Art of surrendering

 Oct 16, 2024. 1607 hrs

Gawat. That time of the month again. Feels like i wanna go somewhere no one knows my name. 

I wanna keep writing but the spirit has gone. And now everytime i look at my book, i feel i wanna puke. How could i read that much book for the past months. I wonder where the energy came from, matter of fact i probably i drained it. 

I wanna write about the art of surrendering: about my patient who never surrender and i surrender to her. I did 3 procedures on her alone only to meet a failure of her expectation. To me its a failure. For her maybe its her strive her fight and pride. Maybe. 

On the phone with my friend, i said,"gw cape ngomong ama dia. She is so persistent. ngalah mulu gw. Padahal gw udah tau bakal gagal." -- they said, "bukan ngalah dung, it is you trying to put yourself in her shoes while maintaining your rationality as a doctor."

I think im gonna tell you the story. 

A couple weeks ago, i got a referral of a mother, 32 yo, pregnant 30 weeks, the baby weight hy ultrasound was 950ish gram. She wasnt supposed to be in labor yet. But she came with cervical dilatation of 3 cm. When usually theres no cervical dilatation in this 30 weeks.

Cervical dilatation of 3 cm means exposure of the babys membrane to the outer world had happened. Out world means bacterias, vaginal fluid, infection, etc. 2 options: A) let the baby out and we treat the baby after she was delivered. B) put so much antibiotics, anti contraction drug hoping the dilatation will close by itself.

Yet, the patient was so educated. She wants to do cervical cerclage, option Z. A procedure to forcefully close the cervix by stitching the cervix from arah jam 1 ke jam 11 ke jam 7 ke jam 5 balik lg ke jam 1 so the cervix will close just like ngiket sarung guling. Chance of success? Less likely.

Why she is being so persistent?

I learned that she lost her kid of 700 g in NICU a couple years ago. The same problem, the cervix dilate way too early. The womb cant handle the weight of the baby. And a slight infection. Make the whole body trying to expel the baby in order to save the baby from ongoing infection inside the mothers system. And her 2nd kid was a miscarriage. 

 I started to think that this mother construct her way to decide based on chaos she had previously, added with buoyed informations of alternatives/options that she herself cannot predict how much hope she should predict/expect. Woman, oh woman when it come into emotional decision, theyre bad at it. 

Sometimes its easier to exchanging knowledge with the husband, more logical and less drama. But still its her body, not her husbands. 

At this time, i chose to break brutal truth than white lie of hope. This gonna be a failing procedure, i explained to the husband.

I did the cerclage as she wished. It was a beautiful cerclage. Considering by the length of her cervix, i was probably wrong. Maybe we could save the baby for another months at least, i thought. She made a good call, i thought. Sometimes mother has hunches that helps the doctor too, you know? Its the connection fo the baby maybe, or God voice thru her. I went home, added another prayer to this stranger. 

The next day, i got fajr calling, but not adzan. This mom went into regular contraction, profuse bleeding and turned out the dilation has increased into 6 cm. This beautiful cerclage tore the cervix. And we cant stop the contraction, her leukocyte build up, the antibiotics failed too, the anticontraction failed too. 

All the sources comes to waste. As expected, i thought. I educated her to have vaginal delivery since the head circumference of the baby was not that big. She had a previous cesarean section, we called this CS for short, before. And again, she got this prior knowledge of the danger of vaginal birth after cesarean as we called vbac for short, and she was denying my advice. Again, ngalah. I did try my best to explain the benefits and the risk from both vbac and repeated cs. She chose exactly the opposite of my advice. 

And i did the CS and i repaired the ruptured cervix. All this for delivering this baby of 1000 g. A fighter. And her mom was a fighter too. And there i was wondering if i could be more firm to her. The baby is in NICU still, i hope she made it. But here i am praying for other people i dont know in an upset way or in a cheerful way, forgetting sometimes to forgive myself for not being able to separate my emotional aspect from professional duty.