Shanksteps #129
She was there when I arrived at the hospital. She was about 18, lying on her side on her bed. Gaunt eyes looked up at me. I approached and asked how she was doing. She said OK, but almost inaudible. I saw a small piece of gauze hanging from her left nostril. It looked like dried, maroon colored blood. Her abdomen protruded with a gravid uterus. She was 7months pregnant. She had come into the hospital with a hematocrit of 10%. Her husband had already given her 250ml of blood and her mother also 250ml. Her repeat hematocrit was 16%. Her husband again gave 500ml of blood. She had developed epistaxis again overnight and had had her nose repacked by the nurse. I checked her conjunctiva and she was very pale. She noted that whenever she sat up she got very dizzy. Her BP was 110/60 and her pulse 136. She needed more blood. As I examined her she was having abdominal pain. I checked her abdomen and found a very firm uterus. The nurse had not tried to get a fetal he
art rate, so we searched for it, but found none. She was having contractions. I asked them to try to find more blood as I continued rounds. After only a couple patients her mother came to get us. She thought she was delivering. The nurse ran to get gloves while I finished with a patient. As I go back to her room I find a still born lying on a small white sheet. Jacques is massaging her uterus, she is bleeding vaginally now, as one would expect. Running to the lab I encounter her one other family member who was being checked out. She did not match. Kanas didn’t want to take my blood as I gave a little yesterday. I sit in the chair. My left arm is swabbed with alcohol. A LARGE 12G needle is inserted into my bulging anticubital fossa. “Red life” flows from me into the bag on the floor. Soon it is bulging with 500ml of blood. I run back to maternity. It seems the bleeding has slowed.
I continue my rounds. After seeing about 6 outpatients, Jacques comes into my office, “Doc, she is still bleeding!” I hurry the patient in front of me out of the room and run to the delivery room with my headlamp in hand. Pools of clotted blood surround her buttocks. I perform curettage and remove some pieces of retained placenta. The bleeding subsides. Her BP is 90/40 and her pulse 145. There is no one else able or willing to give blood. Fluid slowly brings down her pulse.
I am called to see her again. She is having copious, watery, diarrhea. She is very thirsty. We pour in more fluids. Her husband looks concerned. He is happy that her bleeding has stopped but is still worried if she will do all right. I am concerned too. God made us incredibly resistant, but at some point it becomes “to much!” There is no power for two days now. The water has just run out of the tank. We make sure each nurse has batteries in their flashlight and we head home for bed. We have just heard that tomorrow our order of medications is arriving from the south; we must go to Maroua to pick them up. I am thankful to have friends at Meskine Hospital where they will arrive. I call them and they agree to keep them a few days for us. I can operate as planned on the old woman with a partial bowel obstruction and do the circumcision on the 18 year old I saw today in clinic.
God, give me peace and rest for tonight.
In His Service, Greg