Sheer terror. That’s the only thing I can think of that describes our feelings in the situation we were in.
One of our doctors, Sarah, called me at one o’clock in the morning. “Hey Danae, can you please come to help me with a uterine rupture?”
“OK, I’ll be right there.”
Sarah had been up laboring with a pregnant woman. Her contractions had stopped, so Sarah vacuumed out the baby. Tragically, the baby was already dead. But the patient kept bleeding and bleeding and bleeding. Sarah realized the woman had ruptured her uterus and called me. A tear in the uterus is extremely rare in America, but it seems that it’s my bread and butter here.
I head to the operating room to meet Sarah. Five saucer-eyed nursing students stare back at me, clueless as to how bad the situation is. I call the anesthetist, Philippe, and as we wait for him to arrive, we try to get a good IV in the patient. But all we have is a tiny catheter that’s unable to drip fluid into her fast enough. It’s never going to work. I apply firm pressure on her lower abdomen with a second hand inside her to try to compress the bleeding vessels, but it isn’t helpful.
Instinct sets in: must stop bleeding.
“Foley, please. Call the other nurses from the other services. We need a good IV! Call Staci to come help.” We have nobody here to do anesthesia. My physician husband, Olen, is out of town. Staci, another doctor, can help direct care. Still nothing better for an IV.
Any moment, Philippe should walk through that door and place a good IV, and we’ll be all set. I just have to stop the bleeding right now.
No Philippe, but Staci shows up.
The patient starts making gasping sounds.
I cut into her abdomen with zero anesthetic. She’s lost so much blood that she barely flinches. (Not a good sign.) I grab the uterus at its base, stopping the flow of blood. That’s all I can do for now. She’s so close to death. It doesn’t matter whether I do a hysterectomy or not now. I’ve stopped the bleeding with my hand, but if we can’t get a better IV, we’ll lose her. I just squeeze.
She has no blood pressure, no response, no sign of life. Philippe, our anesthetist, shows up. He tries to get a better IV. We administer all the appropriate medications and fluids. But it’s all simply too late.
I ask Sarah to squeeze the uterus while I start chest compressions. I’m trying to run the code, directing traffic to give chest compressions and breath for the patient and give IV medication. Too late. All too late.
Just keep pumping. She can’t die. She labored at our hospital. She’s our patient.
My hands and arms grow tired. The sweat is dripping down my face. Thinking what else to do. But it’s too late.
After a long time, while we’re still trying to resuscitate the patient, I go out to talk to her family. Her husband is there. I ask how many children they have. Three. I tell them how bad the situation is.
I go back inside. We’ve tried resuscitating her for more than an hour. We call it. She’s dead.
I give the news to the family. The mother of the patient was in the maternity ward and wasn’t told her daughter was actively dying. Now, she’s actively grieving.
Even when there’s a death, there’s still work to be done. We do a cesarean section on a patient that was supposed to be done prior to this last emergency. Everything goes well, but now it’s five o’clock in the morning. We’re all beat. We debrief some and then go home to sleep a couple of hours. Sheer exhaustion. That’s what happens after a stressful situation like this. Sheer depression.
The next day at work, I find out the patient had been waiting for a month at the hospital so that she could have a safe delivery. The baby died in labor, and the mother died after a vacuum delivery from a postpartum hemorrhage. A month living at the hospital to ensure she didn’t die in labor at home. And she dies here, instead.
Deeper depression sets in. We failed. I failed. After a month of being safe.
But there’s still more work to be done. I still need to go around and see all the hospitalized patients. Operations on normal cases. Lots of consults. Sarah had gone home to get some rest. I told her that she should take the day off because she had been up most of the night. But she’s taking it too hard to be at home, so she comes back to work in the afternoon to help us with the consults. She’s amazing and smart and strong.
She presents a patient to me named Deborah* who had a vesico-vaginal fistula, an opening between her bladder and her vagina. It was the result of being forced to labor at home for days before finally being allowed to go to the health center to deliver her baby.
Deborah had come to us as a very sad case three years before. Olen had walked by her and smelled her diagnosis. She stunk of concentrated urine, and one could see the drops of urine falling out from under her skirt. At home, things were terrible. Her husband had despised her. Nobody wanted her around. Deborah was rotting away out in the savannah until she somehow made it to our hospital. I operated on her two times to cure her fistula. But these patients often get lost to follow up, and some of them leak again after they go home from being forced to work too early.
I’m surprised that Deborah’s here to be operated on again. I’m already depressed, and now this woman comes back who wasn’t fixed by my major surgeries on her.
But I misunderstood with the language barriers. When I examine her, she isn’t leaking urine. She’s been dry since I did two surgeries on her back in 2015. I had told her then to not work until her follow-up visit with me. Well, now three years later, she’s back for her visit. She hasn’t done any major work for three years. She was too nervous about the fistula breaking open. On her exam, everything is normal. She’s cured.
Deborah explains she’s been arguing with her husband about whether she should be working or not and came back today to ask whether she should. Should she start carrying things on her head and working in the fields this year?
Three years. Three years, and she chose today to come back and ask this simple question! With tears in my eyes, I tell Deborah that today has been an extremely awful day, and I believe God sent her for this very moment to tell me she has been cured. He spoke to her heart so she could encourage me.
I ask Deborah where she lives. She replies that she lives well past Kélo, a town 26 miles away. She got to Kélo and didn’t have any more money to continue her journey, so she walked the remaining 26 miles to our hospital just to ask whether she should start working again three years after she was healed.
If God speaks to your heart, listen. You never know who’s day you could be changing. I’m so thankful Deborah listened to God’s voice and was stubborn enough to walk 26 miles!
* Name has been changed.
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