Junior Doctor's Diary: At 25, she will never give birth again
By Dr Kiaye Oliver | January 13th 2022
The cool winds blew slowly as the sun gently sank behind the hills overlooking our hospital to welcome yet another night. A night in which I would find myself deep in the intestines of the labour ward. Labour must be a challenging experience for women. The magnitude of pain attributed to it as described in Williams Obstetrics and Gynaecology makes it an experience that is only better imagined. The joy of holding one’s child in their arms perhaps is the only thing that makes women endure the misery, pain, and everything associated with bringing life on earth.
Esther’s* life was on the edge when she came into our hospital later that evening. She said that her labour had suddenly stopped, and she was feeling dizzy. Beads of sweat emanated from the glands beneath her skin, giving her face a shiny appearance as it reflected the fluorescent lights above. Her skin was rich in melanin, loads of it, and so you can imagine the shine. She was twenty-five and a newlywed.
When I examined her, her abdomen was unusual. An impression of a baby’s leg appeared on the right side of the umbilicus as I was stretching my hands to feel for contractions. The abdomen was silent, with no contractions at all. My heart jumped a beat; this was actually a uterine rupture! A pregnant uterus gets up to 700mls of blood per minute. It would take you just over 5 minutes to lose the whole of your body’s total blood volume if the uterine vessels were all open.
Esther was on the verge of circulatory collapse. No fetal heart was heard when we listened over her tummy. The bleeding from the rupture was getting out of hand, and the placenta, and so the baby was not getting enough blood. There we were, a doctor, a student nurse, and two lives, all on the brink of tragedy.
“Unipelekee hii lab saa hii, na uniletee results theatre,” I instructed the student nurse who was assisting me as I wheeled Esther to theatre. Maternity is the rotation that properly introduced me to medicine. As I have always said, a pregnant woman is and will always remain a ticking time bomb and must be treated as so.
The hot theatre lights shone brightly onto the abdomen. Faint kickings of the baby could still be seen over the mother’s tummy, giving us a little hope that life could undoubtedly be saved. As usual, I did my bikini line incision as quickly as possible. Esther’s incision site was unusually pale and devoid of flowing blood. We gently separated her abdominal muscles, and a baby’s legs kicked gently in defiance. The uterus was torn, and the baby had been expelled into the abdomen.
We removed the baby, cut the umbilical cord, and handed it over to the resuscitation team to try to do some abracadabra. Meanwhile, we scavenged the abdomen and tried piecing together everything that looked like a uterus.
The only remnants that bore semblance to a uterus were fragments of dead tissue and a cervical stump that stood proudly behind the bladder. The uterus had been slashed almost into two, with a few shreds of tissue floating freely in the abdomen. Confirming its presence as a survivor in a mass casualty was something the cervical stump took pride in.
This time around, I had scrubbed in with a consultant Obstetrician right from the start.
“Doc, we will have to do a subtotal hysterectomy,” he said with resignation, shoulders sagging awkwardly, he meant that we had to remove the uterus. The operation would last another hour, and it involved removing the remaining uterine tissue and closing the stump, which left the vagina a blind hole towards its end. No entry for sperms beyond that point.I am sorry, sperms. The gentle cry of the newborn reminded us that all was not in vain. I felt satisfied and accomplished, two lives saved, right from the jaws of death.
The monitors stopped beeping, and the theatre got deathly quiet, except for the occasional cry of the newborn and the distant sounds of matatu touts. The blood pressure and heart rate readings started showing signs of victory, and the nurses retreated with smiles all over their faces. Esther opened her eyes as we were getting done with the operation.
“Daktari, did my baby make it?” she asked faintly.
“Yes, it is a baby girl,”I said.
Deep down, I felt terrified, for I was preparing to have a deep conversation with her, that she would never be able to give birth again, at only 25!
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