If you just smile

Three of the four nurses I flew with to Haiti left this morning, back to the United States. Beautiful spirits all. Mary and Carol are sisters, who came together to serve in Haiti. Sarah, a lovely young mother from Boston -- the other Boston...my childhood Emerald City Boston. Nurturing souls, found between IV pushes and medication administrations sitting on cots, holding babies, rubbing the backs of elders, hugging casted children. Humble women in bright colored scrub tops covered with hearts and flowers and Tweety Bird and peace signs. Peacefully soft in appearance, solid in a crisis. Our nurses.

Mary, a farm girl from Minnesota, full of surprises, revealed last night she sings in a jazz band. She said she had a dream to sing for the patients before she left.

"You sing in a jazz band?" I asked with a small bit of incredulity at yet another of Mary's hidden layers.

"Yeah," she said simply, with her regular humility.

"Well, what do you want to sing? Sing it for us!" I encouraged, as we sat crosslegged on the beds of our eight-bed medical staff bunkroom, darkness illuminated by a single fluorescent bulb on the ceiling. We leaned in, like teenage girls at a sleepover, in tanktops and scrub bottoms, legs folded up under us. "I want to hear."

She laughed softly, then admitted, "I don't know if I could get through it without crying...singing to all of them..."

"Try with us," I encouraged. "Come on..."

So, she started to sing, softly, a bit hesitantly, but then her voice strengthened to a deep, pure tone. Her eyes lit up. And words, so amazingly fitting for our patients, wafted over us..

Smile, though your heart is aching.

Smile, even though it's breaking.

When there are clouds in the sky, you'll get by...

I imagined her standing in the middle of the courtyard at our hospital in the evening when the patients gather for prayer. Soft spoken Mary. The secret jazz singer. Known only to her patients as the quiet nurse who so effectively cares for them. Breaking into deep, sensual song...A gift, a prayer, for those she has so selflessly been nurturing back to physical and spiritual health.

If you smile with your fear and sorrow,

Smile and maybe tomorrow,

You'll find that life is still worthwhile...

I imagine translating the words of the song to our patients, read in verse. Then have Mary sing, standing small yet powerful in the middle of the darkened evening courtyard. I imagine her patients, sometimes unable to know her true caring, due to the Haitian/English language barrier, finally seeing the truth of her deep feelings for them

If you just...Light up your face with gladness,

Hide every trace of sadness

Although a tear may be ever so near

Mary paused. Her eyes were welling with tears. "I don't think I'd be able to get through it without breaking down..." she murmured with a sheepish smile.

"Oh, yes you will!" I said. "You are going to do this! You will. Keep going!"

That's the time you must keep on trying

Smile, what's the use of crying

You'll find that life is still worthwhile...

if you just Smile...

Hoots and applause filled our bunk room. Hair on my arms stood on end. Mary the Jazz Singer Nurse. With the angelic voice... Wow.

"I don't know..." she said after the scattered claps faded.

"You will do it," I said with certainty. "Tomorrow night. Your last night. You'll do it. I'll make you."

We all smiled as we tucked ourselves into bed.

The next morning, nurse Sarah, who is considering becoming a midwife, and herself had a homebirth several months ago, announced that she wanted to help birth a baby before leaving the country the next day. Sarah had helped with our first challenging 3 pound, 17 day old neonate in distress, and demonstrated herself to be a competent, shakeless powerhouse. Another sweet on the outside, steely strong nurse on the inside, confident presence in a medical emergency.

"Oh, Sarah," I laughed. "You're gonna jinx us."

"I hope so," she said, and wandered away.

So, no great surprise, at change of shift at 7pm, a knock came at the large metal door at the front of our courtyard. Johnathan, our medical student turned translator, came running into the nurses station. "It's a lady having a baby! She's in labor! She's having a baby!"

The nurses and I looked at each other with raised eyebrows. Sarah folded her hands excitedly in front of her, a giant smile on her face. I shook my head in bemusement.

"Geez, Sarah," I said, "Will you now wish that I will win the lottery?"

A strikingly beautiful Haitian woman walked in wearing a flowing sundress, prominent pregnant belly attracting our attention. She calmly sat down on a cot as vital signs were taken. Only a small occasional grimace and a clenching of an eye indicated the pain of the labor, contractions 2 minutes apart.

A history was taken. Yes, prenatal care. Third pregnancy. Otherwise healthy. Laboring for 4 hours. Hoping to deliver with a doctor present -- not a common service available in Haiti, particularly after the earthquake.

Beth, our local midwife, examined the woman and recommended that she proceed to the birthing center, a few buildings down the street, where she is set up for traditional midwifery births. Nurses Sarah, Mary and Carol offered their services. As did I.

"Do you think you'll need any help? I'd love to help, if I'm not in the way," I said.

Ruth enthusiastically welcomed my offer to assist her. Our pediatrician Jenn also committed to being there in case of emergency.

So, the gaggle of women made their way to the birthing center. We changed into scrubs while the beautiful mother-to-be changed into a bright pink soft cotton t-shirt. Her gigantic pregnant belly protruded majestically, and she held it in her hands, eyes closed and quiet, riding out the intermittent labor pains.

