Before I got to the nurse's station after the operation, I heard a commotion. When I got closer, I realized that there were seven or eight people in front of the nurse's station, talking loudly: "Where is the doctor? Find us a doctor quickly!" There was also a person who was banging the table of the nurse's station with a bag in his hand, threatening the nurse.
Liu Fang saw me coming over and said, "No, the doctor is here, and he has just performed the operation." She came over and whispered to me: "Postpartum patients, such as puerperal infection. There are many family members and bad tempers. "
opened the door of the reception room and saw an unkempt woman buried in a pile of thick quilts. When I examined her, I lifted the quilt and a smell came out. I asked about the patient's condition while examining her. It turned out that the patient had given birth at home 20 days after giving birth. The bleeding was not clean, and she started to have a fever this week. She went to the rural health center in the afternoon, and the doctor there said that nothing could be done, so she came here.
I then asked her about the situation when she gave birth to the baby. She said the baby was fine. I asked her if the placenta and had come out. She said she didn't know and asked me to ask her mother. I found the mother among the family members, but she couldn't explain clearly. She just said that the doctor was not in the village that day, and she and the mother's sister-in-law helped deliver the baby. There was a lot of bleeding at the time, and the placenta would not come out after the baby came out. They reached in and pulled it out. They didn't know that the placenta was completely missing.
I asked her if her hands were disinfected and she wore gloves when removing the placenta. She said she was in a hurry and didn't think much about it and forgot to wash her hands. I asked the pregnant woman if she should wash herself every day, and she said what to wash. In our place, pregnant women are not allowed to take a bath, brush their teeth, or get on the bed for a month.
The mother has a severe puerperal infection. The mother should urgently undergo a blood test to understand the infection, and a blood culture should be done to see if there is bacteremia . When reporting the situation to the second-line doctor, the second-line doctor instructed to fight the infection first, closely observe changes in body temperature, consider that there is still residual placenta in the uterine cavity, and perform uterine curettage surgery when the infection is under control.
At this moment, Liu Fang ran over in a panic and said, "It's not good, the mother started to bleed a lot." The second-line doctor stood up and said, "Let's go and have a look." When the family members saw us coming, they all gathered around and asked about the patient's condition and why we still didn't deal with it. The mother's condition is very bad, and the bleeding is increasing. The only way now is to risk uterine evacuation to clean out the remaining placenta in the uterine cavity and allow the uterus to contract and stop bleeding. However, the risk of surgery is also high for such a severe infection. The second-line doctor explained the condition in person. After hearing the second-line doctor say that the mother would have a uterine evacuation, the family members who had been noisy just now suddenly became quiet.
A man who kept his head lowered walked up to the second-line doctor and said pleadingly: "Doctor, please save my wife. She gave birth to a son for me. We have been to three hospitals since we left the village today. People in the countryside and towns said that we did not pay attention to disinfection when giving birth. They said that her stomach was inflamed and rotten, and that she