Just after getting back we had a woman with an 18 week abdominal pregnancy. This baby was growing outside the uterus with the placenta stuck to part of the bowel. She came to us complaining of pain, and she had started to bleed internally. We had to operate, and though the baby could not survive, the mother lived.
Almost all of our operations are carried out under spinal anaesthetic, so the patient is awake during the surgery. One of the more interesting features of theatre ritual here is showing the patient the specimen after we have removed something from their body. My nurses were perplexed when I explained that it was not typical practice in the UK to show patients their uterus after doing a hysterectomy. 'How do they know that you removed it if you don't show it to them?' the nurses wanted to know.
My favourite operation of all is still repairing obestetric fistulas. This young woman is one of our typical patients - Like many of our fistula patients she is from Somalia, a teenager with an early marriage, obstructed labour at home for many days, finally delivering a stillborn infant and left with the hole between the bladder and vagina. Less than an hour of surgical time and two weeks of care in hospital and this young woman went home dry for the first time in years - smiling with hope for the future.
Sometimes patients forget to read the textbooks before presenting to us with problems. 'Everyone' knows that patients are only supposed to get eclampsia after they have first had pre-eclampsia. It's only courteous of them to warn us that they intend to have a convulsion by getting high blood pressure or protein in the urine first. However, two of our patients this month decided to have their convulsions before the other signs and symptoms. Fortunately we were able to stop the fits, stabilize them and deliver them safely of healthy babies. How grateful I am to have magnesium sulphate!
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