Jan 19th/2011
I’m absolutely exhausted and emotional for so many different reasons. Facing so much injustice can almost be crippling at times. Arrived in the ICU for our second day of case studies. Emily and I missed our opportunity to work in the ICU yesterday because we chose instead to help with the transfer to Muhimbili. Sarah asked if we wanted to be involved in a c-section if one came up and to use it as our case study for obstructed labor. We were elated at the opportunity to go to the operating room together and went over the labor and ANC ward to see if there was a patient needing to prepped for c/s. We helped wheel a woman with obstructed labor over to the theater waiting room. I don’t know what the cause/reason was for her labor being obstructed. It could have been any number of reasons but no one really seemed to know. All they knew was that her labor wasn’t progressing enough to get the baby out so they needed to do it surgically. We changed in to our scrubs and got ready to go in to the operating room. I mentioned to Em that we should be prepared to do resuscitation because in all of my other experiences in theater, they are extremely unprepared and ill equipped to deal with emergency situations. We had the bag and mask ready, but I noticed that the suction machine and the oxygen tank were essentially useless because the only outlet that they had on that side of the room was broken. I asked the nurses what could be done about this and if we could move the machines to another area with a working outlet. They told me that they would move them to the other side of the room and plug them in if they needed to be used… Of course I’m thinking that it was almost a guarantee that the baby would be in distress and needing assistance when he/she came out because of the fact that patients usually don’t get into the operating room until the very last minute when it is often too late for the baby or the mother to be saved. In any case, I complied with their way of doing things and took my position as a somewhat passive onlooker for the course of the surgery. The woman was given an epidural higher up in the spine – almost at the point in-between her shoulder blades. (This was a very unwise decision on the part of the anesthesiologist and it led to a number of complications part way into the surgery and afterwards). Once the surgeon had cut through the layers of skin, fat and muscle, he got to the uterus and ruptured the amniotic sac. He reached in to get the baby out but was unable to dislodge his head from the mother’s pelvis because it had descended so far down. He tried three or four times unsuccessfully. The mother was still awake and alert –moaning and crying out while he violently pulled with all of his might to try and get the baby out. Finally, he came. The baby was blue and limp, not crying or breathing. And they were, of course, unprepared to deal with the situation. The nurse brought the small table across the room and moved the suction machine over to plug it in to a functioning outlet. In the mean time, Emily was standing there with the baby in her hands, wrapped in a cloth, not really knowing what to do. We were finally able to lay him down and do the necessary resuscitating to help him breath on his own. As soon as his airways were cleared he became more alert, opening his eyes and letting out small cries. I took him over to be weighed and then dried him off and wrapped him in a clean, dry khanga. I got the name Isaac for him. He was brought to the ICU while we waited to be able to bring the mother over as well. By the length of time it was taking, I knew that there must have been some complications. I hardly know what is normal or to be expected in most medical situations because I’m not fully trained… We wheeled the mother over to the ICU and she was still completely out of it. Potentially unconscious because she wasn’t responsive. We helped transfer her from the stretcher on to a bed and thankfully a couple of doctors came over to check on her. They were extremely concerned and that’s when I knew she was struggling for her life. I had no idea what had led to her being this way. She didn’t lose an abnormal amount of blood and the surgery seemed to go smoothly… She was having trouble breathing and her BP was 40/30 –almost inaudible. At that point I couldn’t stay and watch because the thought of watching another life be lost was just too painful to bear. (She ended up being okay –I found out later that the epidural being given higher up in her spine meant that her lungs and heart were affected). I had to take a walk.
