A miracle . . .

We've had couple of setbacks last week in obstetric care. And I was quite wary of one more bad case. 

Yesterday, we had a 40 year old, mother of four who came in at term. 

MD was in the last week of her pregnancy and had been bleeding for almost a day. She was taken to one of the primary health centres from where she was referred to Ranchi. 

They reached here at around 3 in the afternoon. 

It was a nightmare. A grand multipara at 40 years with Hemoglobin of 4 gm%. The baby was dead. There was blood dripping from her uterus. 

I could only think of all the possible complication . . . all of them which would only ensure her death in a set-up such as ours. 

And we did not know the full history as she was being managed elsewhere. 

The uterus appeared quite flaccid without any hint of getting contractions. 

We talked to the relatives. We needed at least 4 pints of blood. And we were not sure of what all complications she could end up with. 

The husband had about 2000 INR with him. Not enough to even get a vehicle to go to Ranchi. 

We could only pray and request prayers. 

We called up one of the people in government health services and told about my predicament. He informed the concerned people and got about 3 pints of blood arranged. We sent the husband to Daltonganj to get the blood. 

My plan was to do a Cesarian as soon as the blood arrived. 

Late in the night, Titus found the husband sitting in front of the hospital. The vehicle he went in to Daltonganj broke down and he returned. And he looked quite resigned about the condition of his wife. 

However, the lady went into spontaneous labour early morning today and delivered the dead baby. Our guys did a great job ensuring that she did not bled much. The placenta had separated early (abruptio placenta) which was responsible for the ante-partum hemorrhage. 

She's alive . . . and the husband has returned with 2 pints of blood. 

We thank all those who prayed. 

We don't see much cases where a patient has severe antepartum hemorrhage, a hemoglobin of around 4 gm% and later delivers normal.  

Enough for a day . . .

It has been another of those days . . . the outpatient work is light . . .but we have a busy emergency room . . . 

We started off with a young man, PD with snake bite - most probably a krait. Having been bitten at around 9 pm, the previous day, he arrived after about 4 hours of black magic and then 5 vials of Anti-Snake Venom. They came here as there was only a maximum of 5 vials which his well-to-do family could procure in the neighbouring district headquarters. 

He was brought in gasping. We pumped in another 20 vials of the anti-snake venom and hooked him onto the ventilator. 

Then, there were couple of patients with eclampsia for whom we had to do Cesarian section. Mothers and babies are doing fine . . . Then there was a lady brought in with post-partum hemorrhage about whom I will narrate in my next post.

Soon after lunch, we had a troop, exactly 3 women with post-partum eclampsia. The first two did not have much of a problem. The one I want to narrate is the 3rd one. . .

MD, the lady with the post-partum eclampsia came at around 8:30 pm. 

The feeble gasps were the only indication that she was alive . . .No pulse or measurable blood pressure. The heart was in its last throbs . . . And she was all puffed up . . .

Dr. Titus had her intubated only to discover to his horror that she was as pale as paper. . . Must have had a hemoglobin of 1 or 2 gms% . . . She suffered a cardiac arrest in no time. There was no point resuscitating. . .

Titus called me up to tell about the death. He could not find the Institutional Maternal Death Review Forms . . . I thought of going and seeing the unfortunate lady . . . 

She was so pale . . . Tribal motifs tattooed on her arms and neck were very conspicuous against the paper colored skin . . .a Kherwar. One of the most backward tribes in the country. They live in terrible poverty. I'm not sure if anybody has researched much into them . . .

The family hailed from a remote part of Latehar district. She had never ever been to a doctor in her life. Both her previous deliveries had happened at home. The husband . . . a wizened young man with blood shot eyes and a stunted frame looked all confused and lost . . . He and the other relatives had no idea about what had happened during the delivery which had happened couple of days back. . . 

She had thrown a fit today early morning. After having been subject to few hours of 'jhad phuk' (witch-craft), they decided to bring her to the nearest district hospital. The doctors told them to bring her to NJH . . . 

It seemed that as she was brought into the NJH emergency, one of the relatives asked Dr. Titus whether anything can be done here. There was nothing much left to be done . . . 

It was a pathetic site to watch the hospital attenders bundle up her body and carry it back into the vehicle in which she came . . . Came in at 8:30 pm and was dead at 9:20 pm. She may have made it if she was brought in the morning . . .But, who knows if we would have got the blood needed for the transfusion . . . 

We do not know what caused her to be so pale . . .  None of her caregivers during the delivery had come. Maybe, she was anemic much before . . . Or she had bled during the delivery. Nobody knows . . .

As I left the ACU, the young man with the snake bite, PD was still on the ventilator. . . I hope he will be up and breathing on his own by tomorrow morning. . . Well, we've had a long day . . . And I've quite a lot to do before I leave for our Governing Body meetings somewhere in the Corbett National Park starting next week . . .