Not that I'm complaining. No, not me! After all, it really is a privilege to serve the people of the highlands, to do my best to bring a measure of comfort and healing. Sometimes my best isn't enough. Sometimes it's hard work.
In fairness, most nights on call aren't nearly as bad as this one. But if you are inclined to pity me, go right ahead. I'll take what pity I can get.
The night started calmly enough. Dave is a visiting medical student from England, and he was on call with me as "back-up." There was one patient in the labor ward that we had been trying to induce all day, and we had some discussion about how we'd manage her, but finally decided to give up, stop the meds, and resume the efforts in the morning.
I was very sleepy, and quite uncharacteristically decided to go to bed early, confident that Dave could handle the routine questions that might come up through the night. I'd been in bed for 15 minutes when he called to say that there was a patient in the ER with a spear wound to his chest. Knowing that such a wound could be anything from trivial to life-threatening, I told him I'd meet him there and hoofed it to the hospital. This particular "wound" turned out to be at the trivial end of that spectrum. I don't think that the chest cavity was even penetrated at all. And to make matters worse for my attitude, he had driven past 2 hospitals that could have easily treated him on his way here.
Leaving Dave to finish that, I headed home. Just as I was walking away, the ER nurse called out to me that they had phoned from the labor ward, and there was a mother in labor with a cord prolapse. When the umbilical cord comes down into the birth canal ahead of the baby, it can be squeezed to the point of cutting off blood circulation to the baby, and can quickly cause the baby's death. I hurried to the labor ward, and Dave arrived a few moments after I did.
The staff were already doing the basic things that might save the baby's life. The labor ward was chaotic, as it so often is. As I examined the birth canal, I found that there was a weak pulse in the cord, and that the baby was in breach presentation, the legs and bottom coming first. This is actually less often lethal than when the head is tight in the pelvis, compressing the cord. I asked one nurse to call the operating room crew for an emergency cesarean section while another was starting an IV. I was doing my best to push the baby back up into the uterus so that it would not compress it's own umbilical cord.
But over the next couple of minutes we found that the baby's heart beat first weakened further, then stopped. What a helpless feeling to be there while this baby died, just out of my reach. Even if the OR crew had already been there, and if we had run straight to the OR and done a cesarean as fast as I know how to do it, it would have been far too late. It was already too late. All I could do was to try to get the little body delivered without harming the mom. It was with a very heavy heart that I explained this to this young woman and her mom.
(To be continued...)
Photos
1. Dr. Scott Dooley, visiting with Dave Scott, visiting medical student from England
2. A grauitous photo of an exotic-looking tripical flower
3. When everything goes right in the labor ward, this is what we end up with.
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