I’m absolutely exhausted and emotional for so many different reasons. Facing so much injustice can almost be crippling at times. Arrived in the ICU for our second day of case studies. Emily and I missed our opportunity to work in the ICU yesterday because we chose instead to help with the transfer to Muhimbili. Sarah asked if we wanted to be involved in a c-section if one came up and to use it as our case study for obstructed labor. We were elated at the opportunity to go to the operating room together and went over the labor and ANC ward to see if there was a patient needing to prepped for c/s. We helped wheel a woman with obstructed labor over to the theater waiting room. I don’t know what the cause/reason was for her labor being obstructed. It could have been any number of reasons but no one really seemed to know. All they knew was that her labor wasn’t progressing enough to get the baby out so they needed to do it surgically. We changed in to our scrubs and got ready to go in to the operating room. I mentioned to Em that we should be prepared to do resuscitation because in all of my other experiences in theater, they are extremely unprepared and ill equipped to deal with emergency situations. We had the bag and mask ready, but I noticed that the suction machine and the oxygen tank were essentially useless because the only outlet that they had on that side of the room was broken. I asked the nurses what could be done about this and if we could move the machines to another area with a working outlet. They told me that they would move them to the other side of the room and plug them in if they needed to be used… Of course I’m thinking that it was almost a guarantee that the baby would be in distress and needing assistance when he/she came out because of the fact that patients usually don’t get into the operating room until the very last minute when it is often too late for the baby or the mother to be saved. In any case, I complied with their way of doing things and took my position as a somewhat passive onlooker for the course of the surgery. The woman was given an epidural higher up in the spine – almost at the point in-between her shoulder blades. (This was a very unwise decision on the part of the anesthesiologist and it led to a number of complications part way into the surgery and afterwards). Once the surgeon had cut through the layers of skin, fat and muscle, he got to the uterus and ruptured the amniotic sac. He reached in to get the baby out but was unable to dislodge his head from the mother’s pelvis because it had descended so far down. He tried three or four times unsuccessfully. The mother was still awake and alert –moaning and crying out while he violently pulled with all of his might to try and get the baby out. Finally, he came. The baby was blue and limp, not crying or breathing. And they were, of course, unprepared to deal with the situation. The nurse brought the small table across the room and moved the suction machine over to plug it in to a functioning outlet. In the mean time, Emily was standing there with the baby in her hands, wrapped in a cloth, not really knowing what to do. We were finally able to lay him down and do the necessary resuscitating to help him breath on his own. As soon as his airways were cleared he became more alert, opening his eyes and letting out small cries. I took him over to be weighed and then dried him off and wrapped him in a clean, dry khanga. I got the name Isaac for him. He was brought to the ICU while we waited to be able to bring the mother over as well. By the length of time it was taking, I knew that there must have been some complications. I hardly know what is normal or to be expected in most medical situations because I’m not fully trained… We wheeled the mother over to the ICU and she was still completely out of it. Potentially unconscious because she wasn’t responsive. We helped transfer her from the stretcher on to a bed and thankfully a couple of doctors came over to check on her. They were extremely concerned and that’s when I knew she was struggling for her life. I had no idea what had led to her being this way. She didn’t lose an abnormal amount of blood and the surgery seemed to go smoothly… She was having trouble breathing and her BP was 40/30 –almost inaudible. At that point I couldn’t stay and watch because the thought of watching another life be lost was just too painful to bear. (She ended up being okay –I found out later that the epidural being given higher up in her spine meant that her lungs and heart were affected). I had to take a walk.
 |
| isaac. |
I walked down the corridor of the maternity ward, past the labor ward and towards the antenatal/postnatal ward. There was a nurse talking with a group of family members on the other side of the wall –she was in a hurry so she pointed them toward me for the answers they were looking for. I hesitantly walked toward them, we greeted one another, and I explained that I only understood a little bit of Swahili. The man went on to passionately explain his situation and there was obvious frustration coming through in what he was saying. I stopped him and apologized, explaining that I could only understand a little bit of what he was saying. I asked if there was anyone around who spoke English. At that point another man interjected and proceeded to explain the situation to me in broken English. He was visibly upset, on the verge of sobbing, as he explained how this woman/patient had lost her baby the day before. He said that they had already buried the child but now they wanted to take the woman home and they were not receiving any information about the status of her health and whether or not she could be discharged. I apologized again and again and asked for the woman’s name so I could look in to the situation. He told me her name (Shamisi), and I asked what his relationship was to her. It was his wife. It was his newborn child who had died and been buried the day before. My heart broke. I assured him that I would make sure she was looked after. I walked in through the main entrance to the ward and called out her name –she responded and I looked over only to realize that it was the woman from the day before. The 20 year old mother whose newborn son I had named Isaiah and fought together with Emily for his life. Here I was with her again. I had experienced my own grief and sadness over the loss of her son, but to see her and her family members in the midst of such deep pain was almost unbearable. I took her by the arm and brought her to the admissions desk. I tried to get the attention of a nurse to ask why a doctor had not yet seen her but everyone was ignoring me. I managed to get the attention of one woman and she explained to me that she was going to be checked by a doctor and prescribed the appropriate medication. I told her to sit and wait and went back outside to explain what was happening to her husband. I assured him that his wife would be seen by a doctor and said that I would be back in half an hour to check on her. I went back to the ICU for the next few minutes and on my way home I walked through the postnatal ward to look for Shamisi and her family members. They were all gone so I knew that she had been seen and discharged. Thank you Lord. I am thankful that God was able to use me in such a painful situation with my limited knowledge of Swahili and my basic training as a health care worker. I was able to advocate for a woman and be a voice for her family in the midst of their grief. Thank you God.
No comments:
Post a Comment