April 5th, 2018 by Daniel Boron-Brenner

Today’s post will be a case of the day, specifically an emergent C-section. The case came in while I was rounding in the pediatric ward with Dr. Mbanga, the ward rounder and also a general surgeon and anesthetist (many of the doctors seem to occupy several roles at once here.) After hearing about the case of “fetal distress”, we interrupted rounds to hurry to the operating theater. We found Dr. Msani, the men’s ward rounder, already scrubbed in and ready to go. After changing, we helped prep the patient. She was anesthetized with ketamine (after several unsuccessful attempt to use a spinal) and then we began the surgery. With Dr. Mbanga monitoring the sedation, and Dr. Msani performing the operation, I was the first assist, holding retractors, suctioning, and helping where I could. He quickly found the uterus, made the incision, and pulled the baby out. Although the baby was initially listless, I suctioned the mouth and nose while Dr. Msani clamped the cord so that we could move him to the nurse’s arms. As soon as the nurse took him, I heard a little cry and then they whisked the baby away to the warmer. We turned back to the mother and Dr. Msani began closing the incision in the uterus with a thick suture. As he closed, we realized that her abdomen was slowly filling up with blood and that we had missed a bleed somewhere. Minutes of careful inspection ticked by, all the while accompanied by careful suctioning, and we finally found it hiding deep behind the left Fallopian tube. Dr. Msani placed several more sutures, stopping the bleeding, and then we placed the uterus back into the abdomen. As we did, I felt it start to contract, something I will never forget. Then we closed the abdomen, cleaned the patient up, and transferred her to her bed to recover. Another C-section came in while we were closing but I was unable to participate, having gotten blood on the only pair of shoes I could wear for operating (for the curious, they happened to be Crocs, like you might wear for gardening.) I changed and made my way back to the pediatric ward as they wheeled the next one in.