Malaria Nightmare . . .

Salut!

I'm standing awash in pools of blood and amniotic fluid. I've just slashed down deep through skin, fat, and fascia then ripped through muscle and peritoneum to find the bulging uterus. I then cut through well perfused muscle causing arteries to spurt blood into the wound as a gush of amniotic fluid thickly stained with meconium (baby poop) pours onto the operating field. I then reach a hand down into the swirling pool of red mixed with split pea soup green to find a grossly distorted baby's head too big for his mom's pelvis and pull it up and out. I clamp and cut the cord as the blood and gunk continues to pool and splurt all around. I then reach in and rip out the placenta which is in and of itself not a pretty sight, much less when covered with meconium.

It's at this point that I get nauseated. One would think that what I'm in the midst of doing would be enough to nauseate anyone. But this is different. It's sudden. A clamminess; a churning of the stomach; a feeling of light headedness; aching muscles and joints; a splitting headache; sweat dripping despite the air conditioned chilliness of the OR. This can only be...Malaria.

Somehow I find the strength to clamp the bleeders on the uterus, suture it closed and close the skin. I feel ready to collapse at any point. I quickly help clean up the patient as the feeling of needing to vomit increases. My head is going to explode. How do you describe it unless you've experienced it? A clamminess inside. Something that reaches to the depths of who you are and strangles you. We move the patient out to the wards and clean up the OR. I walk back in a haze. One step at a time. You can do it, James. You're almost home. It's 3am.

At home I open a packet of Artesunate and swallow six pills. I chase it with 800mg of Ibuprofen, a promethazine and a gram of Tylenol and then collapse. My body is racked with chills as a cold sweat breaks out all over. I pile on the blankets and crash into a deep sleep.

At 6AM I am awakened by Hortence. Another woman who is having trouble delivering. Using the force of my will only I pull my self from my Malaria/Promethazine fog, slip on my scrubs and head groggily up to the hospital. This woman has great contractions but a huge baby. The head of the baby is very molded and high up in the pelvis. I give her a few chances to push to see if she can make the head come down. In between encouraging and waiting I literally almost fall asleep on my feet. I feel I have nothing to give. Please, God, don't let her need a c-section.

Finally, I face the inevitable, the baby won't come out. But then,
something slips out of my sluggish mind...symphysiotomy. Of course, it's only her third pregnancy and we don't want to condemn her to repeat c-sections every delivery for the next 5-7 times she'll be pregnant. I force myself to walk to the OR and get the syphysiotomy box. I still feel like passing out or just lying down somewhere. It is sheer will-power that keeps me going.

I arrive back to the delivery room. I shave her pubic area, inject lidocaine, prep with betadine, drape with sterile towels, put on sterile gloves, grab the scalpel and cut straight down to her pubic symphysis. I can feel and almost hear as the scalpel cuts through cartilage. My fingers are inside moving the foley catheter filled urethra to the side so it can't get damaged. I feel that it's mostly cut. I stick my finger in and feel a nice gap. I tell Hortence and Moise to pull the legs apart and down to the side. Suddenly, there is a crack and her pelvis opens up. I quickly suture up the wound and almost immediately the baby's head drops down and appears. I suction the nose and mouth and pull the shoulders and legs out. The huge 4.2kg baby starts yelling immediately as I clamp and cut the cord. My adrenaline wears off and my aching body returns racked with chills.

I go home and crash. I sleep for 24 straight hours almost without moving. Every part of me feels like it's been punched and pounded. I feel I can't sink in deep enough into the mattress. I alternate between soaking the sheets with foul smelling sweat to being so cold that even wool socks, a sweatshirt, three blankets and a sheet aren't enough to keep me warm as I huddle in the fetal position. I try to drink but everything has a metallic, bitter taste. I'm dead to the world. I wake up briefly to realize it's night, the generator's on and my wife is standing over me asking me if there's anything she can do for me. I just fall straight back into my self-induced coma after taking my second dose of Artesunate and wait for the morning to come...

James