All was quiet when I went to bed last night, but that only
lasted a few hours. A call at 3am broke
the respite we have had over the last couple of days on L&D. The nurse on the other end of the static
filled line asked me to come quickly. A
pt came in from a different facility seizing.
That was all the information I needed to tell her to start an IV as I
rolled out of bed and started down the dirt road to the hospital. That short walk is always an interesting one
as my mind races with the possibilities of what I am going to find once I
arrive at the hospital. The pt was
post-ictal (the very sleepy state that people go into after having a seizure)
when I got there. Her blood pressure was
high and I started magnesium to prevent any further seizures. The facility she had come from had taken her
blood pressure, watched her seize and then sent her to me without any
intervention. I ordered some labs to be
drawn and then went to work trying to figure out how far along this pregnancy
might be. The pt was in labor and
progressing. I breathed a sigh of relief
when I confirmed that she was indeed far enough along that this baby should be
able to survive without a problem. I was
in the middle of addressing her blood pressure issues when another pt got
brought to L&D in a wheel chair.
The Togolese people have a much higher threshold for pain so
when a pt comes in with distress you know something is wrong. One look at this woman’s face told me
something was definitely up. As we moved
the sheet covering her lap to move her to the bed my eyeballs almost popped out
of my head as I saw a baby that had been breech (feet first) and almost
completely delivered, hanging by it’s head with arms and legs waving back at
me. Thank God that the nurse with me had
her wits about her and she reached down and quickly delivered the baby. I went to the phone and called one of the
other docs to come help resuscitate the baby.
As I was making the phone call the nurse calls me, “there is
another.” I looked at the pt to see what
she was talking about and sure enough, there were twins! What a morning. I pull the ultrasound over and yes, this too
was a breech baby. Vaginal breech
deliveries are not something we do very often in the States. Most often these women have c-sections before
they even go into labor as delivering breech has some definite risks. This was the dilemma, I have never delivered a
breech baby vaginally and it was likely that this baby was going to be
delivered before I could mobilize everyone to do a c-section. Also this pt had delivered 4 other babies
successfully not including the breech baby that had essentially just delivered
itself. Ok, I guess there is a first
time for everything. I called the
surgeon to be on standby just in case.
The second baby ended up delivering footling breech shortly after
without a problem. Praise God! I breathed a sigh of relief when everything
was done and all three of them were safe.
We are trained so much in all of the things that can go wrong with
breech deliveries that I just kept replaying all of those possibilities over in
my head. I am so thankful everything
went that smoothly.
I then turned my attention back to the pt with eclampsia
(seizures). Our one Doppler (hand held
machine that allows us to listen to the baby’s heart tones) was out of
batteries so I was left with our one ultrasound machine in L&D to evaluate
heart tones. Baby still sounded
good. I was so relieved because all of
my attention and the ultrasound had been turned toward evaluating the twin
delivery for the last 40 minutes. I
asked the nurse to give the pt more blood pressure medication and then walked
down the post partum ward and stepped out the back door of the hospital to
stand on the porch. The African sun was
just starting to rise. What a beautiful
gift in the midst of a busy morning. I
was reminded of the verse that says, “His mercies are new every morning.” What peace comes with that. The Togolese women were already busy doing
wash on the grass at the back of the hospital.
I wanted to linger a little longer, but knew that I needed to get back
to my sick pt. No sooner had I walked
the 100 feet back to where she was laying than another pt came in
emergently. She came from another
facility for non-reassuring fetal heart tones.
Because I only had one ultrasound to evaluate both pts with and this
ultrasound had to remained plugged into the wall I had them put this new pt in
the bed right next door. The curtain
was removed from between the two beds so that I could go back and forth with
the ultrasound quickly if I needed to – so much for privacy. The heart tones on the newest pt were ok for
the time being. I decided to allow her
to progress in labor, though I had my doubts because one look at her belly made
me have to reassure myself with the ultrasound that she wasn’t having
twins. This was going to be a really big
kid. After laboring for 30 more minutes
the heart tones began to drop.
Everything was in place for a c-section if we needed one. I called all
the necessary people and we headed to the OR.
As soon as the head was delivered I knew we had made the right
decision. The baby weighed 9lbs 6oz….that
is toddler size for a Togolese woman. We
quickly handed the baby to the midwife and began sewing the pt back
together. Something felt something wet
by my feet and looked down to see that blood was dripping off the table forming
a puddle on the floor and now effectively splattering my unprotected ankles
underneath my scrub skirt. Bummer. At least my socks are black so no one will
see the stains! As we were closing this
pt I received word that the heart tones for our eclamptic pt were starting to go
down. C-section number two of the
morning. We traded out pts in the OR and
were able to get the next baby out without a problem. Everyone is now safely delivered. I had every intention of going to church this
morning, but the pts had other ideas. By
the time we were done operating it was 10 ‘oclock. Rhonda was coming on and it was time for me
to head back to my room to take care of my blood stained clothing. For some reason showers here feel so much
more refreshing than back home J Hopefully,
that is all the excitement for today.
You never know what is going to walk through the door. I just praise God that every single pt was
taken care of and all ended well by the time I left the hospital. His mercies are new every morning….
His mercies ARE new every morning. Blessing to you Kristen. Try and get rest when you can because your blogs sound like you need to stay strong and healthy. What a day you had...all before 10am. Love and Prayers.
ReplyDeleteSo proud of you! Can't wait to hear the stories when you come back.
ReplyDeleteCatching up on your blog and it is creating vivid pictures in my mind as I read! Keep up the awesome work KW!
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