Tuesday, July 30, 2013

Complication after complication

I went for a walk with a few of the short term volunteers up the mountain behind the hospital. A good chance to get away from the cares of the hospital. Nope, nevermind. Way up on top of the mountain path, I got called by the midwife about a patient who I had seen earlier in the morning on rounds. She was complicated, her water had been broken for seven days before she came to the hospital, thus she had begun to have a severe infection in the uterus. I had been treating her with antibiotics. As well, she had preeclampsia, a problem of high blood pressure which can become very dangerous, eventually lead to seizures. I gave the nurse some orders, telling her to deliver the baby. The mom wasn’t having contractions any more, but the baby was sitting there ready to come. A few minutes afterward, my phone rang again. The midwife hadn’t followed my instructions, in fact she had gone home. The next shift had just arrived, and there was only confusion. I could tell that things were going from bad to worse. The preeclampsia was getting worse, the fetal status was getting worse, the communication was getting worse. I tried again to make them understand that they needed to proceed with delivery. I began realizing that the chance for a poor outcome was going up exponentially as I heard the panic in the voice on the other line. I made sure both mom and baby were stable for the moment, and told them to just monitor them and wait. I would be back within 45 minutes. I told the hiking group that I would have to leave them, and headed back. A few minutes later, I saw a rare moped riding along the slippery, rocky mountain trail. It seemed like a God-send. Only rarely do they they ride so far up there to take someone home who lives out in the bush, since the path is terrible. I waved him down. It took a minute to bargain him down to a reasonable price, but then I hopped on the back and off we.

Bumpety, bumpety, bump over the rocks, slipping into the ruts of the path we rode (or slid in many places) down the mountain. The waft of alcohol occasionally passed from the driver’s breath to where I could smell it even riding behind. I held on tightly to the bar behind my seat. I came up with a theoretical plan, that if the bike should begin to fall due to the rough terrain or the inebriated driver, that instead of trying to put my foot down and catch us (as seemed natural), I would spread my feet and catch myself, to let the motorcycle pass in front of me before it fell, leaving me behind and safe. Sometimes I make a “just in case plan”, thankfully, I rarely end up using it.  Too many of those prior motorcycle drivers (and riders) have passed through the orthopedic ward and now hop around with crutches on their one leg.

We made it back in a fraction of the time that it would have usually taken me on foot. I walked into the maternity ward and checked the patient. The mother was lethargic from the medicine that she was on to prevent seizures. We lifted her onto the delivery table. Then I grabbed the gloves and checked everything out. Things were not as had been reported, and they were even a bit worse. I described to the mother that I needed her to push with all of her heart. I applied a vacuum device to help pull the baby out. A few minutes later, out came a floppy and tired baby, barely able to breathe. The resuscitation began on the other side of the room. Meanwhile, I knew that the mother had many risk factors that could cause her to bleed after delivery. And she certainly did. I was almost up to my elbow inside her trying to arrest the bleeding. As I worked deep within her, it felt as if she was on fire with heat from the infection inside her womb. I glanced at the baby, knowing that it too was doing poorly because of being exposed to the infection for too long. The bleeding continued as I returned my eyes to focus on the mother. Medications were coming, but seemed to take so long to get drawn up and unwrapped and such. Finally, the bleeding slowed and I knew that we were going to be okay.

After I wrote a note in the chart, I headed back to the house. My hiking shoes had blood splattered all on them. My arms were tired. My passions were tired. So many problems, both with the patient and with the management of the patient. Another close call, too close. Another sick mom and sick baby. There are so many women and babies at risk, and so many opportunities for poor outcomes. But almost each time, earlier recognition and intervention could give a better outcome. I sometimes blame the staff. I sometimes get so frustrated. I know that it could be so much better. I am praying that God will engage the hearts of the staff to desire to learn more and care deeply. But I am thanking Him that in spite of our failures and lack, He often provides for us anyways.  There were so many other routes that could have ended their story. One complication seemed to pile on the next. But tomorrow, a healthy mom and baby are going home together. Thankfully, this is the story that they get to own. 

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