I thought I was having a hard day...

I thought I was having a hard day. I actually did. The original title for today's blog was even “A hard day”. Well, God had a lesson for me today. The people having a hard day were my patients. I was having the day I was supposed to have, helping them the best I could in very difficult circumstances. Perspective is sometimes hard to obtain. You have to be hit upside the head some times before it really sets in. Let me tell you about it.

The day started out well enough, I ran 8k and I actually got all the way through. After that is when I

started to have perspective problems. I went to do rounds this morning, and noticed an empty bed where there was a very sick patient yesterday. I asked about it, and they said she died in the middle of the night. Granted she was very unwell, and had almost died before she came to hospital, but I was hoping we could slowly get her better. This was not meant to be I guess. You hear the statistics about the maternal mortality rate, but seeing it for yourself is a whole different level of appreciation. I did not even get all the way through rounds and one of the midwives called me to see a patient who had come in with labour pains. She had had 2 previous cesarean sections and the midwife could not find a fetal heart. The ultrasound showed in fact that the heart was not beating. Because of the two previous cesareans

we had to do another cesarean to deliver the baby to avoid any chance of uterine rupture. We don't have the same type of monitoring equipment here, and any attempt to push boundaries and try to deliver vaginally usually ends up in a (worse) disaster. So for the first time in my life I did a cesarean on a patient who I already knew had a dead baby. At surgery it was clear that the baby had died more than a week ago. It was perfectly formed and just looked like it was sleeping. The only silver lining is that she has 4 children and that the uterus looked intact so she can have more if she wishes.

I was telling myself to look on the bright side, my two hysterectomy patients from last week were looking well and should be going home soon. We keep them in longer because they don't tend to come back unless they are almost dying (literally) and the practice here is to put stitches in that have to be removed (not dissolving) so that they will come back and have their incisions inspected. I guess that is what you have to do to make sure there is follow up here.

Then I went off to morning clinic and was seeing patients that are routine for here. A lady 37 weeks along in her pregnancy that hadn't seen a doctor yet. I think she was 37 weeks, measurements are not accurate at this point in the pregnancy. A lady at 33 weeks who had come in saying she was incontinent of urine. Again first visit, and again approximation of weeks pregnant based on an ultrasound today, but I noticed there wasn't a lot of fluid around the baby, and sure enough doing the Speculum exam it wasn't urine, her waters had broken.

Part way through the clinic I was called back to the ward. A lady had come in and was in severe pain.

The intake people said she had shortness of breath, but it was way more than that. She seemed to hurt everywhere. The ultrasound was really difficult. Partly because had a thick abdominal wall even when she wasn't pregnant. I couldn't see the baby well, and I couldn't see the heart at all. It looked like the placenta may have peeled away from the wall of the uterus – that was possibly why she was having all the pain. We went to the OR, and it was another first for me. The baby wasn't in the uterus. It was in her abdomen, and the placenta had attached on the top of her uterus (on the outside) and her right tube and ovary. We delivered the baby – it might have been 20 weeks size at the very most. It gave a few gasps and then passed away. Then we had all the bleeding to deal with. We did a hysterectomy and had to take out her right tube and ovary. She got 2 units of blood (when it is an emergency you don't have to wait for your family to donate!) and as of right now things are critical but stable.

At some point in that surgery is when I felt God talking to me, giving me some perspective. Who was really having the hard day here? Me – I still have all my parts (mostly), I am still alive, and I am going to be sleeping in a regular bed tonight not on an intensive care ward. No, I might be sharing in other people's hardships, and God may have placed me in a place to try to make that a bit better, but I was not the one having the hard. It is pretty clear who was.

"I complained that I had no shoes until I met a man who had no feet." -- Persian proverb

Philippians 2:3-4

Do nothing from selfish ambition or conceit, but in humility count others more significant than yourselves. Let each of you look not only to his own interests, but also to the interests of others.



Some of you will not want to see the pictures I took today, so I posted others instead.