Difficult Day

After waking up at 3am last night for no apparent reason, I was worried about being tired during the 9 cases scheduled for today. I had requested an early start and thankfully had the assistance of a surgical resident, a family practice resident, and a ob/gyn resident who are all on the Ob/Gyn service now. 

The first patient began as scheduled, only this patient was 7. It's rare, but ovarian cancer can occur at this age, and she had a large mass suspicious for cancer. When we looked inside the tumor invaded several other organs; with the help of the surgical resident (Agneta who has a particular interest and knowledge of pediatric surgery) we removed all visible cancer.  After that I proceeded with 2 other surgeries, right as I finished and came home for lunch I was pager 999 (Kenyan equivalent to 911). Running back up to the hospital I met an unconscious mother who delivered at home 5 hours prior with retained placenta. She had a thready pulse and no blood pressure. The OB nursing staff quickly helped as I asked for IVs, epinephrine, pitocin, cytotec, blood, oxygen, a heater, packing, and face mask. As we started the 3rd IV line the fluid coming out of her vein was consistent with saline. Thankfully she came with 3 people all of which we sent to the lab to donate blood. After 3 units of blood, 5 liters of NS, and prayer she began to wake-up and was transferred to the ICU. As I was writing her orders Agneta came to tell me that the 2nd woman we had operated on was hypotensive and tachycardic. On exam it was clear she was bleeding inside. We rushed back to the OR, no more blood was available because I had just given it to the post-partum mother, Agneta suggested that we use the cell saver. I found it near miraculous that Tenwek had a cellsaver (a device to autotransfuse this woman with the blood in her abdomen) and even more so that they got it working in 5 minutes. We were able to stabilize this woman, but she is now also in the ICU. 

Things don't always work here (okay most of the time, things feel very inefficient to me). But today, 3 lives were saved thanks to a lot of people. The team worked well. As I reflect on the exhaustion I feel deep gratitude to the staff at Tenwek. Now, I ask God to bring healing to these lives and to protect them from further complications.