Emergency call

It is 5.15 am when the telephone rings. Immediately we recognize the number of Kaongo Health Centre and Maternity: “We have a client with hypertonic contractions and possible breech presentation. She is not cooperating and we fear to have her here”.

“We are coming now, wait for us!”

There is no electricity and it is a bit tricky for Bro Giancarlo to organize the necessary in the ambulance. He is also a bit nervous because it has been a rainy night and the road will be probably very slippery.

In spite of all the odds, he manages to go and come back in 45 minutes.

We receive the patient in hospital immediately: she looks in great pain; she is extremely restless and sweats profusely.

The first thing to do is an emergency ultrasound to find out exactly about the presentation and to ascertain if the fetus is still alive.

Being on solar panels only, for the running of the ultrasound machine we use the u.p.s. unit which allows us about 20 minutes of power: the presentation is breech and the fetal heart is irregular and slow.

“We must be quick and prepare for caesarean section”

While the night staff of the maternity department prepares the patient, the membranes rupture and we notice thick meconium.

“It is a very severe fetal distress. Hurry up with the preparation. The excessive contractions and the extensive sweating make me fear even a possible rupture of the uterus!”

We set the new theater which has a backup generator already running.

I am the only anesthetist, because it is still very early in the morning.

The spinal is very difficult because the patient is restless and moves continuously while she gets strong contractions. Fortunately I manage to enter in the intervertebral space with my needle quite quickly and I inject the anesthetic drug.

In a moment the mother becomes relatively calm and the contractions stop.

We can start the operation: the disinfection of the skin and the draping of the patient are done at very high speed and we are able to extract the newborn baby in less than 3 minutes.

The operation itself has no much problem: there is no excessive bleeding and the woman is stable from the anesthesiological point of view.

But I am not at peace.

I keep checking at the neonatal coach where the nurse is struggling with ambu bag and oxygen. I continue stitching and completing my operation, but my heart is heavy because I don’t hear any cry from the child.

It is only when I have already stitched the skin that I realize the truth: in spite of all our efforts, we have been late!

Yes, the mother is safe, but the child did not make it.

I take a stethoscope and I listen to the chest: no heart bits and no breathing sounds.

I feel really depressed: we have rushed to Kaongo immediately; we have not delayed the operation… but the child is not with us.

Now in front of us there is the terrible duty of informing the mother of her loss: it is too heavy for me, and I ask Susan to do it on my behalf.

Medicine is like that: even when you have done whatever you could and honestly you believe that you have done nothing wrong, sometimes the outcome is very different than what you expect.

May God accept that little angel in his eternal peace, and may He give consolation to the parents.

Bro Beppe Gaido