I drew in a deep breath as I considered my patient’s test results, wondering how I would explain them to her. These were the type of results that showed something was wrong, but not exactly what or how dangerous it was. This woman thought she lost her pregnancy months ago, but now she was bleeding every day and experiencing significant pain. The test results showed that her body still had hormones related to pregnancy, but the ultrasound didn’t show anything in her womb. There were a number of things that could cause this situation, and none of them were good. I had prayed that these tests would show me what was happening for this patient, and I guessed they told me just enough to move forwards. I stepped into the hallway, hoping to find someone to discuss the possible next steps before I brought the news to my patient.
I praised God that Alice was available in the room next to me, and Veronica had just finished seeing her patient two doors down. As these women joined me in the hallway, I breathed a sigh of relief. Alice and Vero are Malawian Clinical Officers with about four years of formal medical training after high school. They’ve been caring for pregnant patients at ABC clinic for years, and they can perform C-sections and difficult deliveries that I would never attempt as a specialist in Family Medicine. Fortunately, they understand that I’m newly back and needing their advice, especially when it comes to caring for pregnant patients. So I told them the patient’s story and the test results, the conditions I was worried about and the next steps I was considering. They thought of some questions I had forgotten to ask and confirmed my suspicion that we needed one more test to help us know whether the patient needed surgery today or tomorrow. Alice offered to see the patient with me in her room while we waited for the final results. That was an incredible help because my room didn’t have the equipment for a pelvic exam.
With steps of renewed confidence, I started down the hall to find the patient. I found her outside, sitting on the grass with her sister. Apparently the pain medication I gave her had helped the pain but made her feel chills. I sat beside her, squinting in the sun, and began my explanation. I was reassuring but honest, trying to share what we knew and what we didn’t in ways that were understandable but specific. I wanted to convey the seriousness of her condition without being alarming, to involve her sister in the progress of the diagnosis without revealing any of the specifics the patient had told me in confidence when we were alone together. It was good because we were starting to understand what was wrong, I said, and it was good that she came today because this could have been dangerous if she waited even a little while more. We still needed another blood test and an exam to know for sure, but I warned her that she would probably need a surgery to recover fully.
By mid-afternoon, it was clear that this patient would need a surgery. Fortunately, she was stable enough to wait until the next day, when a full team of providers could help her. After confirming details of the planned procedure with Alice, I explained next steps to the patient and sent her off with a prayer. I thanked God that she had come that first day she had pain, and that I had some cancellations in my schedule allowing me to spend over an hour getting to the bottom of her problem. Even as I drove home that evening I carried thoughts of her in my heart. She is going to need healing physically and emotionally and probably spiritually also in the weeks that come. I pray that I can be a part of that healing process.
This month, please pray for the patients and team at ABC Clinic. Please pray for Greg as he prepares for teaching another semester at NTCCA. Please pray for safety for us as we await our second COVID19 vaccine. And please pray for the country of Malawi as a whole.