Have we been quick enough?

It is 7am in Chaaria and I am called urgently from the chapel where I am attending Mass.

“There is a case of cerebral malaria in a pregnant woman at term. Patient is gasping. Please, come quickly”

Actually I have really jumped out of church and run to the hospital, in spite of my age already a bit mature.

The lady was in the labour room and the night staff had already done a lot: we knew that malaria slide was positive because of a test done in a rural dispensary. The HB was good at around 12 grams, while the blood sugar was really low: the nurse on duty in maternity had already given her a bolus of dextrose 50%, while now a drip of dextrose 5% was running into her veins.

She was really gasping, the blood pressure was nose-diving and the heart rate was slowing down rapidly: “give adrenaline, add hydrocortisone, and prepare a second drip with half ampoule of ephedrine.  Put a catheter to monitor the urine output. Keep checking the blood pressure”.

But the monitor unfortunately indicates that the heart is not gaining speed, in spite of all our resuscitation attempts; on the contrary slowly it stops biting completely, together with the disappearing of the last gasps.

I start shouting: “Cardiac massage; please, ventilate with ambu bag; quick, quick”.

Meanwhile one staff is monitoring the fetal heart rate and keeps telling me: “fetal heart is present but it is slowing down”.

In the confusion of the moment, I answer: “what do you mean by that; of course there must be fetal distress because the mother is nearly dying, but we are trying our best with the resuscitation”.

At this point she calmly shows to me a scalpel and she says: “she is actually dead; the monitor indicates that there is no heart activity… but if you delay, also the heart of the fetus will stop for sure”.

I get her point immediately and I open that abdomen there in the labour room and of course without any anaesthesia.

I extract a female fetus, still breathing but in extremely poor conditions.

We start now the tensing maneuvers of infant resuscitation: the heart is slow; the breathing is difficult. We continue relentlessly for long time, but after few hours also the new born passes away.

The young woman was killed by malaria; was the baby killed by congenital malaria only, or maybe my short indecision in doing the caesarean section on the dying mother may also have contributed?

It was a matter of seconds, but…only God knows.

Bro Beppe Gaido

PS: la foto si riferisce al post di ieri. La persona che vedete nella foto è la dottoressa Nadia Chiapello che da tanti anni mi aiuta con la preparazione delle lezioni.