 | Pretty evening tonight after a beautifully sunny day - with the rain and the clouds and the part-sun still out. A few more stories from call, and today. I slept from about 1:30 am until almost time for devotions at 7:30 this morning, and a welcome sleep it was. That's our guest house on the right of the picture, with the porch that has clotheslines strung under it for the rainy season. It's raining; a fine misty drizzle, and the evening sun is behind me - over the mountains. Dinner was fresh-grilled pineapple and pork and brown rice and baby carrots in margarine and brown sugar. And the rest of the pineapple was eaten fresh. Miriam and I picked lemons off the tree (and the ground around it, which is where ripe lemons are found) and we made lemonade. Had the feeling that maybe I was being reminded of the delicate wonder of creation. It's been an up-and-down few days. |
Last night after a quiet afternoon I got a call around dinnertime - "I've got two ladies here, I need you to see them." So I loaded up the Tracker and headed up to the hospital. Patient is a G3P2 with 2 previous c-sections, complains of contractions every 4-5 minutes. I scan her for dates - 38+3 by LMP and 37+3 by my ultrasound, pretty good dating for around here. She's not really contracting while I'm in there, and it's after hours. I call Susan. We talk about it for a bit. We decide to do the C-section...and then she calls back. "You know..."
I want to do this with you, but it's not really cost-effective to bring in the on call staff for a non-emergent c-section...is she really in labor? And the answer is "not really", honestly. Her contractions are spacing out, she doesn't look all that uncomfortable. And so we put the patient on subcutaneous salbutamol (that's albuterol, for the US folks) because there's no such thing as terbutaline here, and they're all the same thing really, and I wrote orders for it to be given every 6 hours and to prep her for a morning c-section, and I went home.
This morning was devotions, and at the end of the devotions was tok save, and Jim stood up. "We only have a handful of flasks of IV fluid left. Please only give IV fluids to people who truly need them. Nurses, do not hang another flask without a doctor's order." And I cornered him. "You want.." Yeah, how long can you hold the section? Two days? "No contractions yet. I'll keep her on the tocolytics." And he nodded. If she goes into real labor, we'll deal with it.
And then there was the matter of the tubal ligation consent. Under most circumstances, the third c-section on a patient is considered an indication for tubal ligation, and patients are counseled that without extenuating circumstances (dead babies, new husband, etc) they'll be asked to sign a consent for tubal at the time of consent for c-section number three. However. There's a law in PNG that states that unless it is a life-threatening emergency, both the woman and her husband must sign the tubal ligation consent. Patient's husband absconded in her third month and hasn't been seen nor heard from since. And, if he did come back, she wasn't sure she wanted him back. "He's not a very good husband. I just married him because it was better than being single." But the law exists, and he could come back and sue the hospital for performing a tubal without his consent.
Sister Sylvia brought me a bilum that is pink and green. Plenty big for all my stuff. A gift, she insisted. And she cornered me: "This patient, the C-section. She lives in Hagen. You want we should send her to Hagen for her section, since we don't have IV's?" And three hours and a few phone calls later, off she went to Mount Hagen to get her affairs sorted out at some other hospital, which is quite possibly the best thing that happened regarding this whole bizarre affair.
Today I also learned how to use the vacuum affair here, which is an old-fashioned glass bottle vacuum pump attached to a metal cup with a chain on it. Most impressive. I also got a new stethoscope, since the one I had borrowed didn't have a diaphragm on it, rendering it a tricky bit of business to use at all. Unfortunately, I also got to use my new stethoscope to confirm time of death on one of our NICU babies. She's not in the picture post; she was one of a new set of 33-ish week twins, birth weight 1200 gm, the smaller twin. She wasn't looking so hot this morning and then I got called emergently out of outpatient clinic to come code the baby. We did compressions and bagged for a few minutes, but it was pretty much futile - what are we going to do for life support if we did get her back? So I did what I have come to see as my most important code duty: I prayed for the baby and the mother and the family. There doesn't seem to be much more that I can do in the face of death around here, and that's hard.
She doesn't have a name - just "Baby of Lucy, twin two". That's the way of newborns around here.
Last night, stitching up a chop-chop in the ER (wife one got the better of wife two with a bush knife), I was busy closing two-layered wounds and irrigating with iodine when I noticed a little commotion behind me - a car pulling around the circle drive with flashers on, security taking the gurney out and bringing it back in, a whole lot of people crowding into my already crowded ER thick with friends and in-laws and interested security men and police from Banz. I looked over my shoulder at the ER nurse (only one!) pressing a stethoscope to a man's chest, amid a rapidfire hum of Tok Pisin. "Arrest?" She nodded. I need your help. I stripped off my resterilized latex gloves and took powder-covered hands to assume the correct listening position. Nothing. His skin was waxen cold, lips pale. Not moving. Not breathing. Heart not beating. She checked his pulse (why do they check at the temple?) and shook her head. "I think he's dead." I concurred, but we spent some time looking busy, examining him. Getting out the flashlight to look at pupils. When someone brings a dead man to the emergency room, you don't just shake your head and leave.
There was surprisingly little wailing. The whole family bowed heads to pray, and they thanked me. Shook my hand. Bundled up their dead father/brother/cousin/uncle and took him back where they came from. And I got out another pair of gloves and went back to stitching, three feet away. Sometimes, it's just surreal.
| Got out of the ER last night around 1 AM after all this suturing and coding and business, and went to get into the Tracker. As you can see to the right, this truck is nothing like my two-door Honda coupe; the step to get into the driver's side (on the right) is somewhere the height of my knee. It's also a diesel, which apparently means that I have to wait for the coil light to go out before cranking the beast (news to me). Anyway, I got in and turned the key like always and the engine went wurrwurrwuh. Repeatedly. Security hiked over. "Won't turn over." He asked me to try a few things. Wurrwurrwuh. Hm. There was a lot of discussing and then a large man walked over. "This is a police captain at Banz; can he try to push-start it?" I handed over the keys, and the police captain got in, and about six big men got in front and they pushed it backwards for about ten feet and wurrwurrROWR! went the engine, and it started chugging along once again. |  |
Appears that the creature in last night's post was in fact a cicada. It was still there this morning, but disappeared during the downpour this afternoon. Pretty bug, in a creepy sort of way.
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