Saturday morning begins with hospital rounds with the residents. We see every patient in the obstetric department and discuss how they are doing as well as future treatment plans.
I go and see a private patient who had a cesarean section several days previously who needs to be discharged. This is a nice visit interrupted by a call from the labor room.
I return to the labor room, and we decide that one of our patients needs an urgent cesarean section for signs of fetal distress on her monitoring as well as for the fact that she is not opening or dilating her cervix at the appropriate rate. I send the medical officer to do this cesarean section while I hang close in case he needs some help.
I am called again to the labor room where another mother’s infant monitor shows prolonged and late drops in the infant’s heart rate which indicates probable infant distress. We decide to do an emergency cesarean section, which is in truth more urgent than the one that is going on currently. There is not an option for a second room, so I scrub into the first surgery so that it can finish faster so that we can proceed with this now more urgent operation. At the end I ask for staple so I can close the skin faster and we can more quickly have the room ready for the next surgery, but for some reason the surgical staff is reluctant to give them to me. They want us to close with a skin stitch which takes much longer. I argue then for a second room that we can start preparing the next surgery while the skin is closed on this first operation. They concede a second room, and I am so thankful! Every minute counts. We do this operation very fast! The baby is OK!
As I walk out the door of the operating rooms and into the delivery rooms I am pleased to be a part of a nice vaginal twin delivery (or was this another day – it gets a little blurry!)
I am glad to rest at home for a little bit, but I had to call Allison to come to the hospital with an umbrella because it started raining thunderously just as it was time to head home. Thank you, Allison!
I am so lucky to be home to see the eruption of the flying termites.
I run in for a emergency cesarean section for a woman with preeclampsia (severe, complicated high blood pressure during pregnancy) who is also 33 weeks pregnant. She was being induced to delivery to cure this severe illness (it is the only way to cure it, and if you do not manage it well you can have both maternal and infant death in the very worst case scenarios) and the baby is not tolerating the labor well. We rush her back for emergent surgery and the pediatric team is ready to help with the infants as needed! I finish just in time to . . .
I run up the hill to the Junior High Band concert from the hospital, arriving just in time!
I return to the hospital at 3 in the morning for twin delivery in which the second baby is in a breech (bottom first) presentation. Both babies looked great!
I go home to rest again
On Sunday morning I return for a woman in hemorrhagic shock (a type of low blood pressure from overwhelming blood loss) who delivered in an outlying hospital but then had a retained placenta which caused her to have massive vaginal bleeding after her delivery. She is stabilized in the ER where she receives 3 liters of intravenous fluid to recover her blood pressure, and we take her back quickly for emergency dilitation and curretage to remove whatever has been left in her uterus causing her to have this massive amount of bleeding. During the procedure she begins to have signs of instability again, but stabilizes with more fluids and blood. A lot of retained parts of placenta are removed manually.
I return to the labor ward just in time to help a mother at full term pregnancy with a prolonged pushing stage of labor. This has led to the infant again showing signs of distress. I cut my first episiotomy in years (fundamentally I am opposed to episiotomies as they can cause worse tearing of the vagina compared to if things are just left alone), and I place a vacuum to assist the delivery. The infant has a very tight cord around the neck that tears as it is reduced spraying blood everywhere. The baby is OK.
I finally do Sunday morning rounds on the patients.
I go home and realize Allison is sick and has been in bed all day. A nasty stomach bug is making the rounds through Rift Valley Academy and among the missionaries of the hospital. I had it last week. I find her some medicine and administer it.
Because the nursery has filled up with sick babies, we have to transfer out a 29 week pregnancy whose amniotic fluid sack has ruptured. She is doing well, but if she delivers now her baby will not survive because we are out of incubators.
I see another patient with vaginal bleeding and severe uterine pain two days after an elective repeat cesarean section and start her on antibiotics for presumed uterine post-operative infection.
Thankfully, I sleep most of Sunday night with only a few phone call consultations.
On Monday morning the boys and I head to Nairobi for teeth straightening appointments.
During all of this there were normal deliveries going on in the background in which I did not have to be present, but I was aware of them. They all went well! Sadly there were also some routine miscarriages, but everyone else was stable. Overall I think it was a good weekend.
Other things of note during my nights on call. Allison kicks me out of the bedroom because there are so many phone calls that you cannot sleep well. So I sleep on a mattress on the living room floor.