Today, I decided to start my day at Solidarité and then move on to Jude Anne, as opposed to the opposite as I've been doing for the last few weeks. Last night, after all, was the first night of Solidarity being open to patients. I thought they'd have a night of nothing at all: but lo, four patients had been evaluated, three transferred, and one delivered. Solidarité has had its first baby.
Now, in having the first baby, apparently there were also some items that they realized they needed but still didn't have. It necessitated an extra trip to Jude Anne to pick up a few things. This is natural, I suppose, but I am worried that despite the teams assuring me that they have everything necessary to do surgery, there might still be a few small items missing.
As a result, we've decided that the first surgery at Solidarité should be a simple, stable Caesarian, to ensure that we can do it. I spent much of the day looking for a good surgical case to inaugurate the OT, but didn't quite find it.
At Jude Anne, we had the same two patients today as yesterday. This afternoon, we transferred one of them to Solidarité (this morning, her blood pressure was still too high, but by afternoon, was under control). The other, we decided not to transfer until we know that the OT works. She has placenta previa, and is stable for now. But if she starts bleeding, she could destabilize extremely quickly and would be a difficult first case for the OT.
In the meantime, I ended up involved in the resuscitation of a woman who I think had a post-partum pulmonary embolism. She had delivered at Jude Anne one month previously, and was carried in today awake but hysterical. She was hypotensive, hypoxic, tachycardic (BP 70/palp, SaO2 84% on room air, HR 170), with distended jugular veins and hepatomegaly. Hgb measured at 9 g/dL. She looked terrible.
I have to say that things were not particularly organized, though the essentials were accomplished. A fluid top-up, the first dose of low-molecular weight heparin, a dopamine infusion. She looked a little better once her blood pressure became more respectable, even though her heart rate remained unchanged, and she was saturating at 94% on 7L oxygen. We agreed that we could not look after her at Jude Anne — it's a maternity hospital, after all, and she needed an intensive care unit. So I sent the Haitian anaesthetist and two stretcher-bearers to accompany her to the general hospital, with a small donation of medications (including more LMWH) and materials (gloves, angiocaths). Also, I gave her family the change needed to pay for starting a chart (25 haitian gourdes, or 62.5 cents US). Her mother was sitting in the courtyard, hands to her face, crying. One of the ambulance drivers was gently explaining things to her; I appreciated enormously his presence and attitude.
Several hours later, I saw the anaesthetist as she returned from the transfer. The expression on her face spoke volumes. It had taken her two hours, because the receiving emergency department was crowded and disorganized, and they could not properly receive even a critically ill patient. They said they had no bed for her. They said there was no oxygen. She was thoroughly disgusted. She despaired for the patient — we all did, even as we were organizing her transfer.