20 minutes to live....

The day before yesterday as I was seeing Gynecology patients in the "office", the Midwife Bernadette called me. Shes states that a patient was brought in, carried by her relatives. She stated that a patient that I had seen earlier today was sick.
This patient came to the office earlier that day with a + pregnancy test. Here we do not have the capacity for a Quantified HCG. But on ultrasound there are no POC (products of conception) in the uterus. I was worried about an ectopic pregnancy, but the Fallopian tubes were normal appearing the ovaries appeared normal. The pt had no pain and was stable. No vaginal bleeding. the uterus appeared a little enlarged but not anything that at that time appeared worrisome. So I recommended close follow up and for her to return the next day and THANK GOD I put on the paper, return sooner if sick. (not that there is any legal ramifications here from any documentation, but for my peace of mind)
Well, when I go to see the patient she is hypotensive, tachycardic, pale and has severe abdominal pain. So when I placed the ultrasound machine on her pelvis, there is an abdomen full of blood!!!!
I explained to everyone present that we need to go to the Operating Theater right NOW. But typical response, no fast movements, so I said in a loud and deep voice.
" If this patient is not in the Operating Theater in the next few minutes she will die! She has 20 minutes to live!".
So I got a fast response and everyone amazingly worked super fast and hard, and she really was in the O.R. quickly.
When I made my incision, mid-line I could see purple under the peritoneum. The abdomen was full of blood. The blood was just pouring!!! The ectopic pregnancy had ruptured!.
It was an ectopic in the cornual region of the uterus which is so bad because it is difficult to detect, difficult to remove and to fix.
I grabbed packing and quickly packed her abdomen. I could not see anything because of the literal fountain pouring out of her. So I used my hands to grasp the uterus and followed down the tubes and felt the rupture on the right side.
I squeezed it closed and the blood stopped!! Thank God!!! Then I placed the clamps, no bleeding!
Then I performed the surgery to fix it. Of course this place is part of the uterus so unlike the tube we can't remove it.
The patient today is doing well postoperatively.
Today Saturday I was called back to the hospital, a mother had been brought in bleeding after a spontaneous abortion this morning. She was at home bleeding for 12 hours. On ultrasound she had a piece of placenta in her uterus still. By the way I am the one performing all the ultrasounds. With my hand held ultrasound. Thank you CMMB. We performed a STAT D&C and now she is doing well. This was her 11th pregnancy.
Because of the polygamy the older wives are trying to keep up with the younger wives, so they keep getting pregnant when the younger newer wives get pregnant. Not really an ideal situation.
Life here is so fun!!!!
The people are very friendly,
The food is great.
The Church is exciting, vivacious and ALIVE!!!!
Praise to you Lord Jesus Christ!!!

PHOTOS....

 Pentecost Sunday, I read the First Reading in English as there is a large Ugandan, Congolese community that does not speak Azande.

 Using the Amazing ultrasound CMMB gave me to bring to Ezo. The women of Ezo love it.

 In the Operating "Theater" doing a Cesarean Delivery. Notice no electricity so we use a flashlight or "torch" as they call it here.

In the OR after delivering the Conjoined twins. The Theater Attendant or OR Tech is using a head lamp so we can see as it weighs a lot and kills my neck if I use it.

Before we send her to jail......... let's save her.....

On Friday, I am in my office seeing our daily 30-40 patients, Mostly Gynecology. Mostly enormous fibroids. (Yeah!!! myomectomies and hysterectomies).
This is not counting pregnant patients. Patients that are already in the hospital. Patients that  I am called to see on other services.
In come 2 staff, "Dr Consoli, this lady is trying to commit a "criminal" (their words, not mine) abortion. This is the second time she has come. She has a positive pregnancy test, she has some vaginal bleeding." "Should we prepare to call the police?"
I see the patient. She appears ill. She is diaphoretic (sweaty), tachycardic, tachypneic, she appears in pain.
I perform a pregnancy test myself. It is positive.
On ultrasound (thank you CMMB and Safe Motherhood for the ultrasound) she has as if from a textbook, a molar pregnancy. Anechoic spaces, snowstorm or granular appearance.
I explain that she has no fetus in her uterus.
She has a molar pregnancy which is dangerous.
They ask me if she already "got rid of the baby". I explain that this is a A molar pregnancy — also known as hydatidiform mole — is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy starts when an egg is fertilized, but instead of a normal, viable pregnancy resulting, the placenta develops into an abnormal mass of cysts.
There is no baby. There is no termination.

We took her immediately to the Operating "Theater" and evacuated her uterus.
She stabilized.
I finished seeing my patients.
The police are not bothered.
The next day, on Saturday, early in the morning I stopped by the hospital to check on her. She was doing very well.
She told the interpreter to tell me that even if this Doctor calls the dead, they will rise.
Thank you but....... no, in scientific terms we evacuated the molar pregnancy and all is well.
Only Jesus raises people from the dead.

Another interesting story is.....
Every night I gather with 20 of the neighborhood children from 3-17 years old. Mostly teenage girls. We say the rosary/pray then we talk.
We talk about different topics. Mostly about my life. They want to know every detail about me.
They can't believe I have no children and HORROR... I am not married!!! Hahahaha......
So one of the girl's mother, wanted me to help the baby. She was saying that the baby has anemia. So she was giving her watered down tomato paste!!!
I explained that the baby looks healthy. Has pink mucous membranes. Is well hydrated. Probably the watered down tomato paste is not needed.
She looked at me like I was an idiot. "Doctor, do you not see the tomato paste is the color and looks like blood. So we are helping her. ".
OK.....
Continue.
What a silly person I am. Of course this is the way to go.........
I now know how movies stars and celebrities feel.
Every where you go EVERYONE stares at you. Everyone wants to shake your hand.
Every one wants to know everything about you.
Every one stops doing what they are doing when you walk in a room.
Wow!!!!!
What a privileged person I am.....
I am really enjoying it here in Ezo, South Sudan.
Saint Catherine of Siena (a Doctor of the Catholic Church) said, "If you are doing what you are supposed to be doing, you will set the world on fire!".
I really feel like I am doing what I am supposed to be doing.
Praise be Jesus Christ now and Forever!!!