My Scariest Day at Work. EVER.

Hello,  it’s Danica again!

So….I had such a traumatic day at work yesterday that I think it deserves a blog entry! Warning… medical talk about messy birthing story to follow…. read at your own risk…

The delivery suite. Where three women can push out a baby at the same time.

The day starts off in the delivery suite were I planned to observe the nurses catching babies. I notice one lady whom they seem puzzled about. They are animatedly talking about her, and I notice the midwife student, midwife teacher, nursing student AND head nurse all take turns checking her cervix (poor lady).

They then ask me to check her. She is fully dilated with a big bulging bag of waters… and no baby’s head to be felt. In Canada, I would have popped an ultrasound on there to see if the baby was head up or down, but, alas, no ultrasound here. I tell the nurses (in my limited French) that I think the baby  in the transverse (sideways) position and that she needs a c-section. They get her ready and tell me I am doing the c-section. OK.

A rather lacking medical supply cabinet.

So they bring her to the OR and the nurse there checks her cervix. He tells me the baby’s head is in fact down. I am feeling stupid for calling a c-section when it wasn’t necessary– but I carefully check her again and I still think the baby is not head down. He checks again, and in the process breaks her water. A flood of amniotic fluid pours across the room, and with it, the umbilical cord prolapses out. All you medical people out there know that this is NOT GOOD! The cord is hanging out, and as the baby gets pushed out of the birth canal, it pinches the cord, cutting off the baby’s oxygen supply, often resulting in death.

Well,  the only way to prevent the baby from dying is to stick your hand up the mom and push that baby back up so that it doesn’t pinch off the cord. So I fire my hand up there and push the baby up (which was indeed in the transverse position, and NOT head down). I am standing there, with my hand in a poor woman’s nether regions, trying to tell everybody in my broken French — “C’est tres importante pour cesarean MAINTENANT! VITE, VITE!” Everybody is moving around in slow mo, and nobody seems to get how urgent this is. I am trying to explain, and get them to call for more help, but I don’t know if anybody understands me. It was such a desperate feeling.

The neonatal "resuscitation" area.

There is an intern there who has done a total of five c-sections in his lifetime, and a completely green medical student. They are slooooowly getting ready to do the surgery. The woman is put under GA by a nurse anaesthetist and finally the surgery begins. I am giving the intern a few pointers on how to do the surgery as I am peering out from under the sterile sheets with my hand still in place! I am praying to God that the baby will make it.

The intern pulls out a floppy, blue looking baby and hands her over to me. I bring her to the “resuscitation table” where I find they only have a towel. No bag and mask, no intubation equipment, no stethoscope. And the suction is broken. I rub the little 4.5 pounder down and pray. And pray. And she lets out a pathetic little cry. She is alive! The nurse takes over and I glance over at the OR table to see how the intern is managing. He is struggling. ALOT. And as I walk over there I notice he is pulling out ANOTHER baby! TWINS that nobody knew about. He hands me another floppy, tiny baby, this time a boy, and I bring him over to his sister. Same routine as his sis, he finally lets out a little sound after giving him a good rub down. Now I run to go scrub in to help the poor intern and student with the surgery. When I walk back in to the room, the nurse is doing mouth-to-mouth resuscitation with a piece of gauze over the little boy’s face. He isn’t breathing on his own. I am torn between helping the mom and helping the baby. I check and see that he still has a decent heart rate, and with some more vigorous stimulation, he cries again. The nurse ensures me that anaesthesia is coming to help with the babies, so once again I go to scrub in.

The ward where moms and babies go to recovery after surgery.

When I get to the table, I am soaked in sweat, partially from fear, but also from wearing scrubs, a thick plastic apron, a gown, two pairs of gloves, rubber boots, a mask, and a hat– all in the humid Burundian climate. The intern is also sweating bullets. It is dripping off his forehead. He unfortunately has misidentified the lower segment of the uterus, and has instead stitched the bladder flap to the upper uterine segment. The poor woman is also bleeding like crazy, and it is hard to see anything. Now try to imagine the panic I feel as I start to come to the conclusion that this lady might die right in front of us. I can see what the intern has done is wrong, but to try to explain to him without speaking his language was truly frightening and so difficult. We managed to get the bleeding under control and I insisted that somebody call another surgeon to come and help. The head of obstetrics finally came and redid the section the intern had stitched the wrong way. She carefully taught him the correct way to do it, and I was very envious of her ability to communicate.

At the end of the day, the mom and her babies survived. And I truly believe God saved them.

What a day! The differences between health care in Burundi and Canada are startling. As the drama of the events unfolded it was impossible for me not to compare how we would have done it in Canada. And to be truthful, I miss the order and cleanliness and systems that I am familiar with. I miss being able to communicate and bond with patients and my coworkers through such a simple thing as language. I do feel, however, that God has me here.

And I am trying to do my best.

Family members waiting for good news outside the delivery suite.