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Artist’s Statement: Lost Stars

McAdams, Ryan M. MD

doi: 10.1097/ACM.0000000000002977
Cover Art

R.M. McAdams is associate professor and neonatology division chief, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;

Author’s Note: The names and identifying information in this essay have been changed to protect the identity of the individuals described.

The cry of a woman in the pangs of labor pierces the sultry midnight air as I rush down the dark corridor toward the bush hospital’s obstetrical ward. When I enter the dimly lit triage room, a short Ugandan nurse motions me toward a drawn curtain where I see a young pregnant woman in a frayed blue cotton dress curled up on a gurney.

Dr. Kaikara, the tall, thin pediatric surgeon, called Dr. K, bends over the pregnant woman and presses a stethoscope against the inside of her upper arm, over the brachial artery.

He places his hand on the woman’s shoulder and says to me, “This is Namazzi. She’s a 20-year-old primip at 36 weeks’ gestation with severe hypertension.” Namazzi begins to twitch with a violence that rattles the gurney.

“She’s seizing,” Dr. K says to the nurse. “Give her 6 grams of magnesium sulfate, then take her straight to the operating theater.” He turns to me. “If we don’t operate now, she will die.”

Before starting the operation, we pause, placing our hands on Namazzi’s illuminated abdomen, and Dr. K says a brief prayer asking God to guide our hands. Then, he picks up a steel scalpel, places the gleaming blade below Namazzi’s navel, and makes a swift vertical incision to the level of her pubic bone, splitting her domed abdomen open as bright red blood trickles from the thick layer of yellow globular fat lining the wound edges. With another steady, sweeping motion, Dr. K slices through the pearly white fascia and the underlying muscular uterine wall, releasing a fountain of bloody amniotic fluid that splashes onto our gowns, flows down the blue drape, and pools on the white tile floor.

Finally, a small foot emerges as Dr. K grasps a little leg and yanks out the bloody baby boy, who hangs upside down and lifeless. I stare at the baby’s perfect facial features while Dr. K hands him to the nurse who wraps the baby in a blanket and takes him away. Dark blood continues to gush from Namazzi’s ruptured uterus.

“Found it!” he says, as the light shines on a stream of blood that spurts from a torn artery. “Hold right there.”

I hold the retractor steady. Dr. K, his eyes locked on the bleeding artery, grabs a long hemostat, reaches forward, and clamps the vessel.

Together, we peer into the empty womb and survey the pink, muscular concave walls.

“We have stopped the bleeding,” he says. Sweat drips down my forehead, and my heart pounds. My sorrow regarding the loss of the stillborn baby is countered by the realization that we just saved Namazzi’s life.

Later, as we walk outside in the darkness on our way to check on a child in the pediatric ward, I look up at the night sky filled with billions of sparkling stars.

“How many beautiful babies have died in our world before they were ever able to shine?”

“Too many, my friend. Too many,” he replies.

My painting, Lost Stars—featured in part on the cover and shown in full here—is dedicated to the millions of stillborn babies who die in the womb worldwide every year. These stillborn babies are still born and still matter.

Copyright © 2019 by the Association of American Medical Colleges