Saturday, January 15, 2011

A night to remember

Somewhere in early 2007,I don't remember the month or the date there happened certain incident or you can say series of incidents which I think helped me immensely in me developing my current mental attitude.

There was this third time pregnant Lady in the antenatal ward of my the then Hospital in United Kingdom.She had two normal deliveries in past and this time was in early labour.The labour room midwife informed, Dr Dwivedee ,xyz was having  foetal distress and she was being shifted to Labour Room.

I assessed the Lady and she was already about 8 to 9 cms dilated with decreased foetal heart rate.I gave her the option an instrumental delivery as she was progressing real fast.I don't know what struck her and she declined to give a consent for the same and wished to have a Cesarean section.I tried to reason out for couple of minutes but then I had to take action fast.Didn't want to give a depressed baby.So she demanded CS and CS it was under General anaesthesia.Baby came out fine.I started closing the uterus and realized that at one particular place there was no spurt of bleeding but despite spending almost 5 minutes to control a small little ooze I wasn't really satisfied.Consultant on call was requested to come.When he arrived and inspected he said' a small ooze.We will win it'.Almost 2 hrs later still that ooze was still very much there despite many stitches by my consultant.That's when I could see glistening sweat drops on his forehead.I suggested do we call the senior most consultant and to which he said a prompt yes.The senior most consultant arrived and by that time the Lady was already in DIC(Her blood wasn't clotting).She had started to bleed from all over the place and one point of time her blood pressure was just 15mm Hg.I was already imagining her figuring in next confidential inquiry .There was another lady fully dilated in occipitoposterior position since last 4 hours.Head consultant asked me to go and conduct a ventouse delivery on her in the meantime as they struggled with that lady.As I was descrubbing I suggested 'Maybe we should involve a cardiovascular surgeon'.They agreed.By the time I was back cardiovascular surgeon was there. Not a very confident one but surely better than us.
By that time a consent was taken to remove the Lady's uterus which was no longer contracting,had become atonic and was blocking the whole operative field as now the lady was bleeding from all over not just uterus.
We kept on struggling overnight and after 7 hours of surgery and 35 units of blood , she survived.
Next night was again a night shift for me.Whole day I had a disturbed sleep where I was just seeing blood all over.A doubt in mind,how will others take?After all I am an overseas doctor.Not one of them.May be I will be the one who will be blamed.Anyways at 8 pm again I reached for my night shift.I got a call from Mr Plemming ,the consultant on call for that day and also the consultant under whom this ill fated lady was booked in clinics.
He asked if,how I was and then he said well done!! you managed the case very well.Though few midwives gave me a different story but the senior most consultant was all praises for you.I started feeling a little better.But any such unexpected incident leaves you and you confidence shaken.A self doubt creeps in.I was trying to help myself come out of this emotional trauma which I had suffered the previous night.That night turned out to be a very busy night.I ended up performing 4 cesareans and 3 instrumental deliveries.Usually registrars used to call the consultants after 2 lscs in a night to help them out.I was determined not to.This was my way of helping me get my confidence back in which Mr Plemming helped me immensely.When I informed him 3rd time in night about a patient needing Cesarean he asked me,Dr Ddwivedee you had a horrible night yesterday and today its so damn busy where routinely registrars call for help.Do you think you can handle it safely?I said very firmly - yes Mr Plemming and if I need your help I will call you.he relied on me,gave me the chance to gain back my shaken confidence.Today,I find that, these 2 nights contribute highly to the mental strength I have today to face adverse events.
The case of Mrs XYZ was audited within a weeks time.I was asked 'why didn't I give her an option of forceps under General Anaesthesia'?In hind sight every one can give you various options but it is only the one facing the situation' then' knows 'being so wise is not easy.'
As far as Mrs XYZ ,she survived and recovered well.Was out of ITU in a day.Discharged with 4 to 5 days.She realised that she shouldn't heve asked for an unnecessary Cesarean.But what she didn't realise was my trauma and my efforts to recover from it were no less than her efforts to recover from her morbidity.

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