BY A KENYAN DOCTOR
I remember that fateful Friday as if it was yesterday. I had been on call for two days, and I left the hospital at 7.50 am to dash home to grab a shower before going back to the district hospital where I was working as an intern. No sooner had I gotten home than my phone rang. It was maternity, and anyone who has been there knows how the story goes…. You know, rifaroos and emergencies as the sisters like calling them. I dashed into the bathroom and showered as fast as I could. There was no time to eat breakfast, for the ambulance was waiting outside. I got to the hospital, and there was an emergency for real.
She was a primigravida, who had been draining liquor for more than 3 days in a certain dispensary which did not deem it appropriate to refer a patient who was clearly having obstructed labor. Somehow the fetus was still fighting, but the distress was obvious. A foul smell was emanating from the birth canal and the fetal heart rate was misbehaving. For once I heard those acceleration and decelerations that they describe in obstetric books. I quickly prescribed a caesarian section, and not long afterwards, the patient was wheeled to theatre as evidenced by the meticulous nursing cardex. Nurses love to cover their asses. As the anesthetist was receiving the patient, I scanned through the cardex. It had all the details anyone wishing to crucify you would look for, including the time when the ambulance came for me and when I arrived at the hospital. These things are recorded in real time. I rushed to the changing room to put on my scrubs in readiness for the operation.
My fellow intern, Dr. Doreen, had just arrived. I welcomed her to theatre. The anesthetist was ready and the nurse was busy setting for us. Dr. Doreen and I had scrubbed, and we were waiting for gowns to be placed on the cart. Then something unexpected happened. The nurse announced that there were no gowns. I was furious. It was true that we had done a couple of caesarian sections the previous night, but that was no excuse as to why there were no gowns. The nurse explained that the autoclave machine had broken down in the wee hours of the night, and the maintenance guys could not figure out what was wrong with it. In short, the gowns were stuck in the damn machine.
We stared at each other as we pondered our next move. In our naivety, we thought of referring until one of the nurses suggested that we improvise. Believe it or not, she got two abdominal sheets for us, and we put them on. The sides were clipped with artery forceps. One nurse walked into theatre as we just about to start operating and her words echo in my ears up to date. She joked about it. “Dr. Mburu and Dr. Doreen, have you changed professions? The place of priests is in the altar where they consecrate bread and wine into the body and blood of Jesus Christ, not theatre, where blood is the order of the day.” As the anesthetist gave us the go ahead to cut through the skin, another nurse joked. “Mass is about to begin! In the name of the Father, Son and the Holy Spirit.”
We literally waded through the operation, and our encounters in there are events that made me very sad. As we made a smile incision in the lower uterine segment of the uterus overt chorioamnionitis was staring at us. A foul irritating smell that is similar to that of pungent chlorine hit our nasal cavities, but then we were keener on extracting the fetus. It could not get worse. As I handed over the kid to the receiving nurse, I saw her face drop. I could tell it was a fresh still birth. They tried resuscitating to no avail as I battled with bleeders. Streaks of blood were dripping to the floor as if it was a stream. I tried packing, but the bleeding was still torrential. I requested the anesthetist to pump more oxytocin for the uterus to contract more, but that did not help either. I requested the sister to call the lab to get blood for the dying mother but as it is in our labs, there was no blood. It was only when I clumped the uterine arteries that the bleeding stopped. I asked for plasma expanders, only to be shocked that a whole district hospital did not know what those were.
At that moment the MO called the consultant to bail us out. Our woes were far from over. Long before we knew it the anesthetist mumbled something that I did not quite get. I watched as his instincts swung into action. The patient was still lying supine on the table with an open abdomen as the consultant scrubbed when the anesthetist did something unexpected. He reversed the general anesthesia he had administered to the patient. We stared at him in shock. I could not understand why he would do such a thing given that our patient had almost gone into shock. Then he explained. “The cylinder that supplies oxygen is out of gas, and there is no reserve. I had to reverse GA so that she can breathe for herself.” As I paved way for the consultant to proceed with the operation, I felt a wave of sadness sweep through me. My heart was hollow. I chose to become a doctor so that I can help the suffering, but how do I do that if I do not have equipments and drugs to do achieve my goals? The consultant, just like us, was dressed in an abdominal sheet, which served as a substitute to a gown.
To bring this story to a culmination, I wish to state that the mother eventually left the operating table stable, without a child and without a uterus. Please bear in mind that the child she was carrying was her first, and sadly, her last.