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Friday, June 14, 2024

The 11th bag of blood saved the mother of twins

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By Dr. Adesina Adewumi
Every pregnant woman or mother-to-be should read this story. Some days we learn from the patients. Other days, we learn from what we do ourselves as health workers. I have the permission of Mrs Tosin Ajayi (not real names) to share with you her near-death birthing experience. It is a story full of lessons for both patients and the health workers, especially the doctors. It was a defining experience for me in my professional career.
It was at a primary health care centre where I was working as a young doctor. I was on call that day. It was around 3 p.m on a Saturday. I saw two army officers rush into our emergency unit shouting for help. It was the wife of one of them that was dying inside a car outside the unit. They were captains, each wearing three stars. One of them, Captain Ajayi (not the real name) was the husband of the woman dying inside the car. Our emergency nurses rushed to the car and wheeled in the woman who was in a pool of blood. She was bleeding. She had just been delivered of twin babies at home three hours earlier. I learnt the bleeding had refused to stop. I happened to be a newly employed medical officer at the health centre but I was reliably informed by the matrons in the emergency unit that they knew her very well. She did antenatal care in the centre but decided to go and be delivered at home.
I made a quick assessment. She was looking weak, drowsy, the eyes were white, the pulse was almost not palpable, and the blood pressure could hardly be recorded. This is what is called SHOCK secondary to SEVERE POST PARTUM HEMORRHAGE (primary type, because it is happening less than 24 hours after the delivery).
My dilemmas were many. In this primary health centre, there was no functional ambulance, and the next General Hospital was an hour away. I was not sure if this woman would make it to the General Hospital if I refered her in this state. I decided to try my best within the limits I had. I put up two IV lines immediately to rush in some water into her body to, at least, wake her up. I added a drug called oxytocin to make her womb to close well in case that was where the bleeding was coming from. I passed urethral catheter for her to monitor her urine output and the one cylinder oxygen we had, I put it in her nose. I sent down to our one-room lab if they could group and cross match the little blood I was able to take from her. As I was trying to check her vagina where the bleeding was profusely coming from, I was simultaneously interviewing the husband who, despite being an army officer, was crying like a baby, begging me like I was God to save his wife. He told me they didn’t plan to deliver her at home. The whole thing happened rapidly beyond their expectation.
As I was checking Mrs. Ajayi’s bleeding, I bore in mind the four Ts principle of cause and treatment of this kind of bleeding after delivery. The 4 Ts are TONE, TRAUMA, TISSUE and THROMBIN. Medical personnel will easily understand 4Ts but what does this mean to a lay man? It means this kind of torrential bleeding after delivery may be due to the womb of the woman opening down, refusing to contract and close (TONE); the woman had a serious tear somewhere from the womb to the vagina (TRAUMA); or it could be that part of the placenta did not totally come out remaining inside making the womb difficult to close (TISSUE). It could be that the woman had a bleeding disorder or overbleeding had started causing problem of more bleeding for her (THROMBIN). I frantically searched for all these 4 causes in her but the first three seemed not to be there. It was looking to me like this woman was having a bleeding disorder (THROMBIN) making her blood not to clot well. I was not able to conduct tests to confirm this in the little health facility.
By now two bags of blood had arrived from the lab. I quickly rushed in these. It was as if I provoked the bleeding more. It became more torrential. I asked the husband and friends to donate but unfortunately the husband could not because of a medical condition. The friend donated one bag. She was given, the bleeding continued. At this juncture I was left with no option than to donate one bag of blood myself. I gave the 4th blood bag, but the bleeding continued. It was as if we were pouring water into the basket. There was a component of blood we could use in this type of patient if what I was thinking and working with was what she had. You don’t necessarily have to give the whole blood but the facility lacked the machine to do blood separation. I was left with no option than to look for more whole blood. Here there were no more people to donate the blood. I saw life leaving this new mother of twins, for the first time in my short career.
I wept openly before patients and other health workers. I picked up my phone kept calling all my friends to come and donate blood for this woman. Heaven heard my prayers that day. After hearing my story on phone, people started trooping in to the hospital for voluntary donation. I continued the blood transfusion as more blood was available. The 11th bag of blood saved her life . The bleeding finally stopped. I reassessed her. She was now stable a little. I knew anything could start again. I had to quickly make arrangements for her to be transferred to the General Hospital. I exchanged contact with the bus and. They were escorted by two of our nurses to the General Hospital. I continued calling them in the other hospital day by day to see how they were doing.
After three days, I called to know how she was doing. I received very bad news that she had gone into kidney problem because of the overbleeding, she was not making urine and not passing urine much. This is what is called ACUTE KIDNEY INJURY secondary to HYPOVOLEMIA. Dialysis was commenced for days. I called after some days again. I was told she could not talk again as she had gone into coma.
I wept again, but this time around, alone behind the closed door of my consulting room. I prayed to the God of heaven who could do all things. I wept before Him on behalf of this patient and I presented my case to God by reminding Him about those twins who had been takng artificial milk formula since they were born. I reminded Him, as if He was not the Omniscient One, that if this woman died, who would take care of the twins.
God heard my prayer. After some days, I called again, and was told she was now making and passing urine and had come out of coma. She had started to eat. For the third time, I wept inside my consulting room, but this time, it was tears of joy in praises to the true God of Heaven who heard my cry over the mother.
Six months later, I saw a call come in, it was Captain Ajayi. My heart skipped beats.
“Doctor, hold on, somebody wants to talk to you”. It was Mrs Tosin Ajayi.
“Thank you for saving my life”.
I wanted to cry again but I held it back. “Who am I to save you, madam. Only God saved you, return the glory to Him,” I muttered.
Their calls practically became a yearly affair to greet me and say thank you. The call that finally touched my heart most came two years after the incident. As usual Captain called and said “Doctor, some people want to greet you”.
I said, “hello”, and on the other side were the two voices in their wobbling little childlike way echoed back to me “eyo”. It was the twins’ voices. That day was their birthday. It was a great day in my career as a medical practitioner. I refused to be overwhelmed by tears of joy. Their mother greeted me, too. To this day, I have practically become a member of the Ajayi’s family. All Glory goes to God.
What are the lessons I learnt from this story?
Lesson 1: Never be delivered at home if there is no arrangement for home delivery for you by your health workers, and you are really prepared for it. Much more, never, never try to deliver a twin pregnancy at home.
Secondly, the essence of doing antenatal care in hospital is not for you to be sure there is no problem with you so that you can be delivered at home. Please, I plead with you, any hospital you do your antenatal care, make sure you are delivered there.
Moreover, please come to hospital on time when labour pains kick in. Don’t say, “I will go to hospital later when it is a little time left.” You can’t afford to waste time or even risk comparing a present pregnancy to previous ones. Each delivery experience differs. Some are faster. Some are slower. It is better to go and waste time in hospital than to deliver precipitatively at home, and probably die in the process.
Finally, this advice is to fellow health workers especially doctors: please try and treat every patient with empthaty. Treat each patient as if the patient is a precious and priceless life. Almost as if a family member that must be saved. Then you will have the zeal to go the extra length to get the 11th bag of blood, if that is what it will take to save the patient’s life.
Dr. Adewumi is with the Department of Family Medicine, Aminu Kano Teaching Hospital, AKTH, Kano, Nigeria.

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