Baby N

Hospice: Howick Hospice
Name of patient: Referred to as, “Ms. N”
Written by: Sister Bev Gibson, Howick Hospice
Diagnosis: TB
Message: Palliative care can be offered along with curative treatments and should commence at the point of diagnosis of a life-threatening illness

I am really privileged to work as a registered nurse in the outreach team of our little Hospice where I do home -based care in the rural community, caring for patients with HIV/AIDS, TB and Cancer, in their homes.

Our TB patients are often really unwell when we admit them to our program, and it was no different with Ms. N who was referred to us from the local clinic. She had typical symptoms of Pulmonary Tuberculosis and was very undernourished.

I was surprised at how well she was responding to the porridge and nutritional advice we gave her every week as her weight began to steadily climb!

It took me a few weeks to realize that her nausea was not from the treatment and her amazing weight gain was because she was actually pregnant! Not what you expect as a palliative nurse, usually dealing with the other ‘end’ of life!

Ms. N was too scared to tell anyone about the pregnancy, fearing they would insist she terminate, and was thinking of stopping the TB treatment (I suspect she may already have.) as she was terrified that the medication would have adverse effects on her unborn child.

We allayed her fears, acknowledging that this baby was clearly precious and very wanted and explaining that nobody would force her to terminate. We explained that even though the medication did cross the placental barrier, it was very unlikely to harm the baby.

She was also delighted to hear that as with her HIV, her baby would not be born with TB if she remained adherent to her treatment.

Our weekly visits took on a different approach. We encouraged her to attend antenatal clinic and we worked closely with those sisters, reinforcing their advice. Our education (some of which had to be unearthed from dark recesses of my brain, as I had last worked in maternity more than 25 years ago!), now included antenatal advice and preparation for the arrival of a precious new life.

Our holistic approach to palliative care took on a whole new look and as she needed us less for TB support, she began to need us more for pregnancy support.

It was so wonderful to see the excitement rising in her little family as her due date approached.

Her 6-year-old took his role as a big brother very seriously and showed me where ‘his’ baby was going to sleep in their tiny shack. Grandma’s feather bed came to mind!

One Tuesday morning I arrived to find an ambulance outside her house and lots of activity- the day had arrived!
Ms. N’s little boy was absolutely terrified. He had no idea what was going on. His mom was clearly in distress, his dad was at work, the neighbours had called the ambulance, people were running around and nobody would tell him what was happening.

We were able to take him aside and quietly and calmly explained. We walked around the other side of the ambulance and looked inside (he’d never seen an ambulance that closely before!) and I explained what all the equipment was for and how it could help his mom. He was much calmer when he said goodbye to his mom and went back into the house with the neighbour.

I phoned Ms. N the next day, “Howu Sister, I have my daughter!” She exclaimed in delight! The next week I got to meet this beautiful, most wanted little girl! Such a joy for a nurse who normally guides to the end of life, to be guiding and welcoming a brand-new life! I love my job!