Saturday, 8 June 2013


When I arrived on D-ward one morning this last week, Sister Wari pulled me from the nursery where I usually start rounds.  There was a critical patient in the delivery room...

Rebecca had delivered her first baby the night before.  The baby was born without a heart beat and was not able to be resuscitated.  He died before taking even one breath.

But the tragedy didn't end there.

Several hours after her delivery, Rebecca began to bleed heavily.  She was given all the right medicines to help contract her uterus and stop the bleeding.  But it just kept coming.  The doctors were called in, more medicines given, a balloon placed in the uterus, lacerations repaired, and five units of blood transfused.  By the time I arrived in the morning, her condition had worsened.  She started to bleed again.  She had no pulse or blood pressure, no urine output.  Rebecca was in shock.  And we were in a fight for her life.

I began barking orders:  "Start another IV.  Get that fluid running in fast.  She needs more blood. STAT!!!"  I found some dopamine and started her on a drip that brought her blood pressure up.  It was still low, but at least she had a pulse.  We gave her a couple more units of fresh blood, including one of my own.  Dr. Jim was consulted.  He replaced the uterine balloon and then took Rebecca to surgery to re-repair her lacerations.

Things were touch and go overnight, but by morning Rebecca was starting to perk up.  I stopped the dopamine and her blood pressure remained stable.  We removed the uterine balloon; thankfully she didn't start to bleed again.  Follow up labs resulted later that afternoon.  I was more than happy with a hemoglobin of 9.5, which means we replaced her entire blood volume with transfusions.

My biggest concern is Rebecca's renal function.  Shock had left her kidneys without blood and oxygen for too long.  And now they are failing.  Creatinine has increased from 1.9 to 5.5 to 9, and it may continue to go up from there.  Unfortunately there isn't much we can do for acute renal failure--no medicines to jump start the kidneys, no dialysis to take their place.  Time will tell if they start to work again on their own.  We will just have to wait and see if our patient is going to recover.

Rebecca was transferred to surgery ward where Dr. Jim is continuing to care for her.  Her overall condition is much improved.  In fact, she looked great when I stopped by to visit her this morning!  But looks can be deceiving.  Rebecca needs a miracle.  I am asking the Great Physician for His healing touch upon this young woman.  Will you join with me in praying for her?

"Is anyone among you sick?  Let them call the elders of the church to pray over them an anoint them with oil in the name of the Lord.  And the prayer offered in faith will make the sick person well; the Lord will raise them up.  If they have sinned, they will be forgiven."
~ James 5:14-15

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