I think I'm beginning to develop a thirst for blood and guts, which is why I asked to do a Saturday night guardia. I was promised blood, guts, and babies and that promise was kept. We were up to our knees in births starting around 10PM last night, with a total of 3 normal vaginal deliveries and one that I will never forget.
Around 11PM while we were tending to a knee injury (about a 4 inch cut, deep enough to see the aponeurosis), we were interrupted by screams of a pregnant woman crying that her water had broke. Immediately we rushed her to the sala de partos, fixed her in a bed and screamed puje, puje! The woman pushed, and to our horror a small arm started to emerge from her vagina. The doctors gasped, backed away, and someone left to find a hospital in Quito that would accept her for an emergency cesarean. Dr. San Pedro, the doctor attending the birth, sighed, looked at me and told me that this is one of the worst things that can happen in a delivery. With each contraction the baby's shoulder and torso would be pushed down on the umbilical cord, asphyxiating the baby.
If this had happened in a private hospital in Quito, or if we had been in the States this would still be bad news bears. But this dangerous medical emergency was compounded by the fact that we didn't have the staff or the equipment to do a Cesarian in the madrugada of a Saturday night. Instead the baby would have to suffer the hour long trip to a bigger hospital in Quito where they could preform the surgery. I watched the seemingly lifeless arm coming out of the mother's vagina as they attempted to find the fetal heart rate with a doppler to no success.
"Un mil lo sientos señora, one thousand I'm sorries, ojala que su bebe vive, I hope that your baby will live" said Dr. Favio to the mother, who seemed to be in no distress at all. "This is a very grave situation señora, do you understand? It is necessary to get you to Quito as fast as possible or else you will lose your baby" Dr. Alvero explained. No response. She had said before that this was her second child. After being asked again she said it was her third. It wasn't until she got to Quito that she admitted it was her ninth child, and she had not received any prenatal care past her second month despite the fact that it is completely free in this country. One visit to an obstetrician could have prevented this unfortunate circumstance. With one ultrasound or with the maneuvers of Leopold the doctor would have easily known that the baby was in a transverse lie, which can be corrected in the clinic. Instead Dr. Favio spent the trip to Quito with one hand in the woman's vagina to prevent fatal umbilical cord prolapse.
The baby made it, by some miracle. Luck was on its side that night.
At the same time that light was being given to newborns last night, one went out. A 24 year old boy came in with a deep chest wound to his left side which punctured his lung. When I got out of the last birth and returned to our humble 10 bed emergency room (literally a room with 10 beds) he had a Glasgow score of 6 out of 15 and was being kept alive by manually pumping oxygen into his lungs. His heart rate was 34 and dropping. They fed him some epinephrine which made it spike to 60 but then drop immediately back to its starting point. Finally it was decided that there was nothing more we could do for him, and the doctor stopped giving him air. He explained to the boy's mother that they had tried their best but he was not going to make it. The mother started shrieking, blocking the doctor's exit from the side of his son's bed and begging him to continue but the doctor refused. Other family members came in and were stricken with the news that the boy was dead. "Levantate levantate, get up get up!" his brother screamed. Grief soon turned into anger. "You killed my son" the mother screamed in the doctor's face. "No, THIS killed your son" Flavio said as he ripped off the makeshift compress they made over the 5 inch stab wound. It was such a tragic scene. I couldn't help but think of the irony of just giving life to 3 babies as one was going away. I'm not a very religious person, and usually not a very corny person either but I hope that this boy found his light as well.
So much commotion for our humble hospital in one night. I am back again tomorrow, hopefully I will have more stories to share.