When a day's work becomes something you'll remember all my life.
On this occasion I speak of an absolutely incredible, what are called "miracles" and that will astonish those who are known.
The event is special, and even more so because I personally. When I talk about it or remember it, I still shudder among us doctors they say "I lost 10 years of my life in 10 minutes", maybe it is true, why is so much stress that when everything is finished right out from under a moving train. Time expands, the minutes become hours, and everything that happens around you do not even remember.
The time to tell it is just that, I can do a bit 'colder than a few months ago and it connects to a newspaper report of a similar event that happened in the U.S., just over the Christmas period last year.
What has happened to me and who was with me was a few months before Christmas and in Italy.
In the American case a woman was about to give birth while everything was proceeding normally and was hit by a cardiac arrest. The immediate medical intervention resolved everything, really miraculously given the seriousness and rarity, and the absolute unpredictability of the case. He also spoke
newspapers and tried again when I read the news of the chills that night, I experienced exactly the same thing.
Probably my fellow gynecologists will be shocked, I do not envy the experience nor did I wish them to live.
One night shift in a maternity ward has no fixed rules: it can go very quiet for a moment without getting up from his chair, can go to 'business as usual "with a couple of parties (always work, but pretty quiet), can be heavy, with women giving birth, others have problems, more or less severe emergencies. Then there is always the danger of the drama and when this happens, who knows why, is always a sudden shift in quiet, without warning, when you least expect it (... and some say ... always at night).
I will tell it like it is, straight off, so maybe I can make (up to a certain extent) the anxiety felt in those moments.
That night it happened something incredible.
mounted to the night shift and was present on the ward a woman to give birth. He had already undergone a Caesarean section four years ago and although this condition (the previous caesarean section) increases very slightly risks in any subsequent spontaneous birth, things proceeded normally.
Labor conducted a bit 'slow but this can be normal. The patient was continuously monitored midwife on duty that I occasionally updated on the situation, the child was fine and everything went on as normal.
Around two in the morning I called the midwife. The woman came to "full expansion" that is ready to give birth, but despite the "push" (the "push" the mother's help, rather they are critical to the delivery, by concluding the fetus until its birth) the fetus does not progress rapidly making everything slower.
I have to make a decision.
In these cases, arrived at childbirth, if despite the contractions of the uterus and the mother pushed the baby is born you can decide to perform a Caesarean section. The fetus is not born inland "natural" and is extracted from the abdomen, with surgery. Fortunately
fetal well-being was full, there was no suffering and this allowed me to take the time to see if there was any chance of avoiding surgery.
then ask your midwife to bring the lady in the delivery room: we could do better, manage better, and also pushed to the limit "help" the fetus in some way.
In fact in the delivery room despite the woman did not cooperate very (she was tired and discouraged) the fetal head down well to be visible from the outside (I avoid medical terms to explain better).
Her husband was present in the delivery room and supported his wife.
I can do is encourage the woman, inviting you to try harder and try for a while ', the fetus was fine and I am reassured. After a few seconds the unexpected
most incredible I've met in my career. During a push
Mrs. arches his back (he was lying), is launching a strangled cry and collapses on the couch.
I look at it and has her eyes closed, I immediately think to a moment of tiredness even a nervous breakdown (in the delivery room you can see this too) ... I do not answer the call, the rise on the eyelids, and I realize that he lost consciousness for a moment and reflect immediately ask to call the anesthesiologist on duty while trying to realize what might have happened (fainting in the delivery room is not an event "usual").
At that point I ask to be sure all employees to take action to prepare for an emergency cesarean section.
calling my colleague found the urgency to alert the midwife shouting something, "there is beat Do not beat me !"... I do not know what has crossed my mind at that moment, I hasten to Mrs. and try to feel his heartbeat.
was under arrest.
The woman for no apparent reason (at that time) had a cardiac arrest.
The drama in the drama was that his child was not born yet ...
ask the midwife to look for the heartbeat of the fetus, but there was a low frequency, a clear sign of suffering: the maternal circulation without the baby was a few minutes of life.
