A good night

4-22-08 (pm); return from IDP camp, I know I won’t be able to sleep after what I’ve seen and so I volunteer for OB call.

Jane, 28 years old multiparous female with a prior c/s is at term and is four centimeters dilated, she desires a repeat c/s.

I also hear there is a young Maasai lady, Joyce, who thinks she is 37 weeks pregnant and has been receiving prenatal care at a district clinic. Here BP’s over the prior month at that clinic have been in the 160-180’s/100-110. We perform PIH labs, urine protein is 3+, platelets are 94,000, Hb is 16, Creatinine is 1.12. She has severe preeclampsia. However she is only measuring 31 weeks. We give her steroids to promote maturation of the fetal lungs and hydralazine to bring down her BP. Plan to take her to rads to perform an US and then repeat her labs in 4 hours. (By the way the hospital still does not have any Mag Sulfate).

Off to the theatre to perform the c/s on Jane, lift up her gown, she has a prior verticle incision. Oh well, no time like the present to perform my first verticle incision. Fortunately it goes well.

Back to L&D to find Joyce is having repetitive decels, we need to take her to the theatre now. Perform her c/s, fortunately it’s her first. She oozes and oozes. They don’t use the bovie here for c/s’s, so I put about 20 figure-of eight sutures in her incision and pray. It works. Gary the pediatrician who I worked with over the weekend, comes in to receive the baby, I think he’ll be glad when I leave.

Back to L&D, Ruth, who is a primip at term, undergoing an induction, is having fetal tachycardia and is remote from delivery. Take her to the theatre where I lift up her gown to find an ex-lap scar, I ask where that came from and she said she had appendicitis. I’ve never seen an ex-lap done for an appy, she must have had a perforation. I perform a verticle skin incision to minimize the scar with some trepidation. We arrive in the peritoneum only to find bowel adhered to the anterior abdominal wall less than 0.5 cm from where I entered. I breath a sigh of relief, better to be lucky than good. Rest of the c/s is routine.

In bed at 4 am. Collapse from exhaustion. Sleep...