Today I went to morning report as usual. Overnight they had a transfer for a uterine rupture. It was a patient with 2 prior pregnancies (vaginal deliveries) who developed severe abdominal pain at about 7 cm dilation. The baby ended up dying and when brought to the OR at this district hospital she was noted to have a posterior uterine rupture. Very strange since she’s had no history of uterine manipulation or surgeries of any sort (that can weaken the uterine muscle and make it easier to tear during labor). The district hospital called CHUK to transfer the patient as the rupture extended into the broad ligament and they couldn’t get control of the bleeding. So they recommended tying a tourniquet around the uterus and transfer her immediately. That is something I’ve never heard of. A tourniquet around the uterus- the chief took pictures, thank goodness because I couldn’t wrap my head around a giant orange tourniquet around the uterus. I’d imagine this is what they must do in the army for acute control of bleeding. Well it worked and probably saved her life. The chief resident overnight did a hysterectomy when she arrived. Apparently the ureter was injured at some point during this whole ordeal so urology was called in to repair and place stents. IMPRESSED. The patient was extubated awake and talking by the time we rolled in for morning report. Also- in other news, the critical patient from yesterday is still alive! Still on pressors and unable to maintain oxygen saturation on a ventilator but alive nonetheless. She probably had a massive CVA. Not sure what her quality of like will be if she survives. Next was a transfer for GTN. Another GTN. JEEZ! This patient is 25 with no children and a huge cancerous uterus now invading her bladder and rectum. She is also thrombocytopenic and severely anemic due to melena (bloody bowel movements) and hematuria (blood in urine). So because of her instability she cannot get chemo which could possibly shrink the tumor down to make her a better surgical candidate and obviously no one wants to operate with the tumors invading into everything. THE CONUNDRUM! We had a heated debate and kind of left things up in the air. No plan as of yet but I feel like you have to mull this over just a bit. She will possibly die if they operate now and chemo may not be a feasible option at this time.
Next, I sat in on their resident meeting. It was 4 hours!!!!!!!! I won’t go into specifics but their concerns are very different from ours back home. They just want a vaginal probe, better ways to evaluate competencies, and to only rotate at hospitals which provide some sort of education. Sounds simple enough. They are also very vocal. It felt as though every single resident spoke. I think back to our resident meetings where you can hear crickets and lasts < 1 hr unless there is some bombshell news to discuss.
The meeting ended at noon. I was literally dying from heat with my white coat on and all 45 residents piled on eachother in this tiny room with no air conditioning. I ran out when it was over to get some fresh air. Magnifique found me in my secret snack spot over looking the rest of the departments and asked me what I was doing for the day…”eh nothing planned I guess.” I told him. So he invited me to the hotel Serena across the street for a conference. The Rwandan Medical Association. They were having a conference on medical emergencies in the context of Rwanda. So all these Rwandan physicians were in this conference hall collaborating and learning. It was great! Of course Magnifique was on some committee for this organization and coordinated the event. He’s such a busy body. He stretches himself way too thin and does everything super fast including speak! It all comes from a good place but it still makes me laugh. In any case it was a great experience and I’m glad I was invited to participate.