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    Walt Shakes

    Walter Ude (@Walt_Shakes) is an award-winning Nigerian writer, poet and veteran blogger. He is a lover of the written word. the faint whiff of nature, the flashing vista of movies, the warmth of companionship and the happy sound of laughter. He blogs at mymindsnaps.wordpress.com.

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ALL IN A NIGHT III (Ward Rounds Episode 9)

Was I dreaming or what? Had I not paid enough for my sins? Why this temptation on a night I was supposed to be reading? Nothing would scare me again tonight, I told myself firmly. If I had seen an entrapped head and survived, then I was going to pull through this one.

Calmly I walked over to the patient, switched the IV fluid to Normal Saline and let it run. She had lost a good amount of blood and even seemed a bit dehydrated. The fluid would rehydrate and expand the plasma until we got some blood. I sent the porter off to the bank with a sample of the woman’s blood.  I went back to the general area of the perineum and with gloved hands began what would be a life-saving search. It had to be those incisions I made, and if they were the sources of bleeding, then there was not much danger. If not, somebody had better transplant that annoying SROC here this minute. I found my incisions but they were bleeding minimally.

The blood was oozing from someplace else. Where? The perplexing question drummed inside my head. A PPH lecture flashed before my eyes and I saw that petite lecturer in her doll-like voice saying: “When you are faced with a Postpartum haemorrhage, you must locate the source. If you don’t, no matter what resuscitative measures you give to the patient, she will still be losing blood. First check for. . .”

I’d checked for lacerations, true they were bleeding, but only minimally. I repaired them as quickly as I could. The young mother was still bleeding. I rubbed off contractions on the abdomen but the bleeding continued. I examined the placenta seated majestically in a kidney dish. It was complete. Could she have ruptured? Oh God abeg naa! My prayers were suddenly coming out in pidgin.

“Sister, please take my phone and call the Senior Reg,” I half-screamed half-spoke to the assistant nurse.

Back into my denim pockets she dug. “It’s not going through.”

“Keep trying!”

“There’s no use trying, it is not available.”

“I said, keep trying!” This woman was old enough to be my mother. I flashed her an apologetic smile that didn’t come from anywhere near my heart, because all I could think from ‘anywhere near my heart’ was that I had only been a Junior Reg just 8 months, and that this was a temptation too hard for me to bear, a Senior Reg temptation it should be, if you ask me. But no one asked me anything these days, no one cared if I could take it, it was just thrust on me. I had to make a decision fast.

“Maaaatron!” I bellowed.

Her hurrying feet increased its pace as she approached. She was saying jocularly as she entered, “Mai own doctor, what is ha-ppe-ni. . . ?” The sentence hung at the roof of her mouth as she saw the bloodied mess on the floor that was not there 10 minutes ago.

I ignored what I read on her face as a quizzical look asking what went wrong. I braced myself, took a deep breath and dug in. I explored the uterus with the border of my hand. I searched quickly and methodically so as not to miss anything. I did not miss anything, there was no retained tissue. The assistant matron was not making headway with the phone call, so I sent her to go see what was keeping the blood.

And as she was leaving, I said after her, “Shout if you have to, quarrel with those lab people if you must, but Sister, you have to be back in the next 10 minutes or we will lose this patient. When you get there, send the porter to the theatre and let them know we are coming with a possible vessel ligation or hysterectomy.”

She hurried off. I had to do the next logical thing, bimanually compress that uterus and pray to God it stopped bleeding. I put my left hand over the abdomen right on top of the fundus and my right hand through the perineum where I had tried exploring and compressed with all my strength. I hung on for dear life, mine and the patient’s. “Matron, abeg, get 2 litres extra of normal saline.”

She got them, exchanged one with the litre that just finished and made to drop the other one nearby as I said, “Matron set that one in the other hand.”

“Hah! But there is no line there.”

I sighed from both weariness and vexation. “You are a midwife Matron, please open another line for this woman with the gray cannula!” Why were these nurses testing my already friable patience?

