DIC=disseminated intravascular coagulopathy, difficult to treat even at home, even when fresh frozen plasma and clotting factors and cryoprecipitate are available. Bleeding bleeding bleeding. In medical school, they told us – yes, facetiously – that all bleeding stops eventually.
This is a slightly-edited excerpt from my diary. Note that's it's pretty technical for the lay person, but my medical friends will understand.
...the early mornings are followed by fairly late afternoons. The patient with pulmonary edema died. The next day, we had a patient who was trying hard: delivered stillbirth with abruptio placenta at 9am, laceration of the cervix and 3rd degree laceration at the perineum. Bled lots, apparently slowed down, then the bleeding picked up again.
When I saw her, she was in the small procedures room, Canadian nurse and British midwife and Haitian midwife supervisor around her, patient in a puddle of blood, reciting psalms in Creole. Apparently had already lost a couple of litres of blood, and from the puddle, I believed it. Blood in the urinary catheter. Some discussion about DIC vs local trauma, 3rd vs 4th deg tear. From somewhere we got some fresh blood, useful for both its red cells and its clotting factors, added more ergometrine, vitamin K to encourage clotting and contracting. Planned to transfer her to OR for exam under anaesth, proper repair of laceration.
Half an hour later, the surgeon called me to the operating room to show me what they?d found. Laceration was 3rd deg, and he was re-repairing it. The bucket between his knees – patient of course in lithotomy position – had about 2L of blood in it. He said when they'd undone the cervical stitch, it had cascaded out, and was still bleeding. Patient was being transfused red cells, were trying to find some more. Decision was made to do a hysterectomy to control the bleeding, so I stayed for the surgery. They didn?t need to me to scrub since the surgeon responsible for the OR was already assisting, but I figured I should stick around. Tried to facilitate more blood.
Two surgeons and a scrub nurse and a messy hysterectomy because she was bleeding and bleeding. Anaesthetist had her on dopamine, despite which, for about a half hour, she had no appreciable blood pressure (but did have a carotid pulse and the oximeter was picking up). The bleeding was welling up mostly from the inferior segment of the uterus. More blood came from the Red Cross. I thought, she's bleeding faster than we can transfuse her. I thought she would die on the table.
I left the hospital right when they finished closing. She did start making urine at the end of the surgery, that's good. Before I left, I found her husband having an anxiety attack in VCT* office. He'd been trying to give blood, poor thing. Drenched in sweat, hyperventilating, complaining of muscle cramps. We gave him something to drink and some diazepam. Coached him on slowing his breathing. He started feeling a bit better, and asked me how his wife was. I said, she?s sort-of OK at the moment, just finishing the surgery, but she is very sick, and I can't promise anything. He asked me if I was Canadian, because I spoke English and French. We found the social worker to talk with him.
The next morning, I asked the nurses if she was still alive. She was alive, awake, making urine, talking to me, had a blood pressure. All good things. Today (day 2), she's in the big room. Her only complaint was that she'd missed breakfast. The nurse told me that she'd walked unassisted from the intensive care bed to her current bed. Her husband was out getting her food.
I think it's a miracle.
*VCT=voluntary counselling and testing. These nurses are specialised in HIV counselling; at Jude-Anne they are instrumental to our blood bank as well as the HIV program.