Couple of days back, we had a very sick pregnant lady
being wheeled in.
As DD was wheeled in, we were quite sure that we were
dealing with a very sick patient. She had been in labour for more than 4 days.
It was very obvious that she had been through a tough time. She was in a
terrible shape; all bloated up; the birth canal was so edematous. The baby was
obviously dead. The head was so high up and appeared to be stuck. The abdomen
had a very abnormal contour which is quite commonly seen with those who
sustained a rupture uterus.
There was a high chance that the bowel and the bladder
were all ischaemic because of the abdominal massage she had over the last 4
days. There was only a 4-5 centimeter diameter of the birth canal. Even if we
tried a craniotomy, there was high chance of severe birth canal injuries. There
was also a chance of a rupture uterus.
She was also in severe sepsis.
There was only one thing that we could think about . .
. to operate and remove the dead baby. The family were very very poor. They had
not even a single rupee to take. They had been to couple of other places. The
travel from their home to the various centres and lastly to NJH had taken up
all the money they had.
Considering the chance of a rupture uterus and bowel
injury, we decided to operate. On hindsight, the decision was a ill thought one.
The uterus was not ruptured. But, the lower segment was like mincemeat. Putrefaction
had set on the baby. On opening the uterus, there was a gush of pus and foul
The bladder was distended and edematous. So was the
bowel. There was no necrosis or ischemia . . . but it was obviously unhealthy
to look at.
I somehow closed the uterus and came out of surgery.
She did well for the first 24 hours. Then, her
condition just deteriorated. She was running high grade fever round the clock.
We had to hook her to the ventilator. There was foul smelling material coming
out of the uterus. Her urine output was fine, but it was getting bloody and
brownish. Her creatinine is about 6.
Today evening, she is all puffed up.
The costs of the treatment has been on the house.
However, we will not be able to give her high end antibiotics like
Piperacillin-Tazobactum. We helped the family arrange one pint of blood. We’re
quite sure that we would not get any payment for this patient. The family had a
RSBY card. We’ve blocked her under the scheme.
Over the last couple of weeks, we've been woken up quite a few days by . . .
Well . . . where did they come from . . . Another snap of the quartet getting ready to sleep . . .
The kids have a great time feeding and watching them .. .. ..
I hope you remember the 'turkey poults' that a fly-by-night salesman' sold me in January. I had been suspicious all the time. However, the guy had done a good job shaving off their necks and coloring their heads. He would have got them by paying some broiler hatchery worker for the roosters. The male chicks are usually killed in broiler hatcheries.
I'm not complaining though . . . In a couple of weeks, we'll have some good meat on the table . . . .