Sunday afternoon surgery... and a sixth sense.

      I was on call this past weekend.  Sunday morning a lady came, in labor with her first child. Everything seemed to be normal except she had an elevated blood pressure. I don't know if it was only because she was in pain or if she really needs a controller blood pressure medication so I just gave her a one time dose of Nifedipine. She was dilated to a six and the baby's heart rate was 136 so I sent her back home with some prenatal vitamins and Tylenol for pain. 

     In the afternoon a 17 year old boy came to the gate with a "blese" (cut) - on his left hand. The fourth finger was totally cut off right at the base of his nail and the fifth finger was almost totally cut off between the knuckles. It was attached by a very small amount of tissue and some skin. The bone was completely cut through. We took him to the clinic to clean it and see if it was something we could fix or if he needed to go down to the hospital. Initially there wasn't a family member with him, just some neighbors. We needed someone to make the decision whether they would take him down to a hospital to find a surgeon to re-attach the finger or what they wanted us to do. The boy's dad was at church but he came to the clinic to meet us. We wanted to explain what options were available. The first option was that we would just put a bandage on his hand and they would take him to the hospital in hopes of getting the little finger re-attached. The second option was we would do what we could here- but that would mean partial amputation of his little finger also- we would not be able to re-attach it. The initial decison was to just do what we could here, and cut off that "piece" of his little finger but that decision was made by the neighbor and the boy's dad over the phone. We wanted to give them a little time to think it over so we used some lidocaine to numb his fingers and cleaned them really well then Jay went to talk with his Dad again. After some discussion, it was determined they would take him down to the hospital in hopes of re-attaching his finger so I worked on putting a bandage on his hand while Jay started to call hospitals to try and find one who would accept him as a patient. The first place he tried was a hospital that uses "Doctors without Borders" but they only accept major trauma and two fingers was not considered a major trauma so they would not accept him. The second hospital he called wouldn't accept him because they do not have a surgeon currently. Whether that meant they truly don't have a surgeon on staff or if they didn't have a surgeon because it was the weekend I don't know. So, plans change again. We do not have an accepting hospital and now Dad is saying "God will heal" his son, they don't have to go down. So we determine to do what we can here. We do have a small tool that is used to cut bone... I can't remember what it is called though. Over the course of the next couple of hours, we trim the bone and close the fourth digit at the knuckle- missing only about one inch of finger and the fifth digit at the knuckle also, but this one is missing over half of his finger, he only has about one inch left. He also gets a dose of IV Ancef, Zofran, and Tramadol. We send him home with 2 different antibiotics and motrin for pain. He came back this morning for his first dressing change. It looks pretty good so far but we are going to try to keep a close eye on it and have asked him to come back every morning for us to look at it and change the dressing.

     This afternoon after the clinic was closed for the day, a lady came to the house in labor. First baby, dilated to 8. Everything seems normal except the Mom's blood pressure is elevated. I was doing a house call when this lady arrived so Roseline and Chancela had checked her. Since it was her first baby it might be several hours yet but I think a sixth sense kicked in here. They decided to have her walk a while then they would check her again. When they checked her the second time, she was ready to push. After she had pushed a short time, I broke her water and soon a little girl was born. She was gasping around and had taken a few breaths and we were using the bulb syringe to help clear her airway. After we cut the cord, they took the baby inside the house and Roseline and I stayed on the porch to deliver the placenta. It only took a few minutes to deliver then Roseline went to get a clean pad for the mom to sit on... and she didn't come back so after a few minutes I went inside too. The baby was not breathing, she had taken a few gasping breaths but was totally limp and very pale and her heart rate was maybe 20 when Jay listened to her with the stethoscope. We were trying everything we could think of to try and help this baby breath. We had gotten a lot of mucous from her nose and mouth with the bulb syringe but she still was not coming around. We had held her by her feet and slapped her on the back, etc... S.L.O.W.L.Y... she was coming around. Her heart rate was maybe in the 60's and we were still getting mucous out periodically with the bulb syringe. But she was starting to pink up a little. We decided we really needed to get her to the clinic, now! At the clinic we have a suction machine, oxygen, and a bag valve mask. We did not have these options at the house. So, I take the baby- still wrapped only in two towels, grab the bulb syringe and head for the vehicle.  Jay runs inside to get the keys. Of course the gate is closed and locked and I head toward it but Brianna is already on her way with the keys in her hand so I turn around and get in the machin. The baby is doing better but still not breathing normally. She is trying to cry though. And, guess what... the machine will not start! The battery is dead. This lady came on a moto and it is right outside the gate. The driver is here somewhere. It is decided that the driver will take the baby and I to the clinic because his moto is right here and Jay will bring another moto. May I add here that it has been raining every day for over a week and the road is very muddy, and slick... Thank the Lord this moto driver seemed to know what he was doing. He drove safely but as fast as he could. I was very thankful because I was holding the baby in one arm and could not hold on with my other hand the whole time. I definitely was holding on with my legs though!😅 Monday is market day in Oriani and to get to the clinic we need to go right through the market. The driver laid on his horn and honked the whole way through market. When we got to the clinic I gave the moto driver my keys to unlock the gate then hurried inside with the baby. The "delivery" cart is kept in the pharmacy so I went to get it first thing and hauled it and the baby into my exam room. I plugged in the suction machine and had part of the tubing to perform deep suction but was missing one piece. By now I am not as worried about the baby, she is crying but still has a lot of secretions. Jay gets there then and gets the suction set up and we deep suction her several times, still getting a lot of mucous out. I checked her heart rate after suctioning her. It is 160. Much better! She is pink now too. Jay had brought the mother on his moto so we get her in the room now also. She had been waiting outside. We monitor them both for a short time and try to get the baby to breastfeed. She doesn't do too well with that yet. We sent them home probably 20-30 minutes later- after discussing that in the U.S. the events of the last hour would surely warrant at least an overnight NICU stay. I firmly believe if we had sent that lady home to have her baby the baby would not be alive... Thank-you Jesus!