Bere 2018 #17
MEDICALLY GRAPHIC- READ BEFORE SHARING WITH CHILDREN!
It is Sabbath. I went in this morning to see patients. In peds, I found the child I had seen yesterday with the black dead patches all over the place. I think it is cutaneous anthrax. My wife had seen it yesterday, she has a very good memory for things, and she came up with the diagnosis. It is rarely seen in the US. It is gotten by contact with animals and animal products. Of course we could be wrong, we have to go on hunches, as diagnosing isn’t possible for many diseases. I check on the surgical ward, the maternity ward, ER, and private rooms. A few patients stop me along the way to ask questions. There was an old man last night who wasn’t breathing well after the family force fed him some bouille (rice, flour drink), and Im sure he aspirated it. He died overnight.
Audrey and I get on Olen’s moto and head out to a church about 20-30 min away. It ends up being about 6 miles. We both chuckle at the masses of kids that see us and yell and wave with smiles, saying “Naaasssaaarrraaa” (white person). At church there are 5 benches for seats and we sit on the front one of the left two benches. Kids gradually show up and sit along the edges and slowly inch forward to look at us. Near the end of Sabbath school, I get a call from the maternity ward. “Docteur nous beswoun de vous vite, Il y a une femme avec une enfant avec le bra dehor.” (if you speak French, please excuse my terrible spelling and grammar). Doctor we need you quickly. There is a pregnant woman with a arm out. If just an arm is out then often the baby is trying to be delivered sideways, rather than head or butt first. Transverse babies don’t come out. They die and sometimes rupture the uterus. So we hop on the moto and head back. Audrey goes to change into scrubs and I go to see the patient.
I see a 18 year old girl with two old women standing by. The girl has one leg draped of the side of the delivery bed and the other knee up in the air. A babies body and legs and one arm are hanging out of the vagina. Apparently she has been like this since she was at home. No contractions. Babies dead (often will die in a couple minutes in this position, because the head compresses the umbilical cord, and then the baby has no more oxygen coming to it). The uterus still seems larger than just a head, so I wonder out loud whether there is a second baby in there. The nurse checked and didn’t hear another heart beat. I’m in my church cloths (nice shirt and slacks), and I wish I had scrubs on. I put on gloves and start to feel the position of the baby. I find there is few things more gross than having gloves on, reaching in to help deliver a baby, and getting half your arm inside. Being covered beyond the limit of my gloves with meconium, vernix, blood, urine, amniotic fluid- I just want to have a shower!! And of course I’m sweating profusely! It seems the chin of the baby is stuck up above the front of the pelvic bone of the mom. There seems to be quite a bit of space towards moms, back but baby is not coming down into that space. I pull and push and twist. How much force does it take to decapitate the head of a baby that is stuck, I think. I don’t every want to find out! I get the babies head turned and it still wont come down. Mom has no contractions. I ask the nurse to start an oxytocin drip. Then mom starts to have contractions. I’m worried that with the contractions and a stuck head, the combination could rupture her uterus. As she starts to get contractions she starts pushing. I had asked the staff to find me forceps, and they arrive. I’m able to get the forceps on the babies head and with mom pushing, me pulling with forceps, finally the head starts to move down. As it starts to move, I stop pulling. If it comes out to fast and doesn’t have time to stretch the vagina, then you get tears that need to be repaired. The babies head is out and the placenta follows shortly as I massage the uterus. I do an ultrasound and don’t see anything abnormal and no second baby. The size of the uterus is also as expected. I take off my gloves. Did they protect either me or her? Unlikely. I go to the sink, and wash my arms up to where my short sleeves begin. It’s good to get all those fluids off me. I am glad for intact skin, without cuts or injuries, as this would make me contracting something more likely. I leave the nurse to check for tears, and call me if she needs me. They will usually repair the tears themselves. I go back to the house, get cold water, and sit in front of the fan.
We could see it and then hear it after that. A huge thunder storm. A number of the volunteers are going to Kelo tomorrow along with AHI lab people. About 8 all together. Now it is raining so hard I have to yell to Audrey who is sitting right next to me. Rain on a tin roof, I love this sound. I still hear the thunder but the rain is the loudest sound. It is finally cooling off after a VERY HOT day. I pray that my patients will do well tonight, as I always pray, and that I will be able to sleep well with the cool evening.
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