Just your typical saturday

To start off . . . I can now empathize with the small town obstetricians who used to dump the ‘pre-term labor’ patients on us during residency.  Yes, I can admit that some patients who were sent to us for evaluation were complete bogus . . . I truly hope that their reasons for transport had to do with patient (specifically infant) concern as opposed laziness.

It was my typical Saturday here . . . sitting at the kitchen table, catching up on some paperwork . . . sweating profusely . . . when one of the physicians tells me he has a pregnant patient downstairs . . .

           

‘okay . . . can you tell me about her,’

‘She doesn’t know her due date.  She said she felt some water from her vagina, and bad epigastric pain.’

‘Did her water break?  Does she have any idea as to how many months she is?  (NO ONE uses weeks here . . . I’ve leaned to stop asking)

‘She has maybe six months.  No . . . her water is not broken . . . I checked.’

‘Did you perform a speculum exam?’

‘No.  I check her cervix.  There is no dilation.’

‘So . . . that is not how you check to see if some ones water has broken.  You need to do a speculum exam . . . I’m just going to go see her.’

I head downstairs to find a woman who is very obviously laboring . . . [she had been told to go home, and even had her prescription filled for pain medicine].  Speculum exam reveals black hair.  She was 5/100/0, and this was her second baby.  A quick BPD showed 31 2/7 weeks.  The closest hospital with a neonatal resuscitation, and the ability to intubate is at least an hour from here. 

In the back of my head . . . I’m thinking . . . I long for the days when this situation was stressful in Columbia.  The days where the intern on night float sent home a laboring 24 weeker while you were in a cesarean section, but the patient still managed to make it pack in time to deliver the baby breech just off the stretcher.  Or the PPROMers who have been getting narcotics for their pain all night, and a you see hair when you perform an exam.  The ending with those cases would always be a neonatal resuscitation team, with all of the equipment necessary to take care of the baby.  [And there is a team of people that follows orders and knows what needs to be done].

I started thinking . . . maybe we can stabilize her and get her to San Marc . . . we can give her some magnesium, give her some antibiotics, betamethosone  and use the ‘ambulance’ to get her there.  [I know that was VERY wishful thinking].  I told the nurse she needed to start an IV right away and get antibiotics in her while I looked for the other medications. 

Apparently right away means after the patient has eaten something, as when I came back in the room after looking through the pharmacy, the patient was sitting on the exam table with a bowl full of meet and rice from our kitchen (some sort of cultural thing . . . it is dangerous to give any type of antibiotics without having food in your stomach).

Next thing I know, the nurse is moving the patient to the delivery room . . . still without an IV in her arm, saying (in creol) the patient needs to push.  Nothing I had said, requested, etc, was listened to . . . it was as if no one cared.  As soon as the patient got on the delivery table, finally with an IV in, she was crowning.  I gowned up, delivered what appeared to be a 32 week infant. 

I carried him to the resuscitation table, stimulated the hell out of him, dried him, asked about five different times for more warm dry blankets . . . and was denied the opportunity to give the baby to the mother.  At least when the nurse returned, she had a heating blanket on him.

I say that we need to get the baby to San Marc where there is the closest thing to an NICU.  The physician tells me that he would need to call the driver, who might be in port au prince.  Finally, after a conversation that should have taken 2 seconds, I convince the other doctor to actually call the driver and have him come to take the baby in the hopes of preventing him from dying.  [The baby is now finally on his way to San Marc.]

For all of this stress, I feel as if I did nothing to help, and even if I did, there is still a good chance the baby will end up dying.  As a physician, healer, good Samaritan, whatever you want to call me . . . I feel like I have failed. A 32 week infant would live in the states . . . and you would have everyone surrounding you working at optimal levels to ensure that baby had every possible chance they could.  It is so frustrating!