Shout to prepare everything that we made the lady to call everyone, anyone, in the delivery room chaos, everyone ran to the right and left, each with a specific task. Recall my colleague shouting and muttering something to run ...
memory of those moments a few seconds and I see myself appalled to think what to do: save the mother or the child? How not to waste time? In those moments you do not do thinking about what but do by instinct, which is certainly guided by experience and from what I know, but it can also be dangerous, fast decisions should provide pause for thought but how do you "think" when you know you have a few seconds, literally, to save two lives at once?
From what seems a story about ten minutes, but all occurred in seconds. My memories have holes, some moments do not remember them very well and then the midwife will remember what I said and did.
I'll jump on the lady who was still lying on the bed and began heart massage. One, two attempts and checking his pulse, still nothing ... it a try, I try to keep your circulation, for the woman and the child must be born again and in the meantime get the anesthetist.
My colleague comes without even suspecting what had happened. When you call an anesthesiologist in the delivery room in general it is "routine" or "urgent" relatively less important than the number taken in the operating room, not where you are giving birth. The anesthesiologist
find me on the delivery table while performing chest compressions he realizes that something is happening is absolutely absurd, known in his eyes to see a fellow obstetrician disorientation while massaging the patient asks me, "but so 'happened!? " I remember him replied "I do not know ... is under arrest, I do not know ...".
Immediately after a start as he prepares for resuscitation the heart starts to beat, but slowly resumed, then more quickly. The anesthesiologist "Convection" Madame, that is forced to breathe with a special instrument (called "Ambu bag") I accertatomi in the delivery room I let the lady in the hands of my colleague, I think the intervention of urgency. At that moment I was not even sure the baby was still alive, to be honest we had hoped but I did not. The midwife
(weeks after the fact) told me that, while carried out cardiac massage was pale and at the end of each massage move my head in a "no" that did not bode well.
Corro in the operating room, in the meantime, everything was ready. Shortly before entering the room late husband who was more shocked than me asks me "... doctor ... my wife, my wife is alive?" I answered "I do not know ... I do not know ... " and if you think grit my teeth to the absurd situation. I did not know really, I did not know if my speech had been able to save the woman and the child or only one of them ... I did not know, I did not know what would happen after.
Within the operating room, nurses and midwives (one of the youngest in the ward, at this meeting was exceptional) run on a stretcher and carry the lady in the room while the anesthesiologist continues with forced ventilation.
They told me that all women admitted to the ward were outside the rooms because they had understood from the chaos that something had gone wrong, I do not remember anyone noticed, I was absolutely taken by the event.
The operating room was almost ready, everyone had done what he had to do, well, nothing had gone wrong (so to speak ...), I'll take five seconds (5) to try to summarize what was going on, ask the Meanwhile call the primary and get everything ready for a blood transfusion.
The lady is ready on the operating table, the heartbeat is regular, the midwife seeks the fetal heart: there is.
The child is still alive but is suffering from. The fetus is much stronger than us adults to "hypoxia", ie the lack of oxygen, but make sure there's no early.
Everything is ready, I avoid spending too much time in hand washing, which is the last thing I think, I beg leave anesthesiologist (in the meantime, the anesthesia team was completed by the chief of anesthesia) that gives me the 'ok and start.
Only then, after reaching the uterus a few seconds later, I realize what happened.
uterine rupture.
The uterine rupture is a rare but dangerous complication that can also be lethal. And 'one of the most serious emergencies in obstetrics. E 'defined as a complication devastating to its severity.
probably during a pull, the old Caesarean scar made by the patient a few years before it was broken open, the lady has tried this for a lot of pain (it's called "a dagger" for its features) which resulted in a reflex ( is called "vagal stimulation), which caused a cardiac arrest.
A set of incredible events, rare, unpredictable and utterly serious.
actually looking at the damage it seemed likely that the uterus was already "open" for some time about the previous caesarean section, in this case is called "dehiscence", that is, a break is not "random" but it is the scar of the previous section. It was not a "break" recently, so that the margins of the lesion were almost healed. I assume that the lady has spent much of her pregnancy with that problem without even realizing it.
cardiac arrest in pregnancy is very rare an occurrence, estimated at a frequency of one case per 30,000 pregnancies. The arrest in the expulsive phase of delivery is an event quite unique, there are only a few cases in the world. The extraction of a fetus during maternal cardiac arrest, must be made (by Caesarian section) within 4 minutes after, or you risk serious brain damage and die if you do not succeed within six minutes to deliver the baby.
skin incision to extract the child 31 seconds have passed. I could not improve myself, my record extraction cesarean is 23 seconds but in this case I've lost a few seconds he looks in my anesthesiologist that I updated on the situation of women.
still have a copy of the paper of record operating that night ... and who you forget it.
