quinta-feira, 11 de março de 2010

Mother of 10

I think that this is a nice music to hear while reading this story....

I am far away, and very emotional at this moment and maybe that is why I decided to write one of the most intense, difficult to share, and painful stories of my life in Congo.

I decided to write this stories and somehow make them immortal because I don’t want to forget, and I don’t want people to forget what is the reality in some places of our planet….I want that my insignificant voice reach as many people as possible, and tell how unfair life can be for some, and how important it is to be aware of this distant reality, for most of us…

And distant not only in terms of geographic display, but most of all, distant from our eyes, from our years, from our mind…. It makes me sad that some wars are so “famous” and get so much international help, and some others, nobody knows, nobody cares, and because of that, will go on forever causing suffering in millions of innocents, that think about PEACE as a dream impossible to achieve….

By knowing our heart will be touched, and after that for sure we will help; with money, with ideas, with our work, and by changing the mind of the ones that make important decisions…. And believe me, it feels really good to help those that need the most and appreciate our help so much…..

The story now….

It was a Sunday afternoon, and I was called to the hospital….nothing new, it happened almost every Sunday that was suppose to be our relaxing day…. There was a 39 years old woman, that gave birth to her 10th son, and she was bleeding continuously after delivering…. For a while they tried with all the available medicines to stop the post-partum bleeding…. But no success! So it was decided to try to stop the bleeding surgically…..when I arrived to the operation room, while getting dressed I knew immediately that it was very serious, I could hear the heart rate (from this device that we had to access the oxygen saturation and the heart rate)…. Bip, bip ,bip , bip …..it was 180 beats per minute….way to fast…. first sign of serious bleeding and hemorrhagic shock …. When I entered the operation room, she was conscious , very low blood pressure 60/30 mmHg…. And I knew that whatever it was that we were looking for it was probably too late…

On that moment….a million things that we don’t have cross, my mind…lab exams that we use almost automatically in our world, but there we could only measure the Hemoglobin level, and that was about it (concerning the lab work that I would need to access that patient properly)… So many times more than ever it crosses my mind “ I wish I was with this patient at home….” The hemoglobin level was very low…. 5 mg/dL….in the begging of the surgery, and she was going to bleed more for sure…. Luckily we had 2 packs of red cells available that matched her blood time…. I say luckily , because our blood bank was always empty…. That population, doesn’t like to give blood….I think that they see it as giving a part of yourself way….like giving a leg or an arm….so they almost never give their blood even if we explain it very well…I guess that they just don’t believe in the strange white people many times !!

I had to intubate the patient (placing a tube in the trachea through the mouth) to protect the airway , and control the ventilation….The surgery started…..they opened the abdomen to see what was wrong…. She had what we call Uterine Atony….. the Uterus was just not contracting anymore….and that was why it wouldn’t stop bleeding…. She just had her 10th baby, and maybe even with more pregnancies in the middle ….. The Uterus, is just not made to be used so many times…. Even though we insisted so much in family planning, for many reasons….these women just don’t stop having children….and probably the biggest reason is the fact that men just don’t accept to use condoms, or even allowing their wives to take the pill…. Because they believe that it’s a sign of their manhood the number of children…. This is very common in “this Africa”…..

The surgeons tried to control the bleeding, but is just the whole Uterus that is slowly bleeding everywhere….for a while they had doubts if they should remove the Uterus (Hysterectomy) or not…. I just told them…. “Do whatever you have to do to stop this bleeding as fast as possible…. Here condition is very critical and it will be difficult for me to keep her alive….and for sure tomorrow she would never survive a second surgery”…. Because I knew that if she would survive she would stay in a critical state for some days…and would never be strong enough during those days to another surgical intervention….not there, not with the conditions we had ….. So they decide to remove the uterus…. Meanwhile, I was trying to control her life, the vital signs, despite the blood that she received….her blood pressure was still low and dropping….and she needed a lot of fluids…. And this is the dilemma!!! Fluid management….too less and her blood pressure would go to low, killing her by lack of perfusion of the main organs (brain, kidneys, heart, liver, lungs….) too much fluids would cause her lung edema (too much fluids in the lungs) killing her after I would remove the endotracheal tube….

I was trying to give her the maximum that I thought that she could handle….and also adding adrenaline (to increase the blood pressure and compensating the inflammatory reaction of the surgery and the transfusions)…but its very difficult to use adrenaline without a perfusion machine, that I didn’t have…. as the flow rate has to be totally exact ….

In my mind is a patient….mother of ten….and the science that I had to use in order to save the life of this woman….

The surgeons finished the surgery, and were happy about their job…and they did a very good job….but I told them….the worst is yet to come….removing the endotracheal tube…

I am a very young doctor with a lot to learn, but with some experience on my favorite area of Anesthesiology….Critical patients…. Dealing with life and death….

After a few minutes, waiting for the effects of the general anesthetics to wear off, I took my time to see if she was able to breathe by herself, and accessing the lungs about the lung edema … The blood pressure was always very low, even though I gave her a lot of fluids and the adrenaline flow rate was quite high….. What she needed was good Intensive Care….and to stay mechanically ventilated for few days….but we had nothing similar….

