What a day!

I almost died. Ok, that’s a bit of an overreaction (which if you know me, you know that I almost NEVER overreact!)  As periodically happens over here, weird skin eruptions will occur on our bodies, causing us to ask ourselves (and usually consult others)….”is this a mango fly (a worm that imbeds in the skin) or a boil?”  Well, I woke up one morning with such an eruption and decided I’d start taking antibiotics sooner rather than later.  I had some Bactrim, so I decided to start it.  Last year I’d taken Bactrim and suspected I had some kind of allergic reaction. My mouth broke out in all these blisters and I couldn’t really eat for 2 or 3 days. A similar, milder thing had happened to me before but I couldn’t remember if I had been taking Bactrim at the time.  When I was home I talked to my doctor about it but he didn’t think it really sounded like an allergic reaction.  Awesome! ( I’ll admit I was always a little too proud about the fact that I could mark “no allergies” and “taking no medicines “ on any medical form I had to fill out).  Oh how the proud will fall.

I was working Sunday morning so took my first Bactrim before I headed down to work.  About 30 min after getting to work I was reading my book when I noticed that my gums started tingling.  Why in the world are my gums tingling? Then I remembered. I’d taken the Bactrim. Could that be it????  I decided to just wait and see what happened, and as I waited, my whole mouth started tingling.  Then I started feeling this ball in the back of my throat that kept getting bigger.  My tongue started swelling a little and I started having a little tightness in my chest with a little cough.  Shoot.  I didn’t know what else it could be except a stupid reaction to the Bactrim so I went home and took some Benadryl.  I was super antsy and couldn’t sit down.  I kept thinking of the patients I’d seen in the ER that came in with anaphylactic reactions.  I did NOT want to be one of those patients!!  I talked about it with a couple of my nurse friends who assured me they could give me a shot of epinephrine if I needed it and that I would probably be fine.  (There’s a chance I have a tendency to overreact….especially when I’m 3 hours away from a doctor, and thousands of miles away from someone who could intubate me). 

My symptoms slowly resolved and I left my visiting nurse friend down at the hospital to keep an eye on things while I went up to the house to make us some lunch.  A few minutes after getting there I got a call in whence my friend said…..”Umm….you should get back down here.” That's the kind of sentence that makes your stomach drop a little.

I got back down to the hospital and met a very pregnant, relatively unresponsive woman.  Her blood pressure was really high and the nurse that took her vitals said that she was “twitching” while he took her blood pressure.  I asked her family how many months along she was, and they said 9.  I asked if she was in labor and nobody said anything.  Ok?  I heard one of the women say that this “sickness” had been bothering her for about 3 days. 

Ok.  I had a couple different things going through my head.  Her blood pressure was really high. Was this eclampsia? Had she been seizing at home?  She also had a fever, so I was thinking it could be cerebral malaria.  She was COMPLETELY uncooperative.  I tried to start an IV and she freaked out.  Three of us had to basically sit on her to allow the lab to prick her finger. When I gave her the injection of anti-malarial medicine, I thought the needle was going to break off in her leg, she was moving around so much. Oh. And she fell off the bed. Off. The. Bed. I couldn’t tell if she was being overly dramatic or if there was something going on with her neurologically. 

Because she was so wild, I couldn’t tell if she was in labor or not. Initially I didn’t think she was….I just thought they’d brought her in because of another illness. But after we stopped torturing her, I began to notice that she seemed to freak out in a somewhat regular pattern.  When she said she wanted to have a bowel movement that sealed it. I needed to do a vaginal exam and see where we were. 

As I inserted my fingers, I immediately felt a head. Holy cow this woman was ready to push!!  Only she wouldn’t push. At all. She did a lot of yelling, but no pushing.  I found the vacuum and wrestled with her to get it attached to the baby’s head.  As the contractions came, so did the baby.  Just like that.  Crying and everything. But it was tiny! (Just over 3 pounds I found out later).  It took me about 2 seconds to look at the baby and her belly and realize that there was another one in there. That’s when I had my “Oh C.R.A.P.” moment  This was my first delivery since I’d gone home in November and my first time delivering twins……EVER!!!!!!!!!!

I reached up in there and could feel the bulging membranes around the second baby.  I used my handy dandy fingernail to rupture them.  As I did, a MOUNTAIN of fluid rushed out and I was drenched!!! My first thought was “I can’t just jump away because I need to guide the head down so the cord doesn’t come down first.” My immediate second thought was “well, if this woman had Ebola (don’t know if you’ve heard about the outbreak over here) which is transmitted via body fluids……I’m in BIG trouble!” 

I reached up and felt a head.  Yea!!!  With a hand.  Not so “Yea.”  When I ruptured the membranes, there was a thick meconium stain. This means that the baby is in trouble.  I did a rapid thought process in my head.  The first baby was small. This one probably is too.  But there’s the hand. Can the baby’s head fit through with the hand? It’s not the woman’s first child which means there’s more space down there, but still. I’VE NEVER DONE THIS BEFORE!!!! And then there was the meconium stain. The baby was in trouble.  We didn't have a lot of time.  The woman wasn’t cooperating which meant she wasn’t pushing, which meant she wasn’t going to be much help. 

I asked my friend to grab my phone out of my pocket and dial one of the midwives who lived close-by.  I wanted her to at least be on the way in case I got into trouble. As soon as I hung up the phone my patient had a contraction and we pulled the second baby out.  He came out screaming.  He was a little bigger at about 3 ½ pounds.  Nothing like the screaming cries of two bouncing baby boys!  As I was delivering the placenta and cleaning her up, one of the relatives said, “Yes, someone mentioned that it was two babies.”  Huh. That might have been nice to know at the beginning. J Oh Salone.  

I was going in and out of the labor room, getting different medicines and I heard one woman telling another….”this woman  (meaning me) has done well! She really knows this work!”  I had to stop her right there and say…..NO!!! This was my FIRST time doing this. I don’t know anything! It was GOD that helped us today! J  And it was.  Just another day in Salone.......