Every doctor has that one patient that they will never forget. The one who gave you sleepless nights and you had nightmares for months. Some are patients we lose and others are near-miss patients.
My patient came into my life in 2011 and she was a near-miss. I worked in an extremely busy city maternity hospital. The experience was surreal. We were a team of nine doctors, all female and most being young moms. We did twelve hour shifts and they could be totally crazy. I loved the high. Babies born left, right and center. Mothers crying and laughing at the same time in immense happiness and midwives whose days were like colony bees.
The low moments were devastating but thankfully few and far apart. No health care provider ever wants to lose a mother whose only intention was to have a baby. It is heart-breaking to have to look a mother in the eye and tell her she has lost her baby, and I kid you not, it does not matter whether the pregnancy is four weeks or forty weeks.
I was at the end of a very busy shift in the emergency theatre. I had done eight caesarian sections and was tired. It was also a very wet El Nino period and I was tired, cold and in need of a hot cup of coffee. The midwife in labor ward came to theatre and asked me to go to the labor ward and review a mother referred to us. I had packed my bag, ready to leave and I reluctantly agreed after she told me that all she needed me to do was to look at the mother and nothing more.
Every obstetrician knows that when a midwife says that, she means to roll up your sleeves and fast. But nothing prepared me for what met my sight. To say the wind was totally knocked out of me would be an understatement. I found a young lady lying on her back. She was covered in mud to the level of her thighs. Her knees we bent up in the delivery position. Her abdomen was huge. Between her thighs, her external genitalia were swollen and disfigured. The baby's scalp was swollen, protruding from the mother, with the skin and hair missing from the exposed area. I was shaken.
I gave the ward team three minutes to have the patient in theatre. I also gave the theatre team five minutes to have the patient on the operating table.
As we prepared the patient for surgery, I was able to take a brief history and what she told me was heartbreaking. She had gone to deliver in a pharmacy. The proprietor told her that they ran a maternity facility at the back of the pharmacy and she would only need to part with Ksh. 500 only. She had been in labor for three days and spent the better part of the day pushing out the baby. Her tummy had been pushed and she had been subjected to terror of unknown proportion. She begged and pleaded with her tormentors to send her to a hospital and they ignored her. The reason she was so muddy was because she had wrestled her way out and escaped into a cab and begged the driver to drop her off at our facility. I was almost in tears of rage. The poor woman was never even told that she had lost her baby.
The caesarian section was going to be a challenge and I anticipated all the possible complications that could arise but nothing, and I mean nothing, could prepare me for the foul smell emanating from the patient's womb. Extracting the baby who was impacted in the mother's pelvis was no mean feat. He weighed 4, 900g and his head was so swollen (caput) and disfigured even in death, it was depressing.
What followed was a bucketful of the smelliest pus I have ever smelt. Everyone ran out of the operating room and abandoned the scrub nurse and I. Suffice it to say, we could not use that operating room for a week.
We had to wash the abdomen and uterus with liters and liters of saline water before attempting any closure. Then we all held our breathe awaiting her reversal from anesthesia. I was fraught with anxiety for the next two hours, is this the calm before the storm? Was she going to bleed uncontrollably now that the uterus had sustained three days of abuse? Would she, God forbid, go into septic shock and require ICU care? I had lost track of the time. The night shift doctor had come in and could not believe she had to spend the night in the smelly theatre.
The patient was retained in theatre under the watchful eye of the theatre team in close proximity to a ventilator in case she required one. I arrived home at eleven in the night, exhausted physically, mentally and emotionally. I stood in the shower for a full hour and it still wouldn't cleanse the stench out of my nose for the next week.
I could not sleep that night as I would wake up startled wondering if the patient was going to make it. This would last me the rest of the week. I cannot describe my relief the next morning when I got a report that she had not only survived the night and gone to the wards.
SHE BEAT THE ODDS, SHE WALKED HOME!!! She passed by theatre to thank us and say goodbye. I do hope that today, she holds a healthy baby in her arms and she had access to quality medical care.