She didn’t need any further prodding as she fixed the cannula and connected the infusion immediately. She was lucky, those veins were not collapsed. The young woman was beginning to flail her arms and hyperventilate from low oxygen. She started thrashing about like someone who was struggling for life, struggling with some force and fighting that her life not be taken from her. I couldn’t maintain my bimanual compression because of this, so I let go. Thankfully the two pints of blood arrived at that precise moment. The nurses held her as I exchanged the IV fluids and commenced giving the blood immediately. It was running fast. In a few minutes, she became calmer. Even though she was still losing blood, the flow seemed to have reduced considerably now. Satisfied with the result so far, I went back to maintaining the bimanual compression. My muscles ached, every group of them ached from every part of me, but I hung on.

It was as I stood in that awkward position that I looked down at my feet and saw that my jeans were soiled with splatters of blood. Thankfully, my feet were not exposed; those farmer’s boots were just the right kind of foot wear for a messy labour ward. When my muscles finally gave way from exhaustion, I let go and straightened every part of my body that had been contorted. I too had to live.

I shook my head a few times to shake off a dizzying spell and I looked, no bleeding!  It must be God finally hearing my prayers. I evacuated the clots that had collected and looked closely. No bleeding.

The cleaner had mopped the whole floor clean by then; the patient was on the third pint of blood, stable; and her baby was sleeping peacefully, at about 4:37am, when the SROC sauntered in and said, “Ehen, Doc how far? Where the patient dey sef? The child don die, abi? I don’t expect these kinds of cases to survive. How far now?”

I was too tired to say anything, to give him a piece of my mind and to let him know God would ask him to give an account of how he lived as a doctor. The nurses were too tired too.

Only the porter seemed to have the strength to reply: “Doctor, no be cases them be o, the mother and child dey alive and thank God they survive.”

Written by Aida Scribbler8943602-surgery-tools-with-blood

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14 Comments

  1. Sallie

     /  November 26, 2013

    Oh God!! Some doctors though… Thank God for remnants like you, Alda. God bless you!

    Reply
  2. consyspark

     /  November 26, 2013

    omg
    .. thank God they survived.. this kain yeye snr reg sef. Ada God really used yhu to save dat womans life

    Reply
  3. uzo

     /  November 26, 2013

    I was literarily yanked into this story, nice one Waltz

    Reply
  4. elrombi

     /  November 26, 2013

    Thumbs up man

    Reply
  5. Yemie

     /  November 26, 2013

    Wow!, like a scene from Grey’s Anatomy, God bless all great doctors and kindly nurses and midwives out there. Its not child’s play the responsibilities they are saddled with each day. I thank God for the passion of the job that keeps them going, no be beans at all.

    Reply
    • I like tнє first line of уσυя comment. I also got tнє Grey’s Anatomy-esque feel from it wнєη I read it. Thank God really for those men aηd women whose hands we entrust our lives aηd they do all they can to preserve it.

      Reply
  6. Maureen

     /  November 26, 2013

    🙂 familiar territory, very familiar.
    Dr Nkem I’m guessing/imagining you left the incisions on the unbooked patient for your SR. Then again I imagine him asking before he proceeds “what’s her retroviral status?” then u’d give him a proper *rmeToMarsAndBack, like you knew before poking ur hands into her perineum in the first place.

    Reply
  7. Well, one good thing happened, and that’s knowing that you have it in you…. But please don’t turn into that kind of your SROC o(who might have been a dedicated registrar by the way)
    Sometimes the things we go through during the junior residency days changes us…. I advocate for more mentorship…
    This was a well written story…

    Reply
    • Good point. No one, I want to believe, starts out being nonchalant in his or her chosen career. Perhaps tнιѕ SROC simply allowed himself to get jaded too fast.

      Reply
  8. nik

     /  November 26, 2013

    nonsense, so it was by 4 that he got the call right?
    coming in to ask silly questions.

    Reply
  9. Lovely. Gray cannula? I haven’t seen that colour before. I’m aware of Blue, pink, green and red. I’ve learnt. I’ve missed working in a hospital. Thanks Ma’am, you remind alot. Thanks Walt, for the tag.

    Reply
  10. Nnamdi Okeke

     /  November 29, 2013

    Nice one from the writer…I haven’t read anything so medical like this.

    Reply
  11. lol. This read pacy with a breath-holding spell. Dedication and calm saved the day. Interesting write, Aida. Lovely too.

    Reply

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