Content note: This post contains a description of a birth injury.
"Martina, Martina, where’s our second doctor?”
Our emergency physician has just had a call from a nearby camp which hosts people who have been displaced by the fighting.
“A woman bleeding heavily after giving birth will arrive in ten minutes. The people who were trying to help her said they removed the placenta normally and then something else – they don’t know what it was. Perhaps a tumor… patient is profusely bleeding and is unstable.”
“Well...” It's not exactly what you want to hear after twelve hours of work. But that’s the way it is.
An MSF maternity clinic was opened here in February and since then I have learned that obstetrics can be pretty harsh. Bearing this in mind, I call our doctor, a midwife and the surgical team so they are ready. The information we receive in advance is not always accurate and I can’t rely on chance.
Martina at work on the ward. Photo: Louise Annaud / MSF
A few minutes later, paramedics dash into our emergency room carrying a pale woman on a stretcher. A puddle of blood spreads below her.
"Hello," I say, trying to talk to her. Surprisingly, she opens her eyes and turns her head towards me. Good sign. She is conscious. I feel relieved.
In the meantime, the emergency physician removes the abdominal drape rolled underneath her. A piece of something appears. We look at each other, shrugging our shoulders. “I don’t have a clue what it might be," he says.
Neither do I.
As a nurse from the university hospital in Prague I am used to calling specialists for everything. I have limited experience when it comes to obstetrics. It doesn’t matter – our midwife is on the way. Meanwhile, we do our best.
We find a vein so we can insert a canula, take a blood sample and check the vital signs. Before we’re finished, the midwife blows through the door into the room, running directly from the operating theatre.
She glances at the patient. “We’re looking at the uterus,” she says calmly. “They didn’t give her oxytocin during the delivery and ripped the placenta out of her with such force that even the uterus was pulled out."
I stare at the midwife and at the uterus, and back to the midwife. I’m stunned. It sinks in that the blood covering the midwife cannot be from this patient.
I look again at the uterus and I say to myself, “sure! What else could it be? It’s simple, it's an inside-out uterus.”
I can’t swear that as a student I always paid attention in my gynaecology lectures, but I'm pretty sure nobody taught us about this problem. I hope that cases like this don’t happen back home in the Czech Republic.
There is no time to lose
There is no time to lose.
I quickly take the blood sample and the request form and hand them over to the lady from laboratory.
“We need the results as fast as possible. And we need at least two transfusions immediately, otherwise the patient is going to die,” I say to her. The interpreter promptly translates for me. After that I run to the lab with her, just in case.
When we get to the lab, she starts to make an analysis straight away and promises to call me about the blood type as soon as possible. I’m glad that we are going to have the results so quickly.
However, my happiness vanishes in just a few minutes as we are informed that the patient’s blood type is 0 negative. This is the worst possible option as not only we have just run out of this kind of blood, but it also isn’t compatible with any other blood type. We need 0-negative blood donors…
None of us is 0 negative.
We swiftly turn to all the people around, the employees, the relatives and even to people waiting around in front of the operating room. Damn it! Nobody is 0 negative!
Without a transfusion she will die. I start to feel helpless. I have no idea where, now – at 8 p.m. – we can find enough donors with what is not a very common blood type.
"Wait!" It’s a woman standing nearby. She holds a newborn in her arms, apparently the baby whose mother is right now fighting for her life.
"Someone should go to the mosque and ask them to announce that a donor is urgently needed,” she suggests.
Six donors in five minutes
“That’s a great idea, I didn’t even know that we could do that,” I admit. Up to now, I’ve thought of a minaret mainly as an alarm clock that wakes me up every morning.
I’m still a bit sceptical: we need blood right now and who knows how long the summons will take. One of our employees hurries to a nearby mosque while I get prepared and go to help our anesthesiologist in the operating room.
The team must be exhausted. They just finished a surgery and we’re giving them a new patient.
The surgeon starts to operate on the woman. Scissors, suctioning, cauterization…
The surgeon gives instructions while I nervously keep track of the monitor anticipating the haemorrhagic shock implicated by heavy bleeding. To my great surprise, the door is suddenly opened by somebody carrying the blood transfusion.
"Five minutes after the announcement, we had six donors,” the man informs us.
“Six?!" I laugh with relief.
“That,” says one of my colleagues, “is amazing."
But there is no time to talk.
I check the blood type one more time and give the patient the transfusion. As the surgeon removes the uterus and stops the bleeding, the anaesthesiologist and I give her the blood and fluids, willing her blood pressure and pulse to stabilise.
And then they do.
We have blood pressure; pulse rate and haemoglobin level are satisfactory. Everything in the operating theatre slows down a bit.
And at least for today, this patient has won her battle. We all did a good job. But the biggest credit goes to the unknown lady from the displacement camp - without her idea it wouldn’t turned out well.
Médecins Sans Frontières has been providing emergency healthcare in northeast Syria since 2013. In Hassakeh, our teams are currently providing direct support to the only fully functioning free-of-charge hospital in the governorate. In April 2018, over 2,300 patients were treated in the emergency room, more than 180 surgical procedures were carried out in the operating theatre, 45 people were hospitalised in the in-patient department and 235 deliveries were facilitated in the maternity unit. MSF is also assisting other medical structures in Raqqa and Deir ez-Zor governorates.