That is my prayer for every mother....
My patient came into my life in 2011 and she was a near-miss. I worked in an extremely busy city maternity hospital. The experience was surreal. We were a team of nine doctors, all female and most being young moms. We did twelve hour shifts and they could be totally crazy. I loved the high. Babies born left, right and center. Mothers crying and laughing at the same time in immense happiness and midwives whose days were like colony bees.
The low moments were devastating but thankfully few and far apart. No health care provider ever wants to lose a mother whose only intention was to have a baby. It is heart-breaking to have to look a mother in the eye and tell her she has lost her baby, and I kid you not, it does not matter whether the pregnancy is four weeks or forty weeks.
I was at the end of a very busy shift in the emergency theatre. I had done eight caesarian sections and was tired. It was also a very wet El Nino period and I was tired, cold and in need of a hot cup of coffee. The midwife in labor ward came to theatre and asked me to go to the labor ward and review a mother referred to us. I had packed my bag, ready to leave and I reluctantly agreed after she told me that all she needed me to do was to look at the mother and nothing more.
Every obstetrician knows that when a midwife says that, she means to roll up your sleeves and fast. But nothing prepared me for what met my sight. To say the wind was totally knocked out of me would be an understatement. I found a young lady lying on her back. She was covered in mud to the level of her thighs. Her knees we bent up in the delivery position. Her abdomen was huge. Between her thighs, her external genitalia were swollen and disfigured. The baby's scalp was swollen, protruding from the mother, with the skin and hair missing from the exposed area. I was shaken.
I gave the ward team three minutes to have the patient in theatre. I also gave the theatre team five minutes to have the patient on the operating table.
As we prepared the patient for surgery, I was able to take a brief history and what she told me was heartbreaking. She had gone to deliver in a pharmacy. The proprietor told her that they ran a maternity facility at the back of the pharmacy and she would only need to part with Ksh. 500 only. She had been in labor for three days and spent the better part of the day pushing out the baby. Her tummy had been pushed and she had been subjected to terror of unknown proportion. She begged and pleaded with her tormentors to send her to a hospital and they ignored her. The reason she was so muddy was because she had wrestled her way out and escaped into a cab and begged the driver to drop her off at our facility. I was almost in tears of rage. The poor woman was never even told that she had lost her baby.
The caesarian section was going to be a challenge and I anticipated all the possible complications that could arise but nothing, and I mean nothing, could prepare me for the foul smell emanating from the patient's womb. Extracting the baby who was impacted in the mother's pelvis was no mean feat. He weighed 4, 900g and his head was so swollen (caput) and disfigured even in death, it was depressing.
What followed was a bucketful of the smelliest pus I have ever smelt. Everyone ran out of the operating room and abandoned the scrub nurse and I. Suffice it to say, we could not use that operating room for a week.
We had to wash the abdomen and uterus with liters and liters of saline water before attempting any closure. Then we all held our breathe awaiting her reversal from anesthesia. I was fraught with anxiety for the next two hours, is this the calm before the storm? Was she going to bleed uncontrollably now that the uterus had sustained three days of abuse? Would she, God forbid, go into septic shock and require ICU care? I had lost track of the time. The night shift doctor had come in and could not believe she had to spend the night in the smelly theatre.
The patient was retained in theatre under the watchful eye of the theatre team in close proximity to a ventilator in case she required one. I arrived home at eleven in the night, exhausted physically, mentally and emotionally. I stood in the shower for a full hour and it still wouldn't cleanse the stench out of my nose for the next week.
I could not sleep that night as I would wake up startled wondering if the patient was going to make it. This would last me the rest of the week. I cannot describe my relief the next morning when I got a report that she had not only survived the night and gone to the wards.
SHE BEAT THE ODDS, SHE WALKED HOME!!! She passed by theatre to thank us and say goodbye. I do hope that today, she holds a healthy baby in her arms and she had access to quality medical care.
That is my prayer for every mother....
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