'His birthday is his mother's death': Woman who died in childbirth could have been saved, says coroner
By Charlie Fidelman, Postmedia News June 19, 2011 6:02 PM
MONTREAL — When Gondiel Ka brought his wife to a Montreal hospital on Aug. 13, 2008, he expected to experience the joy of his third child’s birth, not the anguish of losing his wife.
Christine Sasseville, 38, died six hours after baby Demba was born because of a massive cerebral hemorrhage caused by high blood pressure.
If dying during childbirth at a major Montreal hospital in the 21st century weren’t troubling enough, the fact that Sasseville died of a common and entirely treatable condition of pregnancy makes her death all the more shocking.
Devastating reports last year by the Quebec coroner and the Quebec Public Protector called into question serious gaps in care. Sasseville could have been saved, they concluded.
Maisonneuve-Rosemont Hospital’s accident report noted that Sasseville died because of medical error, specifically because staff did not follow the established protocol for her condition. Doctors had underestimated the urgency of Sasseville’s illness, and subsequent nursing care that night was all but absent. The Quebec College of Physicians is investigating. One nurse has pleaded guilty to negligence before the nursing order’s disciplinary board and is awaiting a hearing on her sanctions, while a second is to appear before the board in October.
Since the start of what Ka calls a terrible nightmare, he has struggled to come to terms with his wife’s death. It was a stupid and sad death, he says. But it should not be in vain, he argues, so that other women suffering from pregnancy complications in modern Quebec hospitals don’t have to die for lack of proper medical care.
“It pains me that anyone could have died like this,” he says.
It’s a normal family evening in the Ka household, a cramped apartment in Montreal. Amy, 19, is unpacking supper groceries, Aly, 16, is on the computer in a corner of the living room. Toddler toys litter the floor.
Baby Demba bounces between kitchen and living room, calling “Papa, papa, papa!” He has gummy candies in one fist and a runny nose that he wipes with the other.
“How about fish? Do you want to eat fish?” his sister asks in French from the kitchen.
Long-limbed and agile for his age, Demba jumps on a threadbare faux-leather couch, dives into his father’s arms, crawls over to the candy bowl on a side table, and accidentally tips his glass of juice to the floor.
“It’s always papa, papa, papa,” Ka says with a rueful smile. “I am his father — and his mother.”
Sasseville and Ka met while studying at the Universite du Quebec at Chicoutimi. They married in 1990 and later moved to Montreal. Sasseville was a nurse, while Ka works as a credit clerk.
Demba is the result of Sasseville’s maternal yearning for another baby in the house — Aly was then 13, and Amy, 16. “She told me: ‘He’ll keep me busy — I’ll run after him,’ ” Ka recalled his wife saying. Once she got pregnant, the couple chose Demba, a word that means “the third one” in Ka’s maternal tongue, Fulani of Senegal.
The baby was due Sept. 12, 2008.
The first sign of trouble in the pregnancy was when Sasseville started having contractions on Aug. 13.
Tests at Maisonneuve Rosemont Hospital clinic, where Sasseville was being followed regularly for gestational diabetes, confirmed pre-eclampsia, or pregnancy induced hypertension, a potentially serious illness. The condition is characterized by a dangerous spike in blood pressure and high levels of protein in the urine.
Most women with high blood pressure have normal pregnancies. But untreated, it can prevent the fetus from getting enough blood and oxygen and can progress to a rare, life-threatening condition that can cause seizures in the mother, and in some cases, coma. The only cure is to deliver the baby immediately, often weeks or months prematurely.
The condition affects four to nine per cent of all pregnancies in first world countries and up to 18 per cent in developing nations.
By mid-afternoon, Sasseville was advised to return to the hospital immediately. Labour would be induced that night or at the very latest the following morning.
They arrived at the hospital at 8 p.m. Her blood pressure was soaring. Normal is 120/80. She was 177/90 — extremely high.
But there was no room for Sasseville in the delivery room.
Sasseville was given a bed on a postpartum floor at about 10 p.m., and Ka went home to his children.
Sasseville spent an excruciating night, unable to sleep because of pain and nausea, blurred vision, severe headaches and vomiting.
In her report, coroner Catherine Rudel-Tessier noted that despite these alarming symptoms, Sasseville’s blood pressure was checked only once during the night. Also, the physician on duty opted to maintain “status quo.”
When Ka returned early the following day, he found his wife in worse pain: violent migraines and electric shocks with every contraction.
By 8 a.m., the patient was deteriorating rapidly, according to her medical file. Her arterial blood pressure was 183/94.
The next doctor who saw Sasseville at 9:50 a.m. prescribed morphine to ease her pain and ordered an emergency delivery.
Ka said he was told to get his wife to the delivery room in a hurry: “I got the wheelchair, I helped put her legs in the stirrups once in the room.”
There was a delay of 90 minutes, however, from the physician’s visit and the transfer to the labour room before Sasseville got a dose of morphine. Better and more consistent pain management would have eased the patient’s blood pressure, the coroner said in her report.
