Tuesday, 17 April 2012

The afternoon before a long weekend

It is a universal feature of health care that Friday afternoons, and the afternoons before long weekends, are bad times. Maybe it is just human error which leads us to suddenly realise that cases we have ignored all week need to be sorted out before the weekend, or maybe it is just the fates playing mean tricks on us.

So the Thursday before the Ethiopian Easter weekend my colleagues left early to visit a museum, leaving me to supervise one Caesarean Section. We all wanted an early night, as we had to get up at 5 am for a flight to go hiking.

As I headed to the OB floor, my resident said there was an anesthesia consult on a second patient going for urgent CSection. It is pretty rare for obstetricians to let anesthesiologists know about their problem patients, they seem to think we prefer to be surprised, so this was interesting and encouraging

So what was the first patient for which the Ethiopians were requesting my North American expertise? Would you believe morbid obesity? The patient weighed 115 kg and was 1.65m tall, so they calculated the BMI at 42.2. She had some high blood pressure but was otherwise healthy. She did not look too difficult to intubate and palpating her back suggested it would not be too difficult to do a spinal. I wrote a note and hoped to get away with leaving it at that.

We got ready to start the first case, but everyone was worked up and agitated about the second case. It seemed I would have to stay for it. I hung around as they cleaned the rooms and got the second patient in. I sent my resident to get a large laryngoscope blade in case we needed it but it could not be found. I let my resident try the spinal. Three attempts and no luck, so I had a go.  A lot depends on the feel of things as you do a spinal, so using a strange needle is difficult. I began confidently, but after four failures I was getting unhappy. Putting patients like this to sleep can be difficult, waking them up safely and having them breathe well can be even more difficult and time consuming. Eventually I tried a paramedian approach and was almost euphoric when the CSF started to flow back, indicating success.

I stayed until after the baby was born and the uterus was sown up and put back, then left by cab. The traffic became horrible, as there were police check points. I suggested we turn off and go a back route I thought I could navigate, but that was just as bad. I paid off the driver and decided to walk, but got completely lost. It was dark, there was no point hailing another cab as the traffic was so snarled, and there are few landmarks near our apartment which people are likely to recognise.

I asked one person for directions, but they turned out to be wrong. When I found a restaurant I recognised, I knew where I was, but I was heading in exactly the wrong direction. As I neared the apartment I noticed that my trousers were wet. After a while I figured out a bottle of juice in my messenger bag was leaking. Finally got home, rinsed out my bag, put my trousers in the wash, and made dinner. The rest of the gang arrived a few minutes later, having also got stuck in traffic.

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