In the practice of medicine, various specialties have their
unique emergencies that raise the blood pressure of the care providers to
varying degrees. For those who, like me, thrive on the adrenaline rush, we are
very much at home in the maternity unit where a moment of calm can herald
unannounced entry of a hurricane that would upset the Richter scale.
The only other unit that rivals our unit is the emergency
room. This explains why most medical successful television dramas are centered
around this deparment. Unlike the maternity unit where focus is on moms and
newborns, the emergency unit is like an open-air market. The emergency team
moves from a burns patient, to a gunshot wound, to a heart attack and a trauma
patients with multiple fractures in one breath, prioritizing and stabilizing
them as they come.
As we continue to heavily invest in reduction of maternal
mortality in Kenya, haunted by unacceptably high figures, let’s take a look at
a dimension that we do not speak much outside the healthcare circles, and these
are the maternal near-misses. According to the World Health Organization, a
maternal near-miss refers to a woman who nearly died but survived a
complication that occurred during pregnancy, childbirth or within 42 days of
termination of pregnancy.
In Kenya, we are beginning to document data on these events
and the statistics aren’t pretty. Hypertensive disease in pregnancy and
postpartum hemorrhage are the leading causes of maternal near-misses. They do
not discriminate across age, socio-economic background or even previous
motherhood record. Every woman is at risks long as she falls in the pregnancy,
childbirth or post-partum category.
Witnessing a maternal near-miss is an out of body experience.
The most unsettling aspect of these events is the suddenness of it all. One
minute you have a stable mother and in the blink of an eye, the fight for life
begins. All the interventions instituted to save a mother’s life will seem
inadequate but there is no room for giving up. Team effort means everything and
singular dedication to the fight is unquestionable.
Catching up with a colleague a few days ago brought the
reality of the near-miss phenomenon closer home. She’s a gynaecologist who
dedicates her life to care for mothers and even that wouldn’t keep the black
hand of death away. After a completely uneventful first pregnancy, she went
into labour smoothly and took her turn being the patient on the couch instead
of the caregiver standing at the side. She had a precipitate labour (when the
progress is abnormally fast) and in less than an hour of admission, she
delivered a healthy baby.
While everyone was catching their breath at the rapid
unfolding of events and the new dad was still caught in the ecstasy of
receiving his baby, the midwife suddenly called out for help. The new mom was
bleeding a river that rendered her unconscious in a matter of minutes. She was
whisked off to the operating theatre and all she remembers was waking up cold
in the high dependency unit, hooked onto monitors with an on-going blood
transfusion. She survived, one foot in the grave, but she survived!
You would think that having come this close to death and
lived to tell the story, that fate would be done serving her the deathly
platter. Despite the scare, she took a daring chance to have another baby.
Thankfully, she handled the second delivery safely. She managed to juggle her
new baby, a toddler, her post-graduate studies and the rest of life peacefully
for a year and her near-miss started to fade from memory.
Just when all was seeming normal, she wakes up one morning to
find herself in the high dependency unit again, with a tearful mother-in-law at
her bedside. How did that happen? Out of the blue, like a thunderbolt with no
warning signs, she had suffered a coronary artery embolism. All she remembers
was reaching under the bed to collect her baby’s toy. Her nanny found her
passed out on the floor and called for help. She was whisked off to the
emergency room and the rapid action by her care team saved her life one more time.
Critical cardiac care, invasive treatments to dissolve the
embolus that was blocking blood supply to her heart muscles, days spent in the
ward allowing her heart to heal and restore normal function and initiation of
lifelong medication to reduce risk of recurrence, were all interventions she
had to undergo to save her life. She couldn’t fathom just how deranged her
laboratory indicators were yet she was still alive. Her heart tracing patterns
on the electro-cardiograph were as abnormal as it can get, yet she walked out
of hospital without any disability.
Despite countless tests, her cardiologist could not pinpoint
any risks that had precipitated her near-miss. She had missed all the subtle
signs of the impending catastrophe; being below 35 years of age, a heart attack
was the last thing on her mind. Being a doctor did not help her be more alert
to the lurking danger. The only glaring reality for her was that she was human
and that life can be really fickle.
To the health care provider, a near-miss experience is
unsettling. It tests your human limits to the very end. Despite all the
knowledge and skills learnt in preparation to save life, this is the one time
the provider feels impotent. Like nothing one does is enough yet the situation
is sliding out of hand extremely quickly. Nothing prepares one for this.
Then just like that, things turn around and the climb out of
the dark hole starts. The patient who is teetering on the brink of death takes
a step back from the precipice and in one breathe, death is postponed. In
moments like this, whatever your conviction, you will acknowledge that a higher
power intervened; a very welcome invisible helping hand.
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