Liberia #14
“Docta, ……… ca” Im sorry, repeat that again. “De… bleed…ca”. Slowly the cobwebs of my mind clear and Im able to make out a little more. I understood, bleeding and car. Ill come. I get out from under my mosquito net and head in to the hospital. At the car out front I hear a woman hasn’t had a period for two months and is now bleeding profusely. I put some protective gear on and then peer into the back of the car with my headlamp. A 20 year old girl looks back at me from the lap of another girl. Im praying internally, Jesus, please help me know if this is Ebola. Ive not seen any, and at 2AM I hope this isn’t my first. Does she throw out? (vomit) “Ya, she trow out.” How many times today? “won taim”. How many times did she toilet yesterday, or today? “She no toilet!” Seriously? How long since she had a bowl movement? “She no toilet!” No diarrhea? “Ya” But BM? “Ya, Yestaday” After a long drawn out conversation, they deny headaches, feeling sick in the past few weeks, weakness, being near anyone who died… I have an uneasy feeling. I look at her eyes, they are very pale. I again ask for heavenly help in deciding what to do. No discernable answer. By bringing here in, if she doesn’t have ebola- I can likely save her life, with a curettage and some blood. If I’m wrong she will die, and potentially infect workers and potentially myself. I decide to curretage. Everyone is gowned up to the hilt, to bring her in the hospital and up the couple flights of stairs to the delivery room where I will do the procedure. I go and get on all my gear too. The gown is to short and I have difficulty zipping it up completely in the front. I need the extra length on my arms, so I don’t get a space between my gloves and the sleeves. So I leave it unzipped a little, at least it is really tyvec, the correct material! I place an apron in front and we give ketamine. In seconds she is out. I examine the area of bleeding. There is a placenta partially out the cervix. I remove the rest and use special instruments to scrape any that remains out. I have nothing on me and she is no longer bleeding much. I again pray that I have done what is the right thing to do. I go back to bed, and toss and turn for a while. I wake up early to talk to Audrey, and the signal is good so we skype, that’s always great!
I find out after worship that the vomiting has stopped, the bleeding has stopped, and I am grateful to have done the right thing. I am more comfortable now, and can focus on other things more clearly, even though a bit tired. There are 18 patients in the hospital. So we divide and conquer. Then to the operating room.
Fully gowned and sterile, we pray, then I place the blade on the abdomen, and with a swift stroke, the edges pull apart and the usual bleeding starts. I’ve chosen not to use cautery on this surgery, because I have a suspicion that the cautery cord isn’t really sterilized well. We dab, and put little clamps on vessels that bleed more quickly. There is almost no fat, so right after the skin is fascia. I slowly enter the inner layers, exposing a smooth broad surface. I put my fingers in, and then use scissors to open the rest of the abdomen. It is a huge cyst. It displaces all the intestines up to near the sternum. She hasn’t been able to eat much for a while, as there is no space in her abdomen. I remove the ovarian cyst, about the size of a womens volleyball. Later we weigh it, 2.7kg (6lbs). I think a gallon of milk is 8lbs. She has an umbilical hernia that I repair that in the closure.
The remainder of the afternoon is filled with >15 outpatients. And the occasional “emergency” sick person in the back of a car, 2 of which I admit, one I turn away with horrible edema and liver failure. I have nothing I can do for him. Surprising enough, he had had most of the labs I would be interested in at another place in town. So the labs and the yellow eyes, confirmed that I couldn’t offer much.