I knew that something wasn’t right when I heard her story. She had
been taking malaria treatment at home, and the sickness should have been
better. The treatment she had gotten was almost always effective. But still,
she was sick. We put her in the hospital and put her on IV medicines to make
sure that she received all that she needed.
But she got worse. She started vomiting, and contractions started.
Labs were drawn as she was prepared for a repeat C-section. Her twins were
delivered safely. But her labs came back, showing that something was terribly
wrong. But what it was didn’t seem to fit in any typical specific diagnosis.
She was destroying her own blood cells, and her kidneys and liver weren’t
working well. This type of pregnancy-induced disease can always be dangerous,
but her type was worse than normal because it was much different and more
complicated. I drew more labs to rule out rare disorders, hoping to find a
medical diagnosis that she could fully fit.
The day after surgery, she started having trouble breathing.
People like her are at risk for this. Suddenly they go from feeling relatively
okay to drowning from the water filling their lungs – we call it “flash
pulmonary edema”. I had already restricted her IV fluids to less than what is
normal to avoid something like this. But she was so sick, and even minimal
fluid went straight to her lungs and tipped her over into respiratory distress.
If the fluid got any worse, she wouldn’t be able to breathe. No breathing, no
living. I knew what to do, and I quickly and urgently gave orders. Sweat pooled
in the notch at the bottom of her neck. She leaned forward, muscles straining
for every breath. There was only one way to help, I had to get the fluid out.
The only way for that to happen was to make her urinate. Her kidneys were going
to have to make urine, make a lot of it, and make it quickly. But they were
damaged already by her disease process. I wasn’t sure if they would be able to
do what I was going to ask them for. I pushed medicines into the IV line,
knowing that the next several minutes would tell me if her kidneys were still
functioning enough to get the fluid out. I watched her urine bag. The kidneys
rose to the occasion and began filling the bag with clear, beautiful urine. I
delighted to see it coming. An hour later, there were only a few beads of sweat
on her brow. A victory won, but the war ravaging her body was far from over.
There were fevers starting too. This seemed like a separate
problem. Fevers should mean infection, but it seemed there was no infection to
be found. I knew that they weren’t from her recent malaria after a day or two
of continued treatment. But blood tests, urine tests, x-rays, ultrasounds –
nothing was showing where the infection was coming from. Antibiotics were
started. Fevers continued. Finally, the only thing left was to assume that she
had an infected blood clot within her pelvis somewhere. I couldn’t see it on
ultrasound, but I knew it must be there. It is sort of a last-ditch diagnosis,
when everything else has been considered. So, I started her on blood thinners
as treatment to break up the clot.
I waited, and doctored, and prayed, and hoped. By this point she
had required five units of blood (since her body was killing off her own blood
cells, we had to replace them with transfusions). The blood would drip in, but
by the next day, the blood level would have fallen again. Finally, the blood
level remained steady overnight. Her other labs also began to move in the right
direction, indicating that the multiple organ systems which previously were
struggling were heading toward normal functioning again. And lastly, the fevers
finally stopped. We turned the corner.
She held her babies in her arms today as I signed her discharge
paperwork. I realized that every day that I had come to sit on the edge of her
bed I had come to like her more. I had become more invested. I had been the one
in charge, working to save her life. I had been the one trying every morning to
figure out how to manage her to restore health. But I wasn’t the one who could
actually make her better. Sometimes women just like her don’t turn the corner.
No matter what we do - not with the best care, not in America, and certainly
not in Africa. I don’t know why one and not another. I only know to ask for
wisdom and guidance as I practice medicine, and know that He is able to be
trusted with the outcomes. So as she left and I said “Thank the Lord for two
healthy babies and a healthy mom”, I didn’t say it lightly. He holds it all together, and I see that is His hand doing so. Mine are too small, too human. I am grateful for the work that they have been given to do, but alone they are not enough. Indeed, thank the Lord for two healthy babies and a healthy mom. He has again provided.
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