I have never seen such a calm labor. Obviously painful, but most pain internalized. The occasional curl of her toes, or a small squint of an eye, a small unsuppressed grunt, a contraction of her pregnant abdomen, demonstrated the progression of her labor. But otherwise no external sign at all. Once again, the Haitian woman revealed what is appearing to be a gender specific and culturally nurtured ability to accept and process the deepest of pain that would leave lesser women (a.k.a. me) writhing and bawling and screaming for an epidural. Amazing strength. Built from a life requiring amazing strength, day after challenging day? Is this the type of pain the stoic women in our hospital endure as they relearn to walk on jagged femur fractures and pelvic fractures?

Five sweltering hours later, as a soft rain fell outside in the darkness, lovely mother squatted, then knelt, then lay supported in the arms of Jazz singer Mary, who from behind dabbed her face with a cool wet cloth, gently messaging her back. Then on all fours, then on her side, then squatting, then pacing. All the while silent. Father sitting in a seat next to the bed, likely overwhelmed by the estrogen swirling around the woman. Though unknown to us, this woman was taken into our care, like a sister. Held, like a sister in a universal and timeless tradition of birth. Back rubbed, legs messaged, brow wiped, whispered support. Doppler checks of baby's strong heartbeat...consistently strong and quick through contractions....a good, strong baby.

Dad was asked, "Do you want a boy or a girl, papa?"

Perhaps intimidated by the 6 sets of female eyes now pinning him to a decision, he smiled rather sheepishly and said, "Whatever....it doesn't matter." And shruged his hands. The women made approving sounds. He was off the hook.

The nurses in this room were not unaware of the metaphor revealing itself on this night, their last night in Haiti. The symbol of hope, in this natural experience of birth. I sat next to Mary on the bed, who sat behind mama, gently rubbing her shoulders in anticipation of another painful contraction. I fanned them both with a clipboard. I looked at Mary and catch her eye, and began to hum her song. Mary smiled, and we hummed together. Then she began to softly sing, "Smile...though your heart is aching..."

More time passes. It is 3 am. Mama is tiring, but labor is progressing. Now, a few moans escape her stoic facade. Then a gush of water. And an acceleration of labor.

Pushing, straining. Nurse Carol places a hand into mama's birth canal, and says, "Oh, I feel soft hair." Smiles all around. A tired smile on mama's face. Straining. Carol places hands gently at the perineum, and with another push, baby's head appears. She is suctioned. There is no cord about the neck. Another push and the slippery baby is out. A vigorous cry. A girl.

She is laid over mama's still swollen belly and we dry her vigorously. I have been placed in charge of baby's care, with Doctor Jennifer available in the room next door. I examine baby for signs of health. Initially pink, a good strong cry, and a fast heartbeat. Then, within moments, a dusky blue hue, no crying, slowed respirations, slowing pulse. No, I say. This is not how the metaphor ends. No.

Baby turns blue. We stimulate her with rubbing and foot flicks. We turn her over to open her airway. In a true medical clinic, we would have blow-by oxygen, but not in our small Haitian birthing center in this post-earthquake Haiti. We suction again. We pull out a pre-prepared ambu bag and breathe for baby, hoping to support her ventilations. Her heartrate drops further. The rule is, oxygen and bagging for heartrate below 100. CPR for heartrate below 60. Despite bagging, baby's pulse drops. My own accelerates. As a rule, it is bad when the healthcare provider's pulse is faster than the infant's. Time races. Our nurse gives artificial ventilations as I quickly initiate chest compressions on the now sickly blue baby. My thumbs cross over each other and squeeze baby's chest between my hands. "Get Dr. Jenn," I say with urgency as I stare down at the fragile bluish form, pumping her heart for her through the soft ribs of her small chest.

"Come on, baby..." I urge. I am reminded of just one week ago, and the 3 pound baby that was dying in front of just this very team of women. "Come on, baby..." Dr. Jenn appears. We continue ventilations and compressions. Seconds of purple lifeless baby stretch before us. No. This is not going to end this way.

Baby begins to perk up. Small arm motions. A cough. A weak cry. Pulse climbing. Stop compressions. Pulse 100. Stop ventilations. Baby breathes on her own. Her color pinkens. Now a vigorous cry. Another, louder cry. Female eyes meet each other once again over baby's now pink form, and deep sighs echo in the small birthing room. Eyes close briefly with relief and thanks.

Mama, who doesn't speak English, lay calmly as we fought for her baby's life. I believe she was unaware of the near crisis averted.

Again, I wonder what would have happened if this birth had occurred on a floor of a home, without medical support. Would the knowledge of the local women, and years of home birthing experience, have been sufficient to save this baby's life? Or would this have been another infant death?

"Okay, Sarah," I say, as she swaddles the newborn and cradles her in her arms. "Looks like you got your wish. You birthed a baby." It's four a.m. And the same women who stared down at the devastation that is now Port au Prince from a charter jet just 10 days ago, now coo and cuddle a pink newborn child. A fitting end to a fitting journey. A metaphor for new beginnings.

As she cleans up the evidence of the labor now passed, nurse Mary begins to quietly sing...

You'll find that life is still worthwhile..

If you just....

Smile.....