Pressure

This week has been one of the busiest weeks of my life! At the end of Wednesday, the other doctor (a recently-employed Ugandan-trained South Sudanese PGY2 - who has done 200 Caesarean sections during her internship!!) and I looked at each other and mumbled that if the rest of the year was like that day, we would totally break down in exhaustion. Well, ironically enough, Thursday was worse than Wednesday and Friday was even more terrible! I heard yesterday was très horrible too, hopefully things have settled down by today.

We had another bub who died on Friday. She was born via vaccum-assisted vaginal delivery two days prior. Her mother had a previous C-section but did report one successful VBAC (vaginal birth after C-section). In retrospect, I thought it would have been reasonable to take her to theatre for repeat C-section; she had prolonged rupture of membranes (over 24 hours) and there were multiple decelerations on monitoring as well as a persistent anterior cervical lip on examination. Anyway, that didn't eventuate and it mightn't have changed the outcome either (hard to predict since we had no way of telling how long the foetal distress had been present). We try to avoid C-sections if at all possible since contraception's unheard of here and it'd be disastrous for a woman with two or more scars to deliver at home.

Anyway, on delivery, there were large amounts of meconium in the liquor as well as in the baby's airway, she had low Apgar scores and took quite a bit of resuscitation. She seemed to do well over the next few hours and was even weaned off oxygen. Right around midnight, I was called back to the ward since she started developing respiratory distress and became febrile despite already being treated with IV ampicillin and gentamicin. The next 36 hours was chaotic as we battled with temps over 41 degrees, seizures presumably due to the high fever, and ongoing laboured breathing even with oxygen and CPAP support. Poor baby, it was all too much for her and she just gave up after around midday. The first hint I got of it (since I was on clinic duty) was when I saw the large group of people congregated around her bed, all of them standing stock still and solemnly listening to someone inside the room speaking. It was quite touching as they then sang a song (a requiem, if you like) before leaving with the body, the women weeping as they did so.

Could we have done anything differently? I honestly don't know. Meconium aspiration syndrome +/- peripartum foetal asphyxia +/- ?occult subgaleal/intracranial bleed (no way of excluding it but no pupillary or limb movement asymmetry) = ultimately futile efforts. Of course, it's no reason to stop trying; in the end, God is the decider of our fates. Because, really, we all die one day. The question is when, where and how. Will we be ready when the time comes? Am I prepared to meet my Maker? At times, I can confidently say 'yes, Jesus, take me home'! However, I've to confess that my heart has also sought greener pastures that inevitably turn out to be gateways into the wilderness instead.

Jeremiah 2:13 "For My people have committed two evils: they have forsaken Me, the fountain of living waters, and hewn themselves cisterns - broken cisterns that can hold no water."

P.S. Regarding the pic, we had an unexpected appendicectomy a few weeks ago. A German missionary from another NGO developed appendicitis (in first trimester pregnancy, no less!) and we had the opportunity to host a visiting general surgeon for the procedure.