|Clothes drying in the sun|
We started fluid resuscitation, gave her what antibiotics we had available and I inserted a catheter into her bladder – pure blood came out and nothing else. We sent relatives to see if any had compatible blood but none did and then we had to try to decide what to do. It was suggested we should send her to Bahar Dar – blood would be more readily available there – but I was in no doubt – she would be dead before she got there. “no” I said “She is too sick to send away” And later I found out that the hospital vehicles are still non-funtional, so we wouldn’t hahve been able to send her way even if had wanted to.
My anaesthetist hesitated once we got her down to the Operating theatre – her pulse was 170 – he mentioned that in Ethiopia it is regarded as a particularly bad thing for someone to have died in the Operating room – better that they die with the family. Should we just send her back? Her blood pressure was still too low to measure and nothing else had appeared in her urine bag apart from blood. It was tempting – the surgery was going to be complicated and even if technically successful it seemed she may not recover – there was no blood, we coudnt get all the antibiotics we needed, her kidneys seemed to have shut down – was this perhaps one of those moments when instead of blundering on and doing heroic surgery that wouldn’t affect the outcome, it would be better to face reality and allow her to die with some sort of dignity, rather than just mutilate her and return a corpse to the family tearfully waiting in the dark outside the operating theatre? Once before I had faced a dilemma like this – it was a year ago in this same theatre when we began surgery for a ruptured uterus and found such damage to the uterus and the bladder I was urged to give up, to not even try to repair the mess. But then I reasoned there was nothing to lose by trying, so I did, and ultimately my Heath-Robinson bladder repair and ureteric reanastomosis saved her life – I was as surprised as anyone, having never before even observed let alone actually performed such surgery. It is a horribly difficult dilemma to face but I decided again that I would not give up without making some sort of attempt to save her. “OK” my anaesthetist said, “Can start” and he put her to sleep