Tale of 2 Anaemic Patients

Yesterday was my first Sunday first call duty of the year 2013.

Early morning, I was informed of a very complicated patient in the labour room. LD, a 26 year old lady has been in labour since Saturday early morning. She has been running from hospital to hospital trying to get some help. The problem was that she had a hemoglobin of 6 gm% and nobody was willing to take her. To make matters complicated she had been given injection pitocin elsewhere. She had a pregnancy couple of years back. The baby had died just after childbirth after she had attempted a home delivery.

She was O positive. Dr. Johnson tried to arrange some staff to donate when she reached late night on Saturday. Unfortunately, we do not have many staff with O positive blood group. There was only one option. Either the patient had to be referred or we had to do the surgery with a consent to do without blood which was not a easy choice. The family having had visited quite a few  hospitals before entering NJH had already spent quite a lot of money on her ‘treatment’. So, the question of going to Ranchi was totally out of question.

However, we decided to wait for blood to come.

It came . . . by around 11 am on Sunday morning. It had been a full 33 hours since she had been in labour. And she was into obstructed labour.

I opened and found the worst I had feared. The uterus had ruptured. The baby was alive but quite sick. The endometrium and placenta was grossly stained with meconium. The baby died by evening. LD lost quite a lot of blood. She is on the ventilator and fighting for her life.

As we were doing LD’s Cesarian section, rather laparotomy, in came SeD.

Frighteningly, SeD also had a history similar to LD.

SeD was brought by her parents. Her father, a wizened old man who had quite a lot of creases on his face was a sorry figure.

The history . . . SeD had also been in labour since the previous day. The family had been to many hospitals. She was also told that her hemoglobin is 6 gm%. And her baby was in an abnormal position. The nurses could not get the fetal heart. I was in a hurry.

I told them to push SeD into the ultrasound. I had a cursory glance at the fetus. The heartbeat was going strong and was a footling breech. No other choice than to do a Cesarian section.

I did not think twice. She was B positive. I send word to 2 of our staff requesting to donate blood. SeD was having very strong uterine contractions. I did not want SeD to end up with the same outcome as LD. Ebez George, our Project Officer and Dr. Basil, our Dentist were were happy to donate.

We did the Cesarian in no time. To my surprise, SeD had a twin pregnancy. Mother and babies are doing well. I had missed that in my ultrasound screening.

I wondered why we did not have a staff with O positive blood who could help LD and her baby. They would have done better. The baby would have been alive.

But, a terrible thing happened later. I went to see SeD’s father. He had narrated to me SeD’s sad story. SeD had also delivered 2 years back, but the baby had died soon after her home birth. When SeD got into her present pregnancy, SeD’s husband took her and left at her parent’s home and told them not to send her back if she did not have a live baby this time.

I was congratulating myself as I saw SeD’s father standing at a distance and was happy that I had good news.

I could only watch with horror the pain that SeD’s father’s voice echoed when he came to know that his daughter had delivered twin girl babies. The creases on his face becoming deeper as he pondered aloud, ‘Doctor saab, I wonder if SeD’s husband would come to take her back with the 2 girl babies’.

Please pray that LD would recover well and SeD’s husband feels proud to be the father of 2 daughters.