Tales From the Field - Part 3

I arrive on the floor in a daze. There is a woman seizing. Two midwives hold her down as the new young OB prepares to suction her. I am instantly awake.

 “How’s her cervix?” I ask.

She holds up two fingers. 

“Two more grams of mag” she calls out to anyone who has a free hand. 

No one does, but the mag appears.

 “It’s twins,” she says.

“Term?”

 “Does it matter?”

We both shrug our shoulders. It doesn’t. Viable or not, they need to come out. We suction the frothy saliva from the airway and from the sides of her mouth. Her tongue is bitten and swollen. She makes a gurgling sound as the seizing stops.

“Prepare her,” one of the experienced midwives says. The OB doesn’t follow at first but I watch as the midwives take charge and start to get her ready for surgery.

Kindness calls me from two beds down.  She is busy with another eclamptic patient, now postpartum and bleeding. There’s a pool of gelatinous blood between the patients legs, with a fresh river flowing into it.

“She won’t let me massage the uterus.” 

The girl is semi-conscious and being held down by family members. “Won’t let you?”  I ask.

Everything is covered in blood. I put on gloves and use my left hand to massage. The patient’s abdominal muscles fight against me. 

“See?” Kindness says proudly. 

The fundus is boggy. I rub in a circular motion, then clamp and hold the top of the uterus.“

“How much oxytocin is in the bag?” 

“10.”

 “Let’s put 10 more.”

 My left hand starts to shake. There is sweat pouring down my face and back. The uterus will not firm. 

“Let me,” Kindness offers. I leave her for a second and quickly grab more oxytocin.  When I return, she is yelling at the patient as she furiously rubs on her abdomen. 

“I am telling her that if she doesn’t cooperate that she will bleed to death.”

I laugh to myself because it is ridiculous.  It’s true but when would you ever tell this to a patient. 

“Let’s give her Cytotec, 1000 mcg.”  She heads for the medication cart.

As soon as she waddles back with the five small pills, I put them into the patient’s rectum as quickly as I can. She fights me but now it’s me showing her what’s best. 

Both of the doctors are there. They bounce back and forth between her and the eclamptic and the newly arrived obstructed labor with possible uterine rupture.  The first eclamptic starts seizing again. 

OK, we need to triage here:  uncontrolled eclamptic with premature twins, nowhere near delivery, true postpartum hemorrhage with hemoglobin of 4.6, or the obstructed labor with a live baby. The last woman seems most stable so we decide to take the hemorrhaging patient first. The boys come with the trolly and off she goes to the OT.

I return to the eclamptic who has been all but abandoned. She is gurgling again and there is now a brown liquid oozing from her mouth and covering the print material under her head. I suction her again, then check her O2 sat: 65% on oxygen. I race to the OT and bring the trolley and its driver back. We are barely able to load her and her giant belly onto the narrow stretcher. I look down on the mattress and see an18 gauge needle covered in blood. I don’t have time to be mad.

We race her through the delivery ward and I just happen to glance down at a woman pushing and notice a small translucent foot protruding from her vagina. 

“You ok in here?”

Elizabeth, one of the senior midwives chuckles.

“I’m fine.”

We are outside in the morning sun and lines of family members watch as we shuttle her along. Her body bounces and her hands and feet flop uncontrollably. She is agitated from the hypertension and she fights the air around her. We hold her down as we push.  

Into the theater we go, my back now completely covered in sweat. I strip out of my damp scrubs and prepare for the OT.  I quickly glance at the hemorrhaging patient in the 1^st OT but have little time for updates. We get our patient on the table and back on oxygen.  I push meds for the anesthesiologist who struggles with the intubation. 

“Merde!”  She cries.

Repositioning, more suctioning and eventually the tube is fed down her swollen throat. Breath sounds. The surgery begins. I squeeze the ambu bag. Kadiza comes from the room next door. 

“The other patient is waking up, what should I do?”

 “Push the rest of the Ketamine.” Sandrine instructs in her thick French accent.

 I add, “And when you’re done with that, can you call maternity and have one of the midwives come and prepare for resuscitation of the babies?”

“It’s twins?”  She asks. 

I nod.

She quickly races out of the OT.

The first baby is almost out so I pass the ambu bag back to Sandrine.  I struggle to get gloves on and just barely do before receiving the first twin.  It is a decent sized baby boy who lets loose a loud bold cry.  Dried and stimulated I leave boy number one for his sibling, another good-sized boy.  I place him next to his brother, just as Kindness arrives.  I laugh.  We dry the second twin and coo at the lively little set of lucky babies.

The OBs continue their work with the mother, but I can tell she is stable. We get word that they’re finishing up in the other room and that all is fine.

“What’s happening with the other patient, the one with obstructed labor?”  I ask, my adrenaline still pumping, mentally preparing for the next c-section. “Oh, she delivered,” Kindness says nonchalantly.  It takes me a minute to comprehend this glorious update.  The team stares at me blankly until I translate into French.  There is a collective sigh of relief. 

Three mothers saved.  4 babies, all alive.  It is only 10am and I am exhausted.