I've been hearing from many of you that you enjoy these posts and I should keep them coming, so here goes a post with no particular theme, but more of a stream of consciousness reflection.
This was a weird week. I delivered a stillborn baby who had been alive at the check 2 days prior, then mom came back because her water had broken a few hours before. Sometime in those few hours the umbilical cord had slipped out through the open cervix (cord prolapse) and the baby had died. When she arrived, the baby was already dead and all we could do was induce her labor and hold her hand. It happened mid-morning, so I had to go from that delivery back to clinic to discuss people's aches and pains which I know are very important to them but seemed so insignificant in light of what had just happened in the other room.
A few days later, I was in clinic and heard a commotion next door in the emergency room. In the few minutes that I had my door closed as I interviewed a patient, a bus had pulled up to the front doors and dropped off a young man who had just been run over by the same bus. He had been leaning out of the door, dropped his phone, and tried to grab for in while the bus was still moving. His body was rolled over by the back tire and he came in with more fractures in his pelvis than I've ever seen, as well as bleeding in his retroperitoneum from the sacral plexus (this type of bleeding is really hard to control). It's one thing to deal with a critically ill trauma (he definitely would have been a Tier I at VCMC) when you have a blood bank that rushes there with several units of O negative blood at the ready, an x-ray technician who has the machine already there, all of your supplies within arms reach, and a fully trained staff ready to stabilize them. It's a completely different situation when he arrives, you can figure out what's wrong with him, but everything takes SO MUCH longer than it would in the VCMC ER. Firstly, you know he's bleeding, but we don't have a blood bank here. At least, not the kind you are familiar with. Our blood bank is the doctors, nurses, staff, neighbors, and family members who volunteer to give their own blood. It is whole blood, taken right out of one person, cross-matched, then given to the patient. He was a rare-for-here type of blood, and our lab went through list of known donors pretty quickly, and then had to get blood types on a bunch of volunteers (including visitors who were there for 36 hours!). Two of our donors with doctors who were stabilizing the patient- they gave blood and went right back to work. Hard core.
The patient miraculously (I don't say that word lightly) made it through the initial tenuous hours, made it through surgery, and is now recovering in our hospital ward. He has a really long road ahead of him, and there are uncountable things that could go wrong before then. Please keep our staff and doctors in your prayers as we are going to need wisdom and more miracles if he is to come through this.
In the middle of the night after that accident, I delivered a baby who was 10lbs 2 oz, which is really fat for these parts. His head and shoulders came out just fine, then his body got stuck. I've never had that happen before. Fortunately, once the head and shoulders are out there's not much danger, so I just pulled and encouraged mom to push hard and eventually the rest of his body slipped out.
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Yesterday we heard that a fishing boat had capsized off the coast, and several bodies were found dead but 9 are still missing. This boat had many young men from the villages around here- my gardener's son, one of our guard's son, a neighbor's husband. There's not much hope they are going to be found alive, and at least 9 families are now left without their providers, grieving. Death seems so prevalent around here, but I don't you ever get used to it.
So that's my week. Recreation has included gathering mangos, getting bitten by ants, hiking through a jungle, playing guitar, and Skype conversations. Pretty normal, right?
This was a weird week. I delivered a stillborn baby who had been alive at the check 2 days prior, then mom came back because her water had broken a few hours before. Sometime in those few hours the umbilical cord had slipped out through the open cervix (cord prolapse) and the baby had died. When she arrived, the baby was already dead and all we could do was induce her labor and hold her hand. It happened mid-morning, so I had to go from that delivery back to clinic to discuss people's aches and pains which I know are very important to them but seemed so insignificant in light of what had just happened in the other room.
A few days later, I was in clinic and heard a commotion next door in the emergency room. In the few minutes that I had my door closed as I interviewed a patient, a bus had pulled up to the front doors and dropped off a young man who had just been run over by the same bus. He had been leaning out of the door, dropped his phone, and tried to grab for in while the bus was still moving. His body was rolled over by the back tire and he came in with more fractures in his pelvis than I've ever seen, as well as bleeding in his retroperitoneum from the sacral plexus (this type of bleeding is really hard to control). It's one thing to deal with a critically ill trauma (he definitely would have been a Tier I at VCMC) when you have a blood bank that rushes there with several units of O negative blood at the ready, an x-ray technician who has the machine already there, all of your supplies within arms reach, and a fully trained staff ready to stabilize them. It's a completely different situation when he arrives, you can figure out what's wrong with him, but everything takes SO MUCH longer than it would in the VCMC ER. Firstly, you know he's bleeding, but we don't have a blood bank here. At least, not the kind you are familiar with. Our blood bank is the doctors, nurses, staff, neighbors, and family members who volunteer to give their own blood. It is whole blood, taken right out of one person, cross-matched, then given to the patient. He was a rare-for-here type of blood, and our lab went through list of known donors pretty quickly, and then had to get blood types on a bunch of volunteers (including visitors who were there for 36 hours!). Two of our donors with doctors who were stabilizing the patient- they gave blood and went right back to work. Hard core.
The patient miraculously (I don't say that word lightly) made it through the initial tenuous hours, made it through surgery, and is now recovering in our hospital ward. He has a really long road ahead of him, and there are uncountable things that could go wrong before then. Please keep our staff and doctors in your prayers as we are going to need wisdom and more miracles if he is to come through this.
In the middle of the night after that accident, I delivered a baby who was 10lbs 2 oz, which is really fat for these parts. His head and shoulders came out just fine, then his body got stuck. I've never had that happen before. Fortunately, once the head and shoulders are out there's not much danger, so I just pulled and encouraged mom to push hard and eventually the rest of his body slipped out.
Yesterday we heard that a fishing boat had capsized off the coast, and several bodies were found dead but 9 are still missing. This boat had many young men from the villages around here- my gardener's son, one of our guard's son, a neighbor's husband. There's not much hope they are going to be found alive, and at least 9 families are now left without their providers, grieving. Death seems so prevalent around here, but I don't you ever get used to it.
So that's my week. Recreation has included gathering mangos, getting bitten by ants, hiking through a jungle, playing guitar, and Skype conversations. Pretty normal, right?
