Morning report this morning. Sixty or so residents, medical students, midwives and attendings cram onto benches as the suns rays begin to creep through the window raising the temperature by the minute. All the house staff in crisp white coats, the nurse-midwives equally crisp in their light dresses, knee-high socks and nursing caps pinned meticulously on their heads. An exhausted resident lists off the happenings on labour and delivery in the last 24 hours.
Total women in labour: 73, vaginal deliveries: 48, C-sections: 17, stillborn: 2. The special teaching case is a woman of 28 years old, gravida 4, plus 1 (apparently that means one kid), previous Ceasar. Presented in active labour for 34 hours. Became fully dilated and the fetal heart was 166 at this time. After 3 hours of pushing there was no fetal heart found and fetal parts were palpated abdominally. Uterine rupture was diagnosed and a c-section was arranged, this happened 3 hours later. The baby was stillborn and a hysterectomy was performed due to bleeding. She became anemic with a hemoglobin of 50 and was transfused two units. We are continuing to give her more fluid.
Wow. BC Women’s is a quiet country hospital compared to this. Our morning rounds include pedantic scientific details of preeclampsia for the most part. We ONLY have about 8000 deliveries a year. Of course, they ARE beating us with the c-section rate, 25% isn’t too bad…but then you have more dead babies and mothers losing a uterus they might have otherwise wanted to use again.
The discussion was stimulating and passionate. How could we not prioritize a woman who had a previous c-section and let her labour this long? We have condemened her to infection, she may get a fistula down the road, we took away her baby. What can we change for next time? They know what care they want to be giving, but are bound by the resources they have. I felt for the poor, haggard-looking resident presenting the case, having felt the wrath of attendings in a sleep-deprived state at morning rounds myself.
Next the NICU gives their 24 hour update. Eight neonatal deaths, 6 pre-term, and 2 at term. One may have had a congenital heart defect.
It all left me a little numb, and it was only 9am.
We were going to head out to Kisenyi, the community where the surveys are going to be done. As we were about to leave, Doreen, the project coordinator, got a call on her mobile. There was an emotional jabber of Luganda and she ran out of the room. She returned after a few minutes, with red eyes. “I’m sorry, it seems my brother is dead.”
WHAT?!?
There had been clashes between university students who opposed one of the candidates being proposed as the new president of Makerere University. Things escalated and a security guard shot two students. As it turned out her brother (cousin) had been shot in the neck and was now in ICU. I’m no trauma surgeon, but things didn’t sound good.
It was 11am… maybe it was just the jet-lagged, but it seemed like a disproportionate amount of death and suffering before lunch.
1 comment:
It is a disproportionate amount of death and suffering. I believe that "disproportion" part was why you became a doctor.
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