Day 16, Lady Sybil

Day 16/46 of the daily Lenten blog

I think I’m bored of yesterday’s topic, let’s move on to something different, shall we?

Nah, just kidding.  Here we go: So I sprinted over, rounded the curtain, and was horrified to find…

A 17 year old girl named Jan (not her real name), with a large round belly, having severe seizures.  Our team was already reacting quickly, addressing her airway, getting an IV, using an ultrasound to check the round mass on her abdomen (which was a baby).  She was 8 months pregnant with her first child.  She was, of course, experiencing one of the most dreaded complications of pregnancy, called Eclampsia.

Eclampsia belongs to a spectrum of disease in pregnancy that we doctors don’t understand completely.  There are many ways to try and detect it before it results in seizures and danger to baby, but it can be tricky to manage properly.  2 things that we know:  1). If left untreated, both mom and baby can die rapidly.  2) the treatment for both is usually to get the baby out as fast as possible.

I’m sure many of you are mentally referencing Season 3, episode 5 of Downtown Abbey, in which dear Lady Sybil dies of complications from this affliction.  Remember how arrogant Sir Philip Tapsell, Obstetrician, ignored the warnings of the old country physician, Dr. Clarkson?  He told them to perform the controversial procedure, Cesarean Section.  But they ignored him, and she died.  Yeah, that was sad…  I want to assure you that immediately after enjoying this program, I cleansed my brain with 6 episodes of Meateater back to back.  No loss of man points.

Back to Jan, the ultrasound revealed that the baby’s heart beat was slow, which is a bad sign.  We started giving Jan Magnesium to lower her blood pressure and stop the seizures, and the seizures did indeed stop.  Then we wheeled her to the OR while everyone prepared for potential surgery.  Complicating matters, her platelet counts were low.  Platelets help you stop bleeding, which is a handy function when someone is about to cut into one of the most vascular organs in the body, the uterus.  A woman can bleed to death fast if she cannot make clots.

Half our team focused on Jan, performing the C-section, getting blood transfusion ready, keeping magnesium running, etc.  The other half prepared for the baby to come.  Because mom received magnesium, and was getting general anesthesia, we were expecting a potentially floppy baby.  We were not disappointed.

As soon as they pulled the baby out of the uterus, they ran him over to our Neonatal warmer where we got to work (it was a boy, BTW). He wasn’t breathing or moving, but in our favor, his heart was beating well.  We gave breaths for him, gave him oxygen, dried him, gave IV fluids, Prayed, and did a bit of cheerleading (“come on, little guy, CRY!”).  Slowly but surely he came around and eventually rewarded us all with a mediocre squeal; we gave him a 6/10 on the cry-o-meter.  We eventually were able to leave him with just some oxygen support.  Our team had won!

Meanwhile, the other team was closing up Jan without any complications.  She was doing well, no more seizures, and her blood pressure was under control.  They had won too!

the a team 80s GIF

This was one of those rare times when everything went just right in a potentially disastrous situation.  As of this evening, mom and baby continue to be doing well, and we are all praising God for this gracious outcome.

Join me as I pray for my patient, Daphne.  I just wrote about her HERE on day 6,  I had to admit her back into the hospital yesterday, and she looks terrible.  Her heart is getting worse, and I fear it is a matter of days left for her.  Her family is gathered around her.  We are perseverating over anything we can do to help her.

Photo of the day:

Honduran Bull.  Most of the cattle down here are some sort of Brahma.

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16, in the books.  See you tomorrow.

 

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