Things That Bleed in the Night

Things That Bleed in the Night

The month-long trip was almost over, and I still hadn’t been woken up in the middle of the night for any emergencies. Until tonight, that is… at 4:30 AM.

I don’t remember much until I got to the hospital, which was only about 50 yards away from the guest house where I slept before being aroused by a hushed, anxious voice calling to me from the darkness outside my screened window. I was needed at the hospital right away.

As I staggered out the door, adjusting my headlight and rubbing my eyes, I wondered what it could be. Whatever it was, it was probably pretty bad. Emergencies in Africa usually are. I mean, you usually get killed or die before making it to medical care or else by some miracle, you actually survive and present with some horrendous problem that could easily be a case report in Western medical literature.

I picked up the pace and rushed over to where I could hear voices and met a few people scurrying into the labor room. As I came into the light, my gaze fell upon a woman who I immediately knew was in trouble. I can’t remember if I said it out loud or not, but all I could think was, “She doesn’t look so good.” Her eyes were partially rolled back in her head, she was gasping for air, weakly, infrequently, laying in a puddle of her own blood. Her skinny abdomen was grossly misshapen for what should’ve contained an average, round, 5-6 lb African fetus. James was standing at her side, shaking his head and muttering over and over, “This is a catastrophe, a catastrophe.”

As we struggled to get functional IV access re-established, the story unfolded. She had arrived about 4 hours earlier in troubled labor. James had been notified, but with such incomplete and poor information that he’d sent the staff back to the hospital to learn more. They returned with more information… 4 hours later. In the interim, IV Pitocin had been initiated, but unfortunately this had only worsened her condition… a bleeding, ruptured uterus. She had been bleeding to death the whole time.

The thought occurred to me that if we ended up coding this woman, there was no more epinephrine in the hospital. This was followed by the realization that this woman was no longer breathing, and we still hadn’t gotten an IV. James quickly started running the code, and chest compressions were started while I got an IV in her external jugular. We considered intubating, but with no oxygen to administer, I saw no advantage in intubating over a simple jaw thrust to maintain a patent airway in a skinny Arab.

We had the monitor from the OR, and her pulse ox was reading in sync with the chest compressions. We couldn’t measure a blood pressure and there were no EKG patches to check her heart rhythm. Oh, and no epinephrine… not exactly a textbook example of CPR. Meanwhile, the husband, standing just outside the window in the cover of darkness, was asking why the baby couldn’t just be cut out if there were problems.

After a few minutes, I got the distinct feeling we were attempting to resuscitate the dead. On one or two occasions I remember thinking, “We should stop this… it’s just futile.” But I bit my tongue. I could see James was dedicated to trying his best to pull this one out of the jaws of death, and I just couldn’t bring myself to oppose the effort.

We took her to the OR, transfused multiple units of blood, tied off her uterine arteries, and poured in 2 packets of Celox to stop the bleeding. In the whirl of activity James remembered that there were some epidural kit trays sitting in the next room in storage, where we could find 1 mg vials of epinephrine to compliment the atropine I had already tried after moving to the OR. We shocked her with a defibrillator, but were able to see little activity on the EKG. Nothing helped. Two and a half hours after starting the code, we stopped.

The child inside her broken body was hydrocephalic and had spina bifida. The large, alien like head would never have been able to pass through her pelvis, nor have lived long, if at all, after being born. It looked like the Devil had taken us for a 2 for 1 special this time. We carefully cleaned off her blood stained body, covering it with the long, gold-threaded, silk cloth covering she had worn when she arrived. It was time to give her back to her husband. I wondered if he would understand what had just happened.

He met us at the door, in the early morning light, as we lowered her cold body onto the ground. I watched as the realization of what he didn’t want to know swept across his creased countenance, replacing whatever measure of hope and joy that I can only imagine a husband and father brings to the birthday of his first child. For once, I was glad I couldn’t speak Arabic. With the Arab he knew, as best he could, James told the story of the man’s now dead wife and son. The man slowly sank to his knees, uncovering his wife’s face to see the truth for himself, cradling her face in his hands. The other Muslim men quickly came to his side, responding to his call for water, as he washed her face and closed her eyelids with his hands. He then covered he again, and began to quietly morn and chant, rocking back and forth while kneeling, surrounded and consoled by his Islamic brothers.

As James and I walked away, I asked him if he knew what the man was saying. “He’s saying, ‘There is no God but Allah, Allah be praised.’ How many Christians do you think would respond like that if this happened to them?” We both knew the answer without saying it.