The child, checked out, starting to cry.
The pediatrician who visit gynecologists while we continue the intervention. I ask pediatricians how quickly things are going, one of them raises his thumb up as if to say "okay" ... A broken
uterus (basically "split in two") has little chance of being saved, so we have to carry out a hysterectomy, ie removal of the uterus that if left in place could cause serious bleeding.
Arriva also involved in the primary intervention, I deadlift.
I sit down and put his head in his hands most of the fatigue of despair.
intervention ends.
The patient was eventually admitted to the intensive care unit in guarded prognosis, significant anemia requiring blood transfusion and the loss of sight. I know it's better and better over the following days, until his resignation in good condition. The baby is healthy.
After a month I meet the lady for the visit. He no longer has her uterus but is alive, in good conditions. His son is alive and well, is well and growing well.
The first time I see the hug, very excited and she is perhaps even more than me does not seem to realize what happened that night. I ask also, "but was aware of what happened?". I answered yes and nothing else, maybe not want to remember, does not elaborate.
The husband thanked him constantly but does not go well, do not ask and do not talk about it.
every time I speak with my colleagues who remember the episode with the midwives to make an example of what it means to "know what to do", I talk with the midwife present that night, we laugh even on remembering my face pale and I told her that she had her hat all awry from the surgery was upset.
We also have colleagues who do not believe it, "come on, you're kidding," making it even more surreal as it happened and who gets the "higher" than those who tell you "yes you could but ... you had ... " without realizing that in my place would need so many saints in heaven, how many I've had and the lady, because in these cases, the facts and decisions of seconds in a minute, should also help you luck and if you hope is on your side. I am the midwife who was with me that night, I look with admiration and pride because it is a girl of 24 years who has done something exceptional, much larger than her.
The morning was already sent, I was quite destroyed and thrown into the house I went to bed.
From the day after everything is back to normal as if nothing had happened.
E 'was perhaps the most dramatic episode that I have had professionally.
This story will take her with me forever but I also know that stories like these happen every day in hospitals around the world. The much criticized doctors because ... why? I do not even know ... I do work hard, full of responsibility, also subject to errors, of course, and this is due to their being human, fallible but also responsible for exceptional performance, miraculous, sometimes heroic acts. This is not news but just listen to some of these experiences that we doctors carry within us.
For two lives saved that night none of us has got compliments, awards, salary increases or pats on the back, is business as usual, the life I chose.
In the newspapers never read these stories that happen every day, read only what a scandal, audience.
Ask an anesthesiologist how many times did resume a person's heart at that moment in perfect health suddenly is left "on foot" from his body swing ...
has literally performed a miracle, he has revived, but that patient probably will never know.
happens every day.
Who insults the medical principle should think for a moment that the great mass of medical workers is represented by honest and prepared by people who pass sleepless nights and takes charge of situations incredible that care, cheers, and talk that raises is often overloaded with work and stress. The cold bureaucrats imagined by some ghosts are crafted to discredit an entire class of people for good and do not say it for me but for all those who have loved this profession before me neglecting family, hobbies and pastimes.
The stories of "big pharma" and the plots if there are some dishonest and certainly not about the thousands of professionals who oversee health all of us and if there was a conspiracy would be the first victims of their own doctors who would treat convinced to give the best.
I hope I never have to pay my price with the duty in this way because it was tough and could end up quite differently, and certainly I would not forgive her.
rarely look into the problem of consciousness of a doctor, his anxieties, worries and stress, we never hear of the daily acts of true heroism and I take this opportunity to remind the thousands of doctors who have passed life to solve the suffering and to bear the pain, people who have been in the hands of the next life and he treated with respect and conscience. Many of them if they are went without even a thank you from those who have saved, but probably not even expect a thank you because what they did was the very essence of the hard task that awaited them.
I hope that woman and that child a good life.
you all good, bright and relaxing holidays and I take this opportunity to thank all of the gifts sent by mail.
the next. We
Wee (original post)
0 comments:
Post a Comment