Special Delivery    From Dr. Mark and Allison Karnes

Greetings from Soddo.  This week has been very different for me. A lot of my energy has been focused on one patient who I will talk about  later.  Also, Alice and I celebrated our 37th wedding anniversary June 8th, but on separate continents.  This was a for for us.  Usually we spend a couple of days going to a bed and breakfast along Michigan’s beautiful west coast.  Alice spent the day returning home to MI from Waco, TX where she had been with David, Betsy and Jack David.  I really missed her but was grateful that she could be with our kids and new grandson. It was a blessing that she was there because Betsy became very ill with gallbladder stones and spent four days in the hospital undergoing two surgical procedures.  While Betsy was in the hospital, Alice took care of Jack David who is now two months old.  Betsy is now recovering nicely and Alice has re turned to Michigan.

Monday afternoon upon returning to the hospital from lunch, I was informedl that a patient had just been admitted to our “ICU” with a ruptured uterus.  I went there immediately and found a young 15-17 year old girl (no one knows how old they are here), who was exhausted and frightened.  Her abdomen was distended and rock hard and looked similar to a two humped camel’s back.  There was no heart beat because her little boy had died at least two days earlier.  She hasd been in labor several days and had ‘pushingn down pain’ for three days. . She was feverish and her baby’s face was presenting at her vaginal opening.  His nose and dmouith couild be seen there, which is termed a face presentation.  She was septic, meaning that she had a life threatening infection.  We immediately took her to surgery and opened her abdonmen.  Upon opening it, we were met with a foul stench that filled the room.  .It was one of the most difficult cases I have ever encountered.  The head was entrakpped within the p elvis making the baby very hard to deliver.  The baby’s skin had already begun to slough off and as we attempted to deliver him it partrially peeled off in our hands.  Finally, afater muich stgruiiggle and maneuvering, we were able to extract him fromhis hyoung mother.  He was placed in a cardboard box on the operating room floor.  Next we had the task odf piecing together her sheredded uterus.  Since she had been in labor for such a long time the lower uterine segment was str etched out paper thin and torn.  It was like trying to sew butter or Jellow together.  The Ethiopian surgeons automaticallyt perform hysterectomies on any patient with a uterine rupture but I have found that the patients do better if we can save their uterus  if possible.  Hers was extremely challenging for several reasons:  she kept losing a lot of blood, her uterus would not clampdown, and she was severely infected.  Her postoperative course has been very rocky and she is acutely illto th is day and still may not survive.  She has a high fever and labored breathing.  Her lungs sound terrible alnd we are afraid she may be developing a pulmonary embolism.  We cannot give her Heparin because, No. 1, we do not have enough of the medication, and No. 2, we have no way to test her clotting lev els.  We have started her on  Aspiri,k our only available treatment.  She has received blood tranbsusions from three relatives, Dr. Michele,  our visiting resident from Muskegon and myself.  Her legs are swollen and ulcerated.  They look similar to an elephants.  She has no bowel congtrol and is unable to walk due to nerve damage from the baby being trapped in the pelvis for such a long time. Her Foley catheter will be in place for several weeks (if she survives) due to the fact she has no bladder control.  Hopefully, she will not develop a vesicle-vaginal fistula.  Her husband has been very supportive.  Please joinus in saying a prayer for her.  Her name is Tesfenesh, which means hopeful.  In the future, hoopefully I can share somen of our other patient’s stories but hers is the most pressing at this time.  Thank you for your prayers and encouraging words.

Mark

PS.  After writing this I went to the hospital and Tesfenesh is doing some better.  We are “hopeful” for her recover!

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