Many times, I come across pregnant women at term who have gone into labour and some very apparent indication would require caesarian delivery to make their outcomes and that of their babies worth the arduous journey of forty weeks. But for some unseen reason, these women after coming to knowledge of imminent surgery start pushing their hearts out in attempts at expelling their babies.
It’s bee a long while without writing anything here. I guess this is worth sharing. Not for self glory but to highlight its necessity in a country with increasing disregard for certain professions like those in healthcare and a misplacement of certain priorities a modern health care delivery system.
Being on call duty and seeing a call from the labour ward at 5:15 am is something I would always dread. “D-R, there is a labour case we have here who is at 5cm of cervical dilatation but the cord has prolapsed so we are calling to inform you”, her hurried voice carried the info over on the phone. ‘OK..lets prepare her for theatre please’, my response with a yawning voice.
Before I could step foot on the cars accelerator, another call came through; “D-R, we are in theatre but the baby is coming out, could you please get here now?” My already hurried gesture landed my reversing car into a ditch in the midst of the blinding fog, delaying some precious seconds of getting out from.
I got to theatre only to find out the woman had delivered to a severely asphyxiated baby on whom resuscitation was being carried out by the attending anesthetist and Midwife. After about 10minutes of this, the baby assumes spontaneous cardiopulmonary activity and is sent to the neonatal intensive care unit. Mother is also stable with contracted uterus and is sent back to the ward.
All is clear now. I return to the wards to start the days work of routine. After completing rounds on three different wards, I decided to pass by the maternity ward designated to operative cases. After having rounds there, I sat with the midwives to enter notes onto the computer software. Then one midwife rushes in, insisting that I come quickly to the labour ward. “D-R, there is a woman bleeding profusely at the labour ward. We have tried our possible best but it is not stopping”. I arrive at the scene and my first glance landed on palpable danger. The seriousness with which some midwives were squeezing units of intravenous fluids down this woman’s veins as others busily worked on her perineum and another’s hand on continuous massage of the uterus over the abdomen was worth ones admiration.
‘Primary Post Partum Haemorrhage’, I mention to myself and start listing the possible ‘Ts’ which could cause it. Tone of the Uterus, Tears, Tissue, Thrombocytopenia. Her BP then 85/45mmHg, with a fast pulse. Definitely this woman is in shock and could deteriorate at anytime. ‘Can we ask for blood?’. Quickly samples are taken and someone rushes to the Blood bank. God being so good, my colleague doctor appears from nowhere for reinforcement. we run through our Ts again, evacuate the uterus of about 800mls of blood, keep massaging the uterus, and then turn inspect the cervix of any tear, which comes out positive, to which we start suturing. After suturing the cervical tear, the uterus which had earlier been emptied and had turned firm from contracting had now become flabby and bulkier. The bleeding from the vaginal introitus had not improved. Man needed to act. The next decision was to take the woman to theatre for possible exploration. But that cannot be possible with the blood pressures we were recording. News dropped that she is blood group AB negative and the hospital did not have any blood available at spare. Attempts at getting donors from here family were futile. The arranged donors who could were about 40mins away. We sat on a timed bomb. Finally a thought came to mind and I left the woman in the care of my colleague so she is sent to theatre.
A quick estimation of my blood sample revealed an Hb of 15.5g/dl, meaning I could donate, knowing that I was a universal donor. Well, I had never donated blood due to how frequently I get malaria. So my blood is precious to me. Before I could be bled, the Laboratory technician asked if I had eaten. It was then I realized that I hadn’t. They quickly got me a bottle of malt to take and down I laid to be bled. I took my second bottle of malt, laid down for some minutes after the donation was over and realized I was good enough to go. The danger was partly gone. She at least had one unit of blood. But entering theatre with an ongoing hemorrhage meant we needed at least 3 units for starters.
I quickly rush back to the ward only to be told she had been sent to theatre. She would possibly need a hysterectomy in the worst case scenario. I had done sub-total hysterectomies before, but this I envisioned may require a total hysterectomy. I quickly called my boss and father under whom I trained in obstetrics and gyaenecology for tits bits on how to handle issues in there. His input put me in the best shape I could be. ,
We open her up only to be met with a ruptured uterus which extended into the cervix with a number of exposed and bleeding vessels. Attempt at salvaging the uterus was going to be detrimental. The woman already having six children with an advanced age meant a hysterectomy was the best option. After 2 hours of herculean standing and neuronal transmission in decision making transmitted through mortal hands, a sub-total hysterectomy was done to salvage the situation but the nature of the cervical tear meant suturing the cervix way down and this lead to another misfortune of having tempered with the left ureter of the woman. But my colleague’s rapt attention caught this, leading us to go back and adeptly undo some stitches. It was close to the end of finishing the surgery that I started feeling dizzy and uneasy. I had to hand over the scalpel to my colleague and scrub out of the case. I rushed home only to find out I had not taken the morning dose of Artemether/Lumefantrine.
I reminisced after taking a bathe on how we had preserved the life of the woman but with unsure minds of the perfect state of her left ureter. The plan was to monitor her with serial scans. Her urine output after the case had been wonderful and two days after, surgery, a first scan done showed no hydroureters. Sigh of relief. At 4pm and one midwife who did Night duty the night before but had to stay behind chasing blood and making calls in search of the same calls to find out if I am well. That was heartwarming. She had just gotten home herself.
These and many more are some of the sacrifices health workers make to ensure that in our very inadequate health delivery system, we preserve the lives of our clients, sometimes beyond our ability and at the expense of our own lives. Well, some people say we knew this before choosing the profession. But the same people we pour our lives out to help are the ones who crucify us and make us regret doing good to others when an indispensable part of us, a part of all humanity across all fields of work, shows itself – mistakes.
When you look at the health system, don’t just think nurses are rude. Do not regard doctors as spoilt and proud. Do not regard Lab technicians as fraudulent. Don’t regard us as killers. We give beyond what we have anytime we stand by, on or before you to render care. Consider the frailties in our health system as well. We are all siting on timed bombs. But maybe your health workers are the Angels with mortal hands.