When I thought it was the right moment, I removed to tube….and she developed this very serious lung edema very fast….causing her heart to stop !! I intubated her again and started cardio-pulmonary resuscitation for a while, compressing her chest as hard as I could, with sweat falling on my hands…. But I lost her…..She died….in my hands….

I have seen many people dying in my short career, and many times I took them in my mind with me for a long time ….but never like this one….. For the first time in my life I had the feeling, that maybe it was my fault, maybe I did something wrong, maybe I could have done better…. For the first time I felt guilty….and until today I think about it with doubts if I could have done better…. I wish I had, there, somebody to share decisions to agree or disagree with my actions….but there was nobody with knowledge of critical patients to take my nightmares away from me….

She was mother of 10 …. we had no idea where the father was…. The oldest children was a girl with 14 years old, already taking care of the newborn and now with 9 brothers and sisters to take care for life…. It was just too strong to see this scared young girl with a baby in her arms receiving the news that her mother was gone…..

I went home, and I suffered in silence for hours…. My colleagues tried to shear me up, saying that I did all I could …. But I just didn’t feel that…. The sad fact that this woman would never die in my hands if I had the means…. And the guilt!! Did I do all I could? Did I do it right?

Was I responsible for these 10 innocent kids being orphans?

Staring at the sky full of stars trying to get answers, of these questions that I asked myself so many times was how I spent that night…. But that sky that covered the beautiful mountains of Eastern Congo, full of life, full of pain….full of war…..gave me no answers….

10 comentários:

  1. Olá Gustavo...
    Não te culpabilizes por uma situação da qual n tens culpa...Trabalhamos com pessoas e todos os minutos estamos a lutar a favor da vida e contra a morte; infelizmente nem sempre vence a vida. Não te esqueças que todas as nossas decisões estão e vão estar sempre carregadas de "e se". Neste caso: se estivesses cá..., se tivesses sangue..., se tivesses uma unidade de Cuidados Intensivos... e se Cá tivesse havido uma intercorrência qualquer e ela tivesse morrido na mesma? Não me parece q tenhas feito nada de errado. Quando voltares a olhar para o céu não procures resposta mas "procura" esta mãe porque o melhor que podes dar a estas 10 crianças é q n deixes caír esta senhora no esquecimento.
    Quanto a ti, agradeço-te: 1º por ver que o "nosso" menino Doutor se tornou num homem com muito valor, 2º por partilhares as tuas histórias e me ajudares de certa forma a "viver" um sonho antigo que sei q n posso realizar.
    Continua o bom trabalho.
    Orquídea (BOC do HSJ)

  2. A sensação de imenso vazio deixada pelo teu texto foi, provavelmente, a mais real, a mais pungente que senti nos últimos tempos. É que estamos tão longe desse lugar duríssimo onde a vida se define que, vezes demais, porque a imaginação não chega para nos tirar daqui, chegamos a pensar que a rotina importa, que vale tanto pensar no dia de amanhã como na terrível injustiça que recai em seres humanos exactamente como nós. Entre outros pensamentos que agora me ocupam, há um que quero dizer-te: a tua dedicação é de uma enorme coragem, tem um valor incomensurável, não depende de êxitos, mas sim de perseverança, está vinculada às circunstâncias e é admirável.
    Abraço-te de longe, de longe no tempo.

  3. grande historia Gusto ... tens aqui um fa do teu blog...grande abraco Leo

  4. Gu, que bom partilhares tuas histórias, esta última tem um final muito triste, tinha que acontecer, ainda bem que estavas lá, grande abraço

  5. Incrível Gustavo, posso dizer que te admiro muito!.
    Um beijinho e um abraço cheios de Força!

  6. porra....sem palavras...sinto-me mesmo muito muito pequenina......keep up the good work, keep caring, and keep sharing your stories and your memories please! sao uma fonte de inspiraçao e motivação!
    grande beijinho, carla

  7. Emocionei-me ao ler este relato! A tua tristeza e dor reflectem o teu humanismo, boa fé, solidariedade. Mais do que isso, são a prova cabal de que tudo fizeste com os meios que tinhas à tua disposição para que o desfecho fosse outro. Dou-te os parabéns pelo que fizeste, a forma apaixonada como o fizeste e a sinceridade com que transmitiste o k sentiste.
    Sinto grande orgulho em ti!

  8. Não há palavras para descrever o que sinto.... nem sei o que escrever!
    Quero-te agradecer por partilhares as tuas histórias.
    Muito obrigada!
    Susana Sousa

  9. Sometimes I think about the disparities and inequalities of our little world. So small that Kalashnikov and other means of destruction are all over the place, children's toys as you say, and so great that what we now consider most basic health care treatment can not cross borders ...
    What you shared here is what frightens me the most when I think of mission, sense of failure!
    I tell you this because I know I would feel and think exactly the same way you did ... but it would not be rational!
    You cannot require of you and life the same when the variables are so different ... support, conditions, technology, ...
    Your experience? It's a valuable input, not a limitation.

    Life it's just not fair. That's why you went to Congo, right?


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