Sasseville got magnesium sulphate to prevent seizures and Tylenol for pain. By 2 p.m., she was vomiting with each contraction. She appeared to be confused, lethargic and drowsy.
Ka says he saw his wife slipping in and out of consciousness. He described her as semi-comatose.
The baby was born at 3:59 p.m. He was limp and lifeless.
“He was the only one of my children who did not cry at birth,” Ka recalled.
Demba was whisked to the neonatal intensive care unit while delivery room staff looked after his mother.
A reading of Sasseville’s arterial tension showed 180/100. The physician tried to wake her, but Sasseville was not responding to her name. She was breathing. But her pupils were fixed.
The doctor called a Code Blue, an emergency alert to resuscitate a patient, and Ka called his mother-in-law and told her to come to the hospital immediately and bring along the two older children.
But it was too late. A scan showed Sasseville’s brain was entirely flooded with blood. Her death was imminent, according to neurosurgeons in the intensive care unit. She was declared dead at 10:30 p.m. She never saw or held her tiny son.
The cause of death was later determined to be a massive brain hemorrhage caused by hypertension.
Demba has abandoned the candy bowl for a bag of baby carrots. He watches his father speak.
Hospital staff in the intensive care unit initially told Ka that his wife’s brain bleeding was probably caused by a malfunction, like a cerebral vein or artery deformity.
Ka asked the hospital for an autopsy: “She had just given birth. I knew something was wrong.” And he called the coroner to ask for an investigation.
“I wanted to know what happened. It’s inconceivable that a pregnant woman in the 21st century dies because of high blood pressure in a hospital,” Ka says.
“She stayed all night in the hospital and her blood pressure was going up. They were reading it, 177/90, 182/90, which was extremely high, so I don’t understand that.”
He takes his glasses off and wipes his eyes. “I could understand if it happened in the bush in Africa, but how is it possible in Montreal?
“I took my wife to the hospital to have a baby. It should have been a happy occasion and the next day I had to buy a coffin.”
When the autopsy ruled out a brain malformation, Ka said he felt reassured.
Then came the coroner’s report that Sasseville did not get the necessary carethat her condition required. Doctors had misjudged the severity of her arterial tension and failed to act fast enough, Rudel-Tessier wrote. “One wonders whether a caesarean section performed on Aug. 13 could have saved her.”
Ka wonders the same thing.
When his wife gave birth to their first child, Amy, in Chicoutimi, Que., nurses checked on her every 15 to 30 minutes, he recalled. It was the same routine when their son Aly was born in Montreal’s Notre Dame Hospital.
Angry, bitter and inconsolable, Ka says that high blood pressure is a red flag for a dangerous condition — there’s a protocol for it and explicit Canadian guidelines. He has those guidelines at his fingertips, printing a copy off his computer.
These are the guidelines that the coroner consulted. These are the guidelines that the hospital didn’t follow.
Hospital officials will not comment on the case, except to say that corrective measures have been taken, said communications director Francois Brochu.
In April 2010, officials sent the coroner a letter stating that the hospital is following her recommendations to improve patient safety, and has implemented a Canadian program of excellence called Managing Obstetrical Risk Efficiently.
Brochu added that the drama of Sasseville’s death was heartbreaking for the delivery room staff, affecting everyone in the obstetrics department deeply.
Life after Sasseville’s death in the Ka household was hard — with upheaval, grief and despair.
Ka had to stop working. He took parental leave for a year.
The local health centre sent a nurse to the apartment three times a week for two months to help Ka with a premature newborn.
“I had two children crying. I had to take care of them, my baby, myself. I had no one — my family is in Senegal, my mother-in-law is in Jonquiere, Que. He was waking up every two or three hours,” Ka says of Demba.
“Aly was having nightmares for months. I was crying.”
Ka is suing the hospital and the two obstetricians who treated his wife for nearly $4 million. Named in the suit are the doctors — Martine Bernard and Julie Guimond — who had Sasseville in their care.
The coroner’s report last year unleashed a fresh wave of grief.
“The children reacted very badly after they found out the truth,” Ka says. “It was difficult for everyone.”
These days Ka takes Demba to daycare before work; his older siblings pick him up after school. Ka does laundry and washing, Amy is the family cook.
Dinner is ready, Amy says. Demba scrambles into a high chair by climbing over the back. “We call him our monkey,” Amy says. “He’s always climbing.”
She sets a plate of pasta covered in sauteed tomatoes and fish on a plastic tablecloth.
Demba waves a fork in one hand and eats with the other.
Born four weeks premature because of his mother’s illness, Demba was a scrawny, tiny baby. He is making up for lost time. “You spend your whole life eating,” Ka teases.
Demba smiles, showing a mouthful of pasta.
Demba has seen photographs of his mother. He has visited the cemetery. But he doesn’t understand yet.
“His birthday is his mother’s death,” Ka says. “I don’t know how he will react to that.”
© Copyright (c) The Montreal Gazette