STAT! Patience

I'm sure everyone MD encounters obstetrical emergencies at some point in their training. We all know how things can go bad fast and how devastating the outcomes can be, for both mom and baby. My first experience with this was in December at Brackenridge Hospital in Austin. I had to excuse myself from the OR during a stat c-section because I could not keep from crying. I figured it was OK to let it out, at least the first time.

I have been on Ob/Gyn at Kijabe for a total of 2 days now and have already asssisted in 2 obstetrical emergencies and one other very sad case. I am not sure how much to share on a blog like this, it can be very graphic and even disturbing if you're not ready for it. Suffice it to say, I was quite overwhelmed walking home today. I unloaded it all on this poor IT tech from Ohio who was nice enough to listen .

Complicating the already serious nature of these cases is that we are operating in a very different culture than the US. Take the case from this morning: a young lady with a very large baby (which unfortunately had already died in utero), presented late last night and was delivered by a rather traumatic forcep delivery. This morning she looked very sick (and almost denied her symptoms outright), with a high heart rate, borderline blood pressure, distended abdomen, and a hemaglobin drop from 13 to 6.8. She needed the OR quickly for probable uterine rupture. But I could not believe the slow pace at which the staff set out to get her there! STAT ultrasound means maybe an hour later. STAT blood means maybe 30 min, no wait... add another 10 to that... we're in the OR but we're still waiting on blood... it'll be here in another 10 min...

And then the patient absolutely refused surgery until her family came. It didn't matter that she was dying right in front of us.

Its a very different type of place. Resources are limited, and the culture is very different. But I can say that we had the patient in the OR, her uterus sowed up (the laceration was nearly from the fundus straight into the top 1/3 of the vagina, if you can imagine that...), with the blood, and everything completed by 11 AM. That's not too bad really. She's currently recovering in the ICU and doing pretty well.

So what am I learning? Calm and patience, even when dealing with an emergency in a foreign land. And pray... don't forget to pray...