Mirlande--November 2020
Mirlande (Photo by John Carroll–November 21, 2020)
This morning as I pulled on the handle of the old brown SUV to open the door, it wouldn’t open. This is not uncommon for Haitian beaters to have this problem. However, four men quickly got out of the car and one of them opened the door from the inside.
There in the middle of the second row of seats was an ill-appearing lady who was breathing rapidly, looked very pale, and whose legs and arms were swollen.
Mirlande, age 40, was referred to me for a “heart problem” and her husband and friends drove her to Port this morning from a small city just south of Port au Prince.
Mirlande gave birth to her sixth baby four months ago. She had had no problems during her term pregnancy and the baby is fine. However, one month after delivery she became short of breath with minimal exertion. Her husband took her to a hospital on Haiti’s southern coast and she was admitted for 12 days but discharged on no medication except vitamins.
During this past week, they traveled into Port au Prince and Mirlande had an echocardiogram which showed a very weak heart with a left ventricle ejection fraction (EF) of only 18%. (Anything less than 40% is considered systolic heart failure.)
Mirlande was too weak to get out of the vehicle and so I examined her in the car. Her blood pressure was very low and the conjunctiva of her eyes were pale indicating anemia. But the most impressive finding was that she was full of fluid that went from her toes up to her lower back. Her heart sack (pericardium) and lungs were also sequestering fluid that her heart cannot handle.
So, while standing at the car window looking at her, I wondered what to do. Mirlande most likely has peripartum cardiomyopathy (a weak heart associated with pregnancy) which is not uncommon in Haiti. And some women with this improve on their own. Also, she appeared very anemic which could be contributing to her heart failure.
If I told her to go back to their village and let nature take its course so she could be with her family, that didn’t seem all bad to me. But I didn’t want to force my “value system” on them. And I thought maybe she would be easy to “tune-up” with judicious diuretics and possibly a careful blood transfusion.
So I wrote the all-important “fiche de reference medicale” to a hospital in Port au Prince and gave her husband 200 dollars to get their foot in the door.
Do I think this will work and that this story will have a happy ending? Not really. But with a 40-year-old mother of 5 kids, we at least need to try.
As they were getting ready to leave, Mirlande’s husband took me aside and said that he had taken her to all of her medical appointments during her last pregnancy. His eyes glistened over while he was telling me this and so I had to look away while telling him he had done everything humanly possible for Mirlande.
(Mirlande’s name has been changed. She gave permission for her photo to be used.)
John A. Carroll, MD
2 thoughts on “Mirlande”
Anonymous
says:
November 22, 2020 at 10:20 pm
What a story! Thanks for sharing the details with those of us who tend to forget how relatively easy our circumstances are in comparison.
ReplyAnonymous
says:
November 22, 2020 at 10:21 pm
Sorry, didn’t mean to be anonymous. This is George Gilbert.
Reply
Comments
Post a Comment