77% is not what I wanted to see when I placed the pulse oximeter on her hand. We were in the OR to do an urgent C-Section.
This a.m. one of our OB patients was looking a bit puny when we did rounds. She was pre eclamptic & her body was swollen everywhere with edema but they were delaying the baby's delivery until it was old enough to survive. Her breathing took some effort but it wasnt terrible. Still, she was looking worse so we decided she needs to deliver today- this mom is hypertensive & fluid is accumulating in her lungs. To be safer, her surgery was scheduled for 2pm since she ate breakfast.
When I arrived to preop later that day, the patient was already in the OR. I could hear her wet cough through the walls. She was struggling to find a comfortable position to breathe: on her side, on her hands & knees. She kept rolling & twisting despite 2 nurses trying to pin her down so she wouldn't fall off of the OR bed. She looked bad. What a downward turn in just a few hours. I had them sit her up with legs straddling each side of the bed. Now she can breathe a bit easier as we finalize the plan.
77% oxygen saturation. For you it would probably be 97-100%. Her cells are starving without enough oxygen and she is virtually drowning in her own fluid. In the US, I would probably intubate her so I could manage her safer. Without a ventilator, things would only worsen here in Chad...& I may never get her extubated. I chose a spinal anesthetic after quickly debating the pros & cons. I do a quick mental check: IV/monitors/turn on oxygen concentrator/ equipment ready for "plan B". Lets go.
This momma is so swollen that I couldn't feel any landmarks on her back. As I pressed the skin on her back to feel her spinous process, my fingers sunk in and left a 1/2" crater. I buried the spinal needle all the way and had to push even deeper to find her spinal fluid. Mom started twisting & moving again just as I was about to inject the medication so I shouted to her & the nurses: S'il vous plaît! Ne bougez pas!
I was already sweating & the thought of failing on this spinal was not helpful. Thankfully it went in easily & we laid her down to do the C-section.
The surgery was textbook. No problems, limited bleeding, mom looked a bit better while breathing oxygen. Unfortunately the baby was pretty floppy at delivery. Stimulate. Suction. Stimulate. He needs to be ventilated by hand. We have all the right face masks & Ambu bags for adults, children, & newborns... But only one oxygen concentrator. So who gets our only source of oxygen? The mom drowning in her own fluids or dusky newborn needing help to jump start his life? The baby wins this one-- we ventilated him for just a few minutes and then eventually returned the oxygen to the mom. I simultaneously gave mom oxytocin to contract her uterus, checked on baby, gave repeated doses of lasix to help mom eliminate excess fluid & breathe easier, irrigated the wound for the surgeons, back to check baby again. Oh, and there was a film crew here recording everything for a project back in the U.S.
No pressure!
Thankfully there was a beautiful ending to this chapter of the story. I whispered into moms ear: C'est un garçon et il est fort. She gave a weak smile and closed her eyes again.
Mom isn't necessarily "safe" after surgery but her oxygen levels were 90% before returning to the maternity ward. We can ALL breathe a little easier now.
-Mason
Thank you so much for all that you do. I am Danae's sister and I recently started reading your blog, partly because they don't post as much as they used to and partly because I love to see a different perspective. They are so blessed to have such a great family. They had been praying for an anesthetist for quite a while now. So many of the stories there do not have great endings, so I am so glad that this one was a great ending. May God continue to bless you.
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