‘Manic Monday’ Teresa says in her post today. Well, I remember where I was in the 1986 listening to “…it’s six o’clock already, I was just in the middle of a dream” Good times.
Hey speaking of good times…I am in the middle of a wild and wooly five day stretch of anesthesia call/duty. Friday was full with with a thyroidectomy, cleft lip repair, open reduction internal fixation, 2 c-sections and an iv sedation. Saturday we ran concurrent anesthetics again with an ortho case and a c section. Sunday we rested….until this am.
The kids came to the door of the Rhodes house just as morning devotion was finishing to say “somebody has called the house and wants you at the hospital Dad”. Ok. Let’s walk quick as the text message comes through the mobile phone that there are two csections for anesthesia. First one is a breech presentation in a first time mom. Check. Second case is twins with polyhydramnios (too much fluid) and a transverse lie. Tougher and hey the other surgery room sures wishes you would hurry up and get over there to start their cases. They have to wait. I need to concentrate on patient safety here. “Hey, Kimosop” (one of the Kenyan medical officers) I say, “you making up for lost time yesterday with two c-sections today?” Smiles. Five minutes later not as smiley as one of the babes is clearly syndromic and stillborn. Aaarggh – nothing could be done – tough case.
Time to get started on the scheduled list. Two tougher cases, one a horrible looking lower limb needing recurrent debridement. Lunch. Ten minutes into lunch break. Emergency c-section. “Hey, Kimosop” I say,”what’s your record for sections in one day?”. Six is the answer – all on a rainy night. Okey dokey. Next is the 84 year old needing orthopedic fix of broken tibia and fibula. Her IV doesn’t work. Much effort to find two tiny IV sites. Case starts. None of the monitors are working. Usually only 50% of the monitoring equipment does not work. No, we are flying on visual flight rules only. Not a happy spot. I prefer some instruments in my twin engine otter. Now the other surgeon wants me to get an IV and sedate a 6 year old for an Achilles tendon repair. What and leave my plane flying without instruments to the first year medical student? Well ya, come on, work to be done. This does not feel comfy. The nurse visiting from northwest Iraq takes over feeling the carotid and radial pulses and estimating blood pressures by their presence or absence. We sedate the kid. Before the surgery starts – maternity calls a cord prolapse c-section. Oh for the love of….this mandates a crash general anesthetic induction. The sedated kid is hauled out of the room. I scurry for supplies. The patient arrives and the news has changed – arm is the presenting part, not umbilical cord so we have time for a spinal (safer approach). OK, I am running out of spinal needles so the bigger ones (the ones with a higher incidence of headache afterwards) will have to do. Baby is very hard to extract. Not active at cord clamp. The nurse repeatedly suctions the baby but it is obvious to me he needs to be manual assisted with an ambu bag to breath. “Start bagging” I say. “Now”. Stares. I walk over and bag the baby but no one is helping do pulse checks etc. I check the pulse — none. Needs to be intubated so I grab the laryngoscope and ask for a neonatal sized ett which is surely in one of the 3 drawers of the neonatal resuscitation table we are using. Stares. No tube. I rush to my machine and look. One that is a size too big but nothing else close. Oh for the love of… I try using the too large tube cause I have nothing else to try. Will not fit…look around for the small sized tubes. None. Inside I am not happy and feel very empty. Baby now has no chance (maybe never did but…..). Aarggh. Why have a resus table and zero supplies in it. (I was not aware of this or would have spent the time to fix it — took me two hours or so on Thurs/Fri to organize my emerg supplies for anesthetics for bigger people so that I could have a comfort level. Never thought to fix the neonatal table). Kimosop says he thinks the baby was gone from the get go — nothing we could do…only God knows but I am not feeling right about the whole scene. One more c-section to go he says as a Vaginal birth after cesarean is not progressing. Of course, one more — only had a total of two stillbirths, today already — twice my career total. Ortho case is still going on — without me. Rachel the Iraq nurse says the plane is coping on autopilot without me. Good spinal topped up with epinephrine and opioid — normally last about 3 hours (case is now longer than advertised and approaching 3 hours). Do the next c-section – live baby 🙂 after enormously difficult extraction again.
Ok. Ortho case still going with Rachel the RN. Achilles tendon needs to be sedated the second time – ok. Teresa drops off supper halfway through. By the way, the spinal is wearing off — case is taking 2x predicted length. Oh, dear, let’s give her sedation and cross fingers it is done soon. Breast abscess needs sedation and an IV. L breast twice normal. Huge amounts of pus — did not accumulate overnight. Haven’t had monitors for either of the last cases. The cleaning and autoclaving department is running out of stuff. Monitor with my eyes and hands.
Still on-call — hoping not to break Kimosop’s record. I’ve got interesting days in my life story books from Canada but this one might take the cake.
“These are the days when you wish your bed was already made” It’s a line from the Manic Monday 80’s tune. Not sure if it applies but it’s closer than “kissing Valentino by a crystal blue Italian stream”.