Tales From the Field - Part 4

Her abdomen is a fleshy, mountain of cellulite, her umbilicus the pinnacle.

“Jesus.  Is she ruptured?” I stare and can’t make heads of what I’m seeing.

“Or is it an umbilical hernia?” the other midwife suggests.

 I touch her belly and feel something just below the surface of the skin, the baby’s head. 

“Oh my God, I think she is ruptured.” I rip the extension cord of the ultrasound from the wall and pull it to the bed.

“I’m not sure what I’m looking for.” I thrust the probe into Monique’s hand.

The three of us stare at the screen. I am lost. Fetus, placenta; can you actually see the uterine wall burst open? We don’t have much time to figure it out. She’s in shock. Plasma is pouring into her veins.  Blood is on the way. 

“We go to OT.”  Monique says definitively. 

A second line, Foley, consent, and we’re ready. The trolley comes and we transfer her as quickly as we can.

 In OT 2, I stand next to Sandrine knowing she’ll need an extra set of hands to help her bag. She hands me two syringes. 

“Jusqu’à trois et jusqu’à deux?” I ask.

“Qui.” 

I push. 

“Suction!”  She cries. 

We suck saliva from her throat to clear the way for intubation. Sandrine struggles as I try and push on her larynx in just the right way.

“Merde!” I press a little to the left. 

“Yes, yes, ok.” 

She feeds the tube down her throat. 

“Stethoscope!” The scrub nurse tries to place it around her neck.

“No!  You!” But she looks down and sees the patient exhaling into the tube. “Ok, c’est bon.”

 I squeeze the bag. Her pressure is 70/30.  The surgeons work quickly. Skin, fat, fascia. It’s as though her insides explode. They pull the uterus from the abdomen. We gasp at the giant gaping hole. A macerated fetus covered in coffee colored blood is tossed on the field below them. It looks like it’s been dead for days.

“What about her uterus?" I ask.

Heads almost touching, the OBs examine the job in front of them. They decide to suture. I bag. Blood arrives and Sandrine hangs it. I watch as the diastolic climbs to 50. I feel a glimmer of hope. 

 Suture after suture is placed, running up the entire length of the uterus. We are there an hour at least. I watch as Asari, the other OB squeezes the uterus. It looks flaccid and I know that even with oxytocin it won’t contract.

“Can we get consent for hysterectomy?” 

Asari explains sometimes it takes too long. The right person has to be there to say yes. We send one of the nurses to check. He returns quicker than I expected, holding the paper.

“They consent.” The surgeons proceed. 

“Who said yes?” I ask. 

“Her mother.” I think of my own mother, signing my uterus away to save my life. I swallow the lump in my throat.

 Another hour goes by as I watch as the perfectly sutured uterus is excised; clamping, cutting, tying off. Finally it is removed. I wonder what is done with it now, but don’t ask. The fetus and placenta the family will take. But what about her uterus?

I leave the OT.  I need to return to the ward to see what else has happened in the hours since we left. 

 I make it through the day. And even my call that night. Another section for obstructed labor, luckily both mother and baby are fine. Monique, Sandrine, and I are like robots, doing the work that needs to be done at 3am.  

I go home and sleep, for just a few hours. I am restless and tired but can’t seem to nod off again.

I go out to get some breakfast just as the sun is coming up. Monique and Sandrine are standing morosely over their coffee. Something must have happened to our patient.

“Elle est mort.” 

“She died?" I am crushed. I really thought that she would make it. 

Monique wipes away a tear. To be an OB on this project is an awesome responsibility.

“They come at the last minute. It’s not your fault." I say.

I know she knows this but we feel it all the same.