Two patients were lost in a day

It is sad. We lost two patients today. The pregnant woman with burns whom we sent to Benson Hospital on Friday, died that night. The baby was stillborn. The mother's blood pressure remained low after transfer and she succumbed hours later. I recalled that her blood pressure had dropped the night before. We were all busy with the two laparotomies and I had just ordered to give her some fluid therapy. Her low blood pressure may have caused the baby's death, but the cause of the sudden drop in blood pressure was really unknown. She had low-grade fever. We had changed the dressings before transfer. The wound was clean and did not look infected. We had only twice used short general anaesthesia with ketamine for dressing the wound. The wound was superficial and clean. We had monitored the baby daily and it was active all along. We don't know how much the nine months of pregnancy and more than thirty percent surface area burns, although superficial, had stressed her physiology. We did not have any antenatal records. She was young and healthy. The haemoglobin was not low. We should have performed the Cesarean Section earlier, after she had recovered from the acute burn phase. We might have saved both of them. I regret so much and feel sorry for the family. The second loss was a five-year-old boy with pulmonary tuberculosis referred from Island Clinic about two weeks ago. He had pus collecting in his left lung. We had put in a chest tube to drain the pus. He developed massive hemoptysis the day after but was resuscitated with a transfusion. The infection was not under control and the pus recollected. We needed to put in the second tube for him yesterday morning. He deteriorated in the afternoon. When he came in he was already only skin and bone. We thought he might die a few times. He finally had a release from his suffering. His mother was very sad. So far, I have witnessed two young patients die of uncontrolled tuberculosis, an expected treatable disease in our locality. It is sad. But the result of the two laparotomies, one for a five-year-old boy with typhoid perforation and the other a thirteen-year-old girl with a ruptured appendicitis and intra-abdominal pus collection during the last two nights, was good. Both were admitted in very poor condition. We thought we might lose both of them. But their condition improved so much after surgery. They are stable for the time being. Hope they may remain well. We really learned that life is not under our surgeons' control. What we can do is just so little and we can only try to do what we can with the resources available. I had a chance to visit the Mercy Ship this afternoon. There was a Malaysian Chinese girl named Janice who arrived in Monrovia last Sunday, and went to Mercy Ship to see a friend working there. She comes from the MSF Hong Kong office. She is a pharmacist and comes here to work with MSF Spain and MSF Switzerland at Benson Project for six months. Au Yiu Kai