hours. The warning signs often include “feeling kinda weird.” The only cure is delivery.

 

            What if my husband and I had been driving TO vacation instead of back home? I probably would have had a seizure in the middle of a lake in New Hampshire.

            What if I had just gone to sleep when we got home?

            What if I had continued arguing with my husband about going to the hospital?

            What if the nurses and doctor had trusted their instincts that I was suffering from “food poisoning?”

            What if my blood pressure hadn’t been SLIGHTLY elevated due to stress, encouraging my doctor to order a blood test?

            What if I didn’t live near Boston, which is home to many of the smartest doctors on EARTH? What if I had to stay with my hometown OB, who had never heard of HELLP and was still using the outdated term “toxemia?”

            What if I had developed HELLP when I was 22 weeks pregnant, instead of 38? What if my daughter hadn’t been ready?

           

            My husband, daughter, and I are beyond blessed to exist as an entire family. I thank God every day for my daughter’s life and mine. I spent the first several months post-partum adjusting to being a mother and trying to forget all the pain and horror and terror that I went through in the 36 hours before my daughter was born. But now, as life has settled down a bit (or I’ve just gotten used to the madness of having a small child!), I’m realizing that it would be irresponsible and potentially murderous for me to “forget” and remain silent. If I am capable of helping someone and fail to do so, I have failed as a mother and as a human being.

            I had never heard of HELLP syndrome throughout my entire pregnancy. I read all the pregnancy books, and I obsessively scoured all the pregnancy websites, yet saw nothing about this horrible killer. Even information about Preeclampsia was rare—it’s as if doctors don’t put the information out there so as not to scare the hypochondriacs. After all, it IS rare. But what about those of us who actually get the sickness? Don’t we deserve to have some knowledge before potential sudden death?

            I’m not going to forget, and I’m not going to stop talking about it. I’m going to bug my doctors, and remind them to educate themselves as well as their patients. I’m going to talk about HELLP syndrome to every single person I can, for as long as I can.