I don't know what to title this blog.

Two nights ago I was in the OB ward, working evening shift.  I started off the shift with a bang, as a woman needed a C/S as soon as I arrived.  No problem.  She was a breech baby and the woman’s belly was so big that we were suspecting twins.  When the surgeon cut into the uterus a literal fountain of fluid came out.  We all yelled “woah!!!”  The woman had polyhydramnios.  This is when there is more amniotic fluid than there should be. It hadn’t been a second baby in there, but just lots of fluid.  Unfortunately this is often associated with birth defects.  As soon as they handed the baby over to me, I knew this would be the case with this little one. 

Her head was too big and looked like a mushroom.  She had two clubbed feet, four fingers on her right hand and her eyes could not open.  She wasn’t breathing well so I worked at resuscitating her. Eventually she was breathing on her own, but her respirations were ragged.  As they finished sewing the woman up, I took the baby back to the ward, keeping her on oxygen.  All evening I kept her on oxygen and suctioned her over and over as she kept coughing up more fluid.  At 8:56pm became unable to continue her fight and passed away.  Her mom didn’t cry.  I’ve found that I am actually more surprised when the women do cry. So many children die in childbirth that it’s not wholly unexpected. 

About the time that I was pronouncing this baby, a woman walked in, obviously great with child.  She was being assisted to walk by two different men so I ushered them back to the labor room.  I began with my usual questions.  “What time did the belly begin to hurt?”  The husband told me that it wasn’t just the belly, but the whole body that’s hurting her.  Oh?  So she’s not having the kind of pain to give birth?  Nope. 

Ok, my train of thought moved to malaria.  I started to take her blood pressure but couldn’t hear it.  That’s weird.  I moved on to take her pulse and was surprised to see it was 200 beats per minute (normal is 60-100).  This was fast!!!  Sheesh, no wonder she could barely walk.  I took her to a bed and tried once again to get a blood pressure and got 90/?  Well, she was holding her own.

My first thought was that she was in SVT (supraventricular tachycardia) or some kind of rapid a-fib.  Since the doctors had left the hospital but were still in country I called one of them to see what kind of meds we could give her to bring the heart rate down.  Of course I have my list of things we’d do in the States but we couldn’t do any of them here, and since OB was never my thing, I wasn’t sure what meds would be safe in pregnancy.  After chatting with the doc I checked her hemoglobin (maybe she was anemic?) and started some IV fluids (maybe she was dehydrated?)  We gave her one medicine to try and bring her rate down.  I was told that we actually have an EKG machine that works. Perfect! Unfortunately the only guy that knows where all the parts are and how to work it turned his phone off and when I sent someone to his house he wasn’t there. There was nothing else I could do.  As I left her in the care of the night nurse, I just prayed that the fluids would bring the rate down. 

I went back down a little early the next day because I was so curious about how she was doing.  I saw her empty bed and immediately asked if she’d died.  The nurse laughed and said that no, she was over on the other side.  When I went to look at her, I could immediately see that her condition was worse.  Her lungs were now full of fluid and she was working a lot harder to breath. Her O2 sat was 69% (should be above 90).  I gave her some Lasix to get rid of the fluid on her lungs, put her on oxygen and gave her some dexamethasone in case the baby wasn’t full term.  The doctor had called a little earlier and said that if her condition wasn’t any better, we needed to go and get that baby. 

But how could we take her to surgery in this condition?  She couldn’t even lay down and her heart rate was still 200!!  Unfortunately there was another woman waiting for a C/S as well. We decided to take the non-critical woman first, in the hopes that the Lasix would continue to work and take off some of the fluid off her lungs and she would be more stable for surgery. 

I went and caught the baby from the first surgery and then was back to my critical patient.  She was continuing to go downhill.  At this point, we’d been hemming and hawing about whether or not to take her to surgery because we weren’t sure if she would survive.  Now I could see that she wasn’t going to survive if we continued to do nothing. My small hope was that somehow taking the baby would relieve some pressure on her heart and cause her rate to go down.  It was a thin hope. But it was all I had. 

Unfortunately the stable C/S turned out to be messy. It was her third c-section and during the last one the surgeon had inadvertently sutured her intestine to the abdominal wall (or somewhere it wasn’t supposed to be) so the whole thing had to be done with extreme caution and she bled a lot.  It was taking forever!!! 

While I was waiting for them to close the woman up, I went back to the woman in the ward.  We wanted to check for a fetal heart rate, even though at that point I thought we should probably go try for the baby even if it wasn’t alive.  As I stood there, with the Doppler on her belly, she was saying things like “Take me for the operation.  Anything that you need to do just do it. I will bear it!”  Then she took her final breath. And was gone. 

Of course I started going over and over things in my brain.  We’re very fortunate that it’s not too often that we lose a mother.  I had admitted her last night and she had lived all night, all day, and within two hours of me coming and messing with her, she was gone.  What could I have done differently?  In hindsight I should have taken her to the OR when she came the night before, as she’d only become more unstable as time progressed.  But I was afraid if I took her last night she would die on the table and we hadn’t tried everything yet.  Anyway, over and over in my brain.  She left four little ones at home.  Lord help them.

I’m really sorry that I’ve had so many downer blogs lately!!  I usually try to alternate so that a feeling of depression doesn’t come over my readers whenever they see I’ve posted something new.  Life is hard here, but our God is still alive and my hope is that someday Justice will reign!