Someone grab a flashlight!

March 23

I'm standing next to the table, shrouded in a dark green surgical gown that practically drowns me, mask, head covering, sterile gloves.....I stare down at my hands, one pulling the uterus back on top of the abdomen and the other disappearing inside the woman. Outside the rain is coming down in torrents. Inside, Dr. Fam starts yelling over the roar of the weather, "Somebody get me a torch! A flashlight! I can't see." We are in the midst of a cesarean section and the power has gone out....again. It is my first full day in Nigeria, and this is one of the last positions I expected to find myself in.

But a familiar position.

My eyes gaze fondly at the small cramped operating theatre, memories coming back from 5 years ago when I stood often in a similar room in Tchad. I remember doing surgery on a man with ruptured bowel, the patient kept trying to strangle me from the side and we couldn't get his intestines to fit back in him. I remember spending hours in the middle of the night, painstakingly helping the surgeon put in hundreds of tiny stitches to re-create a mangled hand on a woman. I remember pulling babies out of many uteri.

Mind back to the present, the power has come back on. Dr. Fam and I continue to stimulate the uterus trying to get it to contract down. The uterus is still soft and there are little bleeders everywhere not wanting to stop despite all his suturing. This mom came to the hospital with obstructed labor. The story I heard is that she first went to a "mission house," which is a place run by local churches offering help for pretty much anything. From what I've been told, these places don't seem to be as great as their name suggests. They "help" people with medical problems, much like a traditional healer, despite having no medical training and often do more harm than good. They chain up psychiatric patients and try to beat the devil out of them. Kind of scary, and sad that it is under the name of the church.

Anyway, it had been relayed to us that this woman had actually delivered the head at the mission house, but the baby wouldn't deliver any further, so they actually pushed the head back in! When she came to the hospital, we were still finishing a different cesarean that Lisa and I helped with resuscitating the baby. So with the main operating room tied up (that woman was hemorrhaging badly), we prepared the second, less used OR with Dr. Fam who came in to do the second surgery. I thought I would just be observing...we had come to teach neonatal resuscitation and this would be a good chance to see how they do things and get ideas for what material we should focus on. But maybe because it was the weekend and less staff were around, or because in these areas of Africa, an extra pair hands can always be used, but Lisa and I were quickly pulled in. Lisa got ready to help receive the baby and I scrubbed in to help Dr. Fam.

With the first cut into the uterus, pure brown amniotic fluid came pouring out. Meconium everywhere. The baby was big, floppy, and quiet. He'd been in distress for quite a while. I suctioned the mouth and nose, clamped the cord, Dr. Fam cut, and then quickly handed him off to Lisa and the nurse anesthetist. They ended up suctioning a bunch of bloody meconium out of his lungs and successfully resuscitated him after a bit of work. I didn't know much of what was going on with the baby as we continued with the mom.

The surgery took forever for a cesarean. Partly because she kept bleeding and we didn't want to close her up until it was under control, and partly because the power kept going out. But I had a great time hanging out with Dr. Fam! He told me about all the other countries he has worked as a surgeon and the difference in people & cultures. Then we compared notes with places that I've worked. Every 10 minutes or so, the power would go out again, it would get dark, and we'd try to remember where the bleeding was and put pressure on it until someone could grab a flashlight so that he could continue suturing. 

So great to be back in Africa in surgery!