Monday, March 11, 2013

Recent Patient Stories

In the Gynecology Operating Room
Her story was partly sad, partly interesting. I got to fix her complication from some other surgery at an outside hospital. Seven months ago she had “appendicitis” and was taken to surgery. However, upon looking inside her abdomen during surgery here, what she actually had was both ovaries and tubes along with her uterus and appendix removed. No one ever told her about the complete removal of all of her female organs in addition to her appendix. She just knew that she hadn't had a period since. Huh? Where else would that happen? She is just over 20 years of age and someone basically made her menopausal with no hope to ever bear children, and didn’t even tell her. But worse than that, and the reason she came to my attention, was because of a big swollen belly with a pelvic mass. Since I hadn’t known that she already had her ovaries removed, I was thinking perhaps an ovarian tumor (likely cancer, though rare in this age group). Upon inspecting her organs during surgery, I realized that not only had the prior surgery done the things mentioned above, but also had injured part of her urinary system. Her body had found a way to sort of wall off a large collection of urine, but over the months, it was collecting as well in the entire abdominal cavity, making it swell. She had amazingly been able to filter some of that urine back into her system (somewhat like peritoneal dialysis, for those medical people out there), and so had remained relatively healthy in spite of it. So upon opening her belly,  out poured over 7 liters of urine that had been collecting into her belly. After much dissection, we were able to reconnect her urinary system the way it was supposed to be to provide proper function. It was very satisfying to go in thinking that some young woman may have terrible cancer, and then to come out (a loooong time later)  having fixed a treatable problem. Daily we cared for her, and daily she improved. She heard the gospel, and hopefully saw it, day after day. She was happy to be healthy again and prepared to leave the hospital with a future ahead of her, a hope that some normal life awaited her. Although we couldn’t do anything to improve her fertility issues, at least she could be healthy again.As I gave her discharge instructions, I told her the routine precautions. But I told her something else too, something that I had begun to think of while I cared for her. I told her of how important it was for her to stay in school and to continue her education. This was one of the most important things she needed to understand. You see, for an infertile woman, the world here would tell them that they have little value. She will likely never find a man who will marry her, knowing that she cannot produce children. This will affect her financially, socially, and emotionally. She knows, in a vague sense, what her condition means, but in the future it will become very, very practical. Many struggles are yet to come, a whole lifetime of them. I pray that she will face them knowing the value that she has in the eyes of God, for the world here will likely offer her much opportunity for discouragement.

A Few Halls Down, In Labor and Delivery
I had just walked in the door from rounding Sunday morning. I was thinking of the upcoming surgery of which I had just notified the OR. The phone rang as I was shutting the door behind me. The voice was familiar, it was a midwife from the maternity ward. “Double footling breech with feet in the vagina”, she said. I grabbed the set of special delivery forceps that were sitting on my dresser and rushed out. It was as I had been told. The mother was pushing with all of her might. I had to choose – a cesarean or vaginal delivery. Emergencies are managed much more slowly here, I knew that by the time we got to the OR and ready for surgery, the baby would likely already be out. So I told her to push with all of her heart. The water broke a moment later, and into my hand fell a long loop of umbilical cord. I pushed past it to grasp both feet. They came down fine, we were making progress – until the mid abdomen. Then the baby just stopped coming. I cut an episiotomy to give more room for the manuevers which I knew may have to be performed  (though the old scissors really chewed an episiotomy instead of cut one). I gently put traction on the hip bones, but still progress was slow. Finally the arms. But they were still a bit higher than I wanted, and it was so difficult. I felt the pop of a bone as my finger finally swept it outward. I felt the first arm come down. The nurses stood beside me. We struggled with the second arm. I heard the nurses praying as they worked, and they heard me pleading with Him for help. It had been minutes, the umbilical cord had been squeezed off by the weight of the babies body as it fit through the narrow canal. The body just hung there, half out. As I worked, sweat rolling now, I thought to myself “we may lose this one”, which added a quick breath of momentary panic before again my hands continued with the necessary movements. Finally, both arms were out. The head, usually the most difficult part, was yet to come. I maneuvered that head exactly as it should have been, but it wasn’t coming. I asked for the forceps, and applied them. Just as the second one was fitting in place, the head began to come. Limp, pale, lifeless, and nonresponsive, the child was finally released. I instructed to begin oxygen (though we don’t have an oxygen tank, we can concentrate oxygen from the air) and begin compressions. Within a few minutes, a glimpse of a tiny movement brought encouragement. Another series of long seconds passed, and then a cry came. Plenty of cries followed, and then our own voices joined to rise up with praises to God from all around the delivery room. From the mother, to the woman with the mop, we all rejoiced together. We looked around at one another. There was a sheet of blood dripping off of both my arms, reaching the whole way up to my shoulder. The nurses white gowns were spotted with dark red. But we looked like the happiest, most delighted people in the world. I fixed the tear on her bottom, and then wrote the delivery note. I found myself stopping every couple of minutes to catch my breath, and then with it to thank the Lord again. 

1 comment:

  1. WoW! Praise the Lord, indeed! Thanks for sharing