On Call

2008
Searwar, John E.

The anesthetist was frantically and literally pouring blood into the veins of a young woman, lying on the operating table, when the surgeon in desperation shouted to his young assistant, an intern, "Press the 'dam' Aorta as hard as you can". It was a last minute effort to control the profuse and uncontrollable bleeding.

This incident occurred in July 1959 at the Georgetown Public Hospital, the largest hospital in British Guiana, [now Guyana], the only British colony in South America. In this five hundred bed general hospital, it was not unusual for one doctor to be on call for Medicine, Surgery and Obstetrics and Gynecology, whereas in the developed countries, there would be at least one doctor 'on call' for each department. I was the young assistant just out of medical school and had had a very busy weekend . I was therefore eager to snatch a few minutes of well deserved rest. However, soon after 'collapsing' in the resting chair in the Emergency Quarters, the phone rang. I was called to the Obstetrics Ward. A young woman was having severe abdominal pains. In those days there were no ultrasound or CT scanning machines, so one had to rely on his clinical acumen. I examined and reexamined this patient but could not make a definitive diagnosis, so I called out Tracey, the general surgeon on call. Neil Tracey[an Edinburgh trained general surgeon] was covering for the Obstetrician, who was ill. Tracey responded immediately , but after a detailed history and a careful examination was just as baffled as me. He therefore decided to do an emergency diagnostic laparotomy, that is open the abdomen to have a first-hand look .

The anesthetist, Dr.Leslie Luck and the nursing staff were quickly summoned to the operating room and the operation began. When the abdomen was opened, it was discovered that this was a case of a full-term intra-abdominal pregnancy -- a very very rare occurrence. In these cases the fetus starts to develop in the Fallopian tube, which eventually ruptures. The fetus however in these very rare cases, instead of perishing proceeds to develop amid the intestines, to which the placenta becomes attached and from which it gains its blood supply. A healthy baby boy was delivered. The surgeon then indicated that he would remove the placenta [‘afterbirth’]. I was shocked. I had witnessed one such case during my six years of training at the University hospital and the placenta was left in place and it eventually absorbed. In a normal pregnancy the uterus contracts and closes off the blood vessels, thus inhibiting bleeding but the intestines cannot do this. I, in endeavouring to avoid an imminent disaster queried diplomatically in a loud voice, 'Is this the current practice'? The anaesthetist and nursing staff glared at me, but held their peace. Tracy paid me no attention and the hint fell on deaf ears. Tracey proceeded to remove the placenta which resulted in profuse and uncontrollable bleeding as the sinuses involved, cannot be ligated or cauterized.

Eventually, the obviously distressed and profusely sweating surgeon packed a sterile towel against the aorta, with one end exiting through the abdominal wound which was carefully sutured around the protruding towel. He removed the towel gradually, a bit each day until it was all out over a period of fourteen days. To his great surprise and relief the baby lived, the mother lived and most of all, as he put it, he survived, older and wiser.

Theme: History | Histoire
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Birth | Naissance

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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