CHAD
26 MILES S
Originally from the United States, Danae Netteburg is an obstetrician/ gynecologist who has served in Chad for more than eight years.
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heer terror. That’s the only thing I can think of that describes our feelings in the situation we were in. One of our doctors, Sarah, called me at one o’clock in the morning. “Hey Danae, can you please come to help me with a uterine rupture?” “OK, I’ll be right there.” Sarah had been up laboring with a pregnant woman. Her contractions had stopped, so Sarah vacuumed out the baby. Tragically, the baby was already dead. But the patient kept bleeding and bleeding and bleeding. Sarah realized the woman had ruptured her uterus and called me. A tear in the uterus is extremely rare in America, but it seems that it’s my bread and butter here. I head to the operating room to meet Sarah. Five saucer-eyed nursing students stare back at me, clueless as to how bad the situation is. I call the anesthetist, Philippe, and as we wait for him to arrive, we try to get a good IV in the patient. But all we have is a tiny catheter that’s unable to drip fluid into her fast enough. It’s never going to work. I apply firm pressure on her lower abdomen with a second hand inside her to try to compress the bleeding vessels, but it isn’t helpful. Instinct sets in: must stop bleeding. “Foley, please. Call the other nurses from the other services. We need a good IV! Call Staci to come help.” We have nobody here to do anesthesia. My physician husband, Olen, is out of town. Staci, another doctor, can help direct care. Still nothing better for an IV.
Any moment, Philippe should walk through that door and place a good IV, and we’ll be all set. I just have to stop the bleeding right now. No Philippe, but Staci shows up. The patient starts making gasping sounds. I cut into her abdomen with zero anesthetic. She’s lost so much blood that she barely flinches. (Not a good sign.) I grab the uterus at its base, stopping the flow of blood. That’s all I can do for now. She’s so close to death. It doesn’t matter whether I do a hysterectomy or not now. I’ve stopped the bleeding with my hand, but if we can’t get a better IV, we’ll lose her. I just squeeze. She has no blood pressure, no response, no sign of life. Philippe, our anesthetist, shows up. He tries to get a better IV. We administer all the appropriate medications and fluids. But it’s all simply too late. I ask Sarah to squeeze the uterus while I start chest compressions. I’m trying to run the code, directing traffic to give chest compressions and breath for the patient and give IV medication. Too late. All too late. Just keep pumping. She can’t die. She labored at our hospital. She’s our patient. My hands and arms grow tired. The sweat is dripping down my face. Thinking what else to do. But it’s too late. After a long time, while we’re still trying to resuscitate the patient, I go out to talk to her family. Her husband is there. I ask how many children they have. Three. I tell them how bad the situation is. I go back inside. We’ve tried resuscitating her for more than an hour. We call it. She’s dead. I give the news to the family. The mother of the patient was in the maternity ward and wasn’t
told her daughter was actively dying. Now, she’s actively grieving. Even when there’s a death, there’s still work to be done. We do a cesarean section on a patient that was supposed to be done prior to this last emergency. Everything goes well, but now it’s five o’clock in the morning. We’re all beat. We debrief some and then go home to sleep a couple of hours. Sheer exhaustion. That’s what happens after a stressful situation like this. Sheer depression. The next day at work, I find out the patient had been waiting for a month at the hospital so that she could have a safe delivery. The baby died in labor, and the mother died after a vacuum delivery from a postpartum hemorrhage. A month living at the hospital to ensure she didn’t die in labor at home. And she dies here, instead. Deeper depression sets in. We failed. I failed. After a month of being safe. But there’s still more work to be done. I still need to go around and see all the hospitalized patients. Operations on normal cases. Lots of consults. Sarah had gone home to get some rest. I told her that she should take the day off because she had been up most of the night. But she’s taking it too hard to be at home, so she comes back to work in the afternoon to help us with the consults. She’s amazing and smart and strong. She presents a patient to me named Deborah* who had a vesico-vaginal fistula, an opening between her bladder and her vagina. It was the result of being forced to labor at home for days before finally being allowed to go to the health center to deliver her baby. Deborah had come to us as a very sad case three years before. Olen had walked by her and smelled her diagnosis. She stunk
