Busy!

I was going to try to post yesterday, but the day had other ideas.  It started out by getting woken up at 5am by a phone call from the American trained midwife I am working with asking me for help.  In my half awake state and with the static on the other end of the phone I had no idea what was wrong, but knew that I just needed to come to L&D and quickly. 

I threw on my glasses and some clothes and was out the door, speed walking down the dirt path to the hospital in the dark with flashlight in hand.  When I had arrived to L&D it became apparent that there were two women that needed c-sections rather emergently and now we had to decide which one to take back first.  One was a Falani woman who had a previous c-section and then 6 subsequent successful VBACs (vaginal birth after cesarean).  VBACs are a little bit risky because there is a scar on the uterus from a previous c-section and the stress of pregnancy and labor on that scar can cause the scar to break open and rupture which can be life threatening to both mom and baby.  This pt had been laboring all night and had pushed her baby to a +2 station with no further descent (the baby had gotten stuck just before being able to deliver).  The baby now was starting to have some decels in the heart rate (showing signs of distress).  The second woman was someone who had been “evacuated” to our hospital.  An evacuation basically means they were at another clinic or what they call here a “dispensary” and something has gone wrong so they come to us (usually they come at the very last minute and it is a true life or death emergency).  This pt came to us because she was 8 months pregnant and had started hemorrhaging.  She hadn’t felt the baby move in the 24 hours.  We quickly threw the ultrasound on her and see that she is abrupting (the placenta is detatching from the uterus and is bleeding).  The baby still has heart tones.  Given the amount of bleeding this ptwas having and the fact that there is no electronic fetal monitoring here and all monitoring is done by intermittent dopplers we decided to take the pt with the abruption to the OR first.  Delivery of this baby went perfectly.  In the mean time the Falani patient was being prepped for the OR and as soon as we were done with the first pt we brought the Falani woman with active phase arrest back to the OR.  The pt also requested that we do a tubal ligation at the same time.  This delivery went fine as well… or so we thought. 

After bringing this last c-section to recovery I rounded on a few pts and then went back to the OR for a scheduled hysterectomy for a large fibroid uterus.  These are both fun and challenging cases because no two cases are ever the same. Todd, the long term missionary here who is a surgical PA has done many of these and it has been so great to work with him and operate under his guidance.  Just after this is finished I am asked by the visiting cardiothoracic surgeon to assist him in operating on a 4 month old boy.  This boy had a bad infection in his neck that had drained into his chest and we were going to open up his chest and clean out the space around his lungs which had filled with pus (sorry, that might be too much detail).  I had to laugh as I thought about the situation in the middle of the case.  Here is an OB resident assisting with a pediatric thoracotomy. The infant needed this surgery badly as the infection at this point had become life threatening.  The anatomy of the chest is so incredible.  Watching the lungs inflate and deflate with every breath and the heart beat to keep the child alive is amazing.  In the middle of this I get called to go the L&D immediately.  It sounded very emergent so I scrubbed out of the case and went to see what was going on.  Our second c-section of the morning was hemorrhaging.  The nurses had already given her all of the medications that we have to stop bleeding.  I went to see the ptand pulled clot after clot of blood out of her uterus.  I asked the nurse to get her vitals and the pt no longer had a blood pressure.  The pt was beginning to become unresponsive. This was bad. My heart quickened and I instructed the nurses to open the IV fluids wide open and to start transfusing blood into this pt.  I also asked them to grab one of the surgeons for help. Todd came around the corner after they pulled him out of the OR where he was prepping a pt for a colostomy take down.  It didn’t take much explaining on my part to tell him what was going on.  He immediately instructed the nurses to move the pt back to the OR.  We were going to do a hysterectomy.  The poor pt who was already on the OR table, spinal in place getting prepped for surgery for the colostomy take down was taken back to the recovery room and this hemorrhaging pt took his place.  I am not even sure that our pt had completely received the ketamine (the anesthetic drug we use for sedation) before we started opening her.  In the 30 seconds it took us to get back inside her abdomen her uterus was filled with blood. We completed the hysterectomy and her vitals started to stabilize.  Praise God.  My hands were shaking as we closed.  What a morning.  I looked at the clock as we finished and it was only now 1pm.  At this point I had missed  both breakfast and lunch, hadn’t showered, brushed my teeth, put in my contacts or even remembered to put deodorant on ( I told everyone to stay far away).  It was time to head back to the guest house to take care of some of these necessities.  I was exhausted and super thirsty.

The air conditioning in one of our two ORs (the one I for some reason tend to operate in the most) isn’t working.  This makes that OR super hot.  The African sun beats down on it all day and as a female I am required to wear a long skirt and on top of that a special scrub dress and then my surgical gown and of course a surgical hat and mask.  By the time I am done with any case I am completely soaked.  My gloves keep wanting to slip off because I am sweating so much and it is sometimes all I can do to keep from dripping into the surgical field.  With all of the OR cases that morning I new that I was getting dehydrated quickly and because I hadn’t expected to get called into the hospital that morning (I wasn’t technically on call that day) I hadn’t refilled my water bottle the night before.  Important lesson learned, always be prepared.  The guest house had graciously set aside a plate of food for me.  Lunch and water never tasted so good! The long term missionaries here say that after a while your body adjusts to the heat and humidity and it doesn’t bother you as much.  I wonder how long that takes?  I have started to develop a really wonderful heat rash on my arms, neck and chest. 

I was so tired and worn out yesterday and knew that I needed to just spend some time with the Lord.  I was reading Ephesians 4 which was exactly what I needed.  When I am tired or hungry or uncomfortable it is so easy for me to start focusing on myself and my needs.  I got the gentle reminder from the Lord about my attitude to walk with humility, gentleness and patience bearing with one another in love.  I so needed that.

I just realized that I never told you about the other staff that I work with here.  The long term missionaries are Todd – a US trained surgical PA who more often than not fills in as a general surgeon, Kelly – a US trained pediatrician who is here doing the Samaritan’s Purse post residency program, Rhonda – a US trained midwife, Brenda – a US trained medicine PA.  There is one other short termer here with me and his name is Ed.  He is a US trained cardiothoracic surgeon, but has surgical skills that go far beyond just the heart and lungs.  There are also a couple of Togolese nationals that work here as medicine PAs.  That is the staff for the hospital.  Such a wonderful team to work with!

I was technically on call last night, but after the morning that I had praise the Lord that I had a quiet night and didn’t even get called in once!  I was so tired, I needed a full night’s sleep.  I can’t remember the last time that happened. 

Prayer request from here – there is a 4 year old girl named Bernadette that came to the hospital 2.5 weeks ago and it was discovered that she has a benign brain tumor in the back of her head.  It is not cancerous, but it is growing quickly and she was starting to have some really bad symptoms from it.  She needs surgery, but there is no one here in the country of Togo that has the skills to help her.  Even though the tumor is benign, she will die from it because of it’s size if she doesn’t have surgery. Through a series of events we were able to tell this American organization called Healing the Children about her and they arranged for a pediatric brain surgeon in Louisville, KY to operate on her.  We were able to get a passport and visa for her in two weeks ( unheard of here in Africa) and Healing the Children arranged for her to fly to the US.  The pediatric surgeon and his family agreed to house her in their home while she recovers and then she will come back to Togo.  What a blessing.  She is scheduled to begin the journey to the USAtoday, however, the last few days have not been going very well.  Her pain has worsened and she now has a fever.  They are racing against time.  They have decided to get her on the airplane as pray that God will let her live until she reaches the US.  I suspect she is going to go right from the airport to the hospital if she makes it that far.  Please be praying for her as well as for Kelly who will be going part of the way with her.  So many times situations like this in Africa are without hope, but this little girl actually has the chance to have surgery, be cured and live a normal life.  The outcome is truly in God’s hands.  

I so appreciate everyone's comments, prayers and encouragement.  It is nice to know that I am still connected with those back home even though I am half a world away.