Emergency Caesarean Section in 10 minutes

Once again, Monday has been busy. While I was doing a change of dressing for a small girl with burns, our field coordinator came to the OT and told us that a pregnant woman had been admitted to ER with the umbilical cord prolapsed out of her vagina. The coordinator asked me whether we could handle this case here. If not, we needed to transfer the patient to Benson Hospital. I went to the ER and found that the woman was in labour. The umbilical cord was hanging out of her vagina, still with a strong foetal pulsation. We couldn't wait, nor transfer the mother to other place. I called for an emergency Caesarean Section and we went in to operate immediately. From the time of her arrival to the ER until the baby was delivered, it took less than ten minutes. Both mother and baby were well. I then took about thirty minutes to finish the operation. Although I have not done a C-section for four years since Kenya, I think I did it as well as any obstetrician. I must say we have a very good team in Mamba Point Hospital. One of the ICU nurses came in to help with resuscitation of the baby. Every one of us was so excited once we received a big cry from this baby. It's a boy. The mother was happy but had not yet recovered from her terror and worry. The baby looks small but weighs 3.27kg. They told me that African babies are strong and heavy weighted. They asked the mum to call the baby, Paul. So from now on, I have two babies in Africa. Since then, emergency cases have been rushing in. One of them, which is also the most exciting, was a nineteen year old woman with abdominal pain, low blood pressure of ninety over sixty and severe anaemia with haemoglobin of 4.7 (normal: 12 to 14 for woman in HK). Her abdomen was distended. John performed the ultrasound and I did the most direct test by inserting a needle. It was an ectopic pregnancy. We immediately arranged the OT. I went to the blood bank and asked for an urgent blood transfusion. The woman's blood group is O positive. Two of her relatives were of different blood groups, one A and the other AB. Luckily, there was stock of group O in the blood bank and we went in for surgery at once. There was more than three litres of blood in the abdomen. It was a ruptured tubal pregnancy. The vessels were still spouting when we went in. The operation went smoothly and the woman is well. We took a short break and then did a close reduction for a strong young man with shoulder dislocation. Before induction, the anaesthetic assistant advised us to put the patient on the floor for easier manipulation. As we need to use counter force on either side of the shoulder to distract the dislocated shoulder first before reduction, it is much easier for us to put patient on the floor. We took his advice. Can you imagine? The patient was lying on a mattress on the floor with the anaesthetist and surgeon kneeling down by the patient as playing Judo. All of us were very interested. The two strongest guys in OT were responsible for the distraction, one was John, and the other was Momo. It only took one pull for a successful reduction. Everybody cheered. This is FUN! I left John for the remaining two emergencies and departed from the OT with sweat, laughter, satisfaction and happiness. Au Yiu Kai