Miracles

 While we were home in the states last year, someone asked me if I saw miracles happen here.  

Well, the truth is, no, not everyday.  But I still know that God is working even when there are not out-right miracles.  I believe that in Heaven we will be amazed to know the amount of miracles that happened that we didn’t even notice. 

I have never walked on water.  I have never seen a withered hand instantly healed.  I have never seen a dead man walk out of his tomb after being dead for 3 days. 

I WILL say that when my miso stash was low, it somehow worked mysteriously more potent.  Really.  And then some wonderful person sent me more. 

I do believe that God works through modern medicine.  He also works through the archaic medicine that we try to practice here. 

Last night we witnessed a miracle. 

I suppose it could be explained away by the affects of modern drugs working on her system.  But it was still a miracle.  And everything good that happens comes from God.  And we praise Him. 

And I need to go check on her to see how she is doing. 

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She presented this morning at 2:30am.  Pregnant.  Term.  Vaginal hemorrhaging.  Been in labor since last night.  No wait, family changed the story.  Been in labor since the night before. 

Whichever the story, her vaginal exam told me that the baby was floating in her abdomen.  Normally, a woman in labor for a long time would have a baby fixed in the pelvis.  The contour of her abdomen was also not right.  It seemed exactly like Uterine Rupture.  I know this problem all too well here.  The uterus gets tired, like an old paper grocery sac, and breaks, expelling the baby and placenta into the abdomen.  The uterine arteries and veins get torn too and can continue to bleed until they are repaired or the patient dies.  It’s a lot of blood.  Like a battlefield on the losing side. 

Right away I called my OR team on the telephone (Simeon and Samedi) and told the family we were doing surgery.  The night nurse Josephine covering surgery and maternity helped me carry the patient, literally, to the gurney and roll her to the operating room. 

We started an IV and fluids and waited for Simeon and Samedi to arrive. 

While scrubbing, I started to doubt my quick decision.  Had I decided too hastily? 

The spinal anesthesia had gone in and the patient was doing okay.  Simeon prepped her abdomen and Samedi and I put our sterile drapes over her, leaving her huge pregnant belly open to cut. 

But then her blood pressure started to tank.  She had been quite dehydrated from losing so much blood, so we were pouring fluids into her veins.  Josephine somehow started a second vein, and we gave even more fluids.  Nothing was helping.  50/20....40/20....Somehow she was still breathing. 

I had Josephine fish the phone out of my pocket and hit a few buttons to call Olen who was sleeping at home. 

“Dear, please come.  I have a lady trying to die on us.”

He started to explain to me how to mix up epinephrine, “Um...can you just come?” 

It’s hard to wait for the patient to stabilize her blood pressure before starting the surgery if she’s bleeding out in her abdomen.  So we say a quick prayer and I make a huge vertical incision in her abdomen. 

As we suspected there was a term dead baby floating in her abdomen just under the skin incision.  People here are skinny, there’s not much to cut.  I pull out the baby and placenta, and start to search for the bleeders. 

When a uterus ruptures, the normal anatomy is not so “normal” anymore.  Parts of blood vessels clot off.  Some of the blood congeals, mixing with normal tissue.  Some of the normal tissue dies...it’s one big mess.  The main goal is to stop the bleeding, and not get the ureters. 

Meanwhile her BP is still tanked.  It’s still 50/20.  Olen has arrived by now and has started giving her epinephrine. 

My patient’s uterus is so badly torn that I decide to do a hysterectomy.  I start on the left.  I’m trying to move quickly to stop the bleeding. 

I hear Olen tell me to feel for a pulse on her aorta. 

I feel. 

There’s nothing. 

Oh, great.  My patient has died. 

Wow, okay...I feel like a failure.  “So, that’s it, there’s nothing else we can do?”  I pound on her chest a few times, but it seemed hopeless. 

“Okay, there’s one more thing I’m gonna try, “ Olen says.

I get a little frantic and start suturing in big bites to just tie off things so we can close.  This is so sad.  I’ve never had a patient die on me while operating.  I’ve had several patients die here postoperatively, but not during the operation. 

It was at least one or 2 minutes.  Olen had started an epinephrine drip and had already given atropine IM while she was bradycardic (slow heart rate) and hypotensive, before her heart completely stopped.  Now he was kicking himself for not giving a little IV atropine earlier.  He opened the epinephrine drip to full-speed bolus and gave a gram of atropine IV push. 

Then, I heard it.  The pulse ox started recording a heart beat. 

Is that her?  I feel her aorta.  It was miraculously beating! 

Her BP improved, we finished up the c-hysterectomy, put in an NG tube to help evacuate the air that went into her stomach from bagging her (artificially breathing over her mouth), and watched her carefully for a while. 

I go home grateful that she is still alive. 

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Okay, back from checking on her.   

She’s still comatose.  She remained that way all day. 

My thoughts went crazy.  How do you take care of a long-term comatose patient in a place like this?  How many of her brain cells were killed during all of that hypotension (low blood pressure), during the several minutes that she was literally dead?  Maybe we shouldn’t have tried so hard.  Maybe God shouldn’t have worked a miracle. 

God knows what He’s doing.  It doesn’t always turn out the way we think it should.

The patient’s parents are unhappy that her abdomen is so distended.  I don’t scold them for bringing her in so late in labor.  There must have been a reason.  I’ve gotten my self in trouble for scolding.  When I scold it seems like the patient dies and then I never see the family again.  And that does nothing for relations with people, which is why we are here. 

We continue to pray for her.   I told the family they had to donate blood to replenish the blood we already gave her. 

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The next day.....she starts to wake up.  She’s REALLY agitated.  (some CNS abnormality I presume from lack of oxygen to the brain during the surgery).  She half wakes up and thrashes around a bit.  We give diazepam. 

I’m REALLY agitated.  (I don’t get diazepam).  I gave her 2 units of blood with the surgery.  The family promised to give blood yesterday.  They refuse now.  I need to give her another unit of blood. 

Well, actually I don’t really know if she needs it, but she probably does.  We have no functioning exam for hemoglobin or hematocrit (something broke), so I have seriously been going on clinical basis... color of conjunctiva and how much blood I think they lost. 

So she DEFINITELY needs more blood and the family WILL donate! Seven family members crowd around the bed.  I make everyone leave for now unless someone will donate blood. 

We have given all of her meds and surgery for free up until now.  She now has a fever, so I had written for IV quinine and triple IV antibiotics.  This is very expensive for people who live here.  You can’t give free meds from the hospital forever, so I offer to pay with money that people give us only AFTER the family gives blood. 

I leave and come back.  Two guys have donated.  The women refuse to give.

I leave and come back in the afternoon.  After many long discussions, another lady finally decides to give blood.  I hang the third bag of blood. 

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She came around.  Slowly she woke up.  She had good days and bad days.    Yesterday I discharged her on postoperative day 9 in pretty good health, though a little weak walking around still. 

The best part for me.....her name. 

Danayo Blandine.  I kid you not!  Spelled just like that on the carnet (her medical booklet). 

(For those of you who don’t know...my maiden name was Bland....so her name is basically a french version of my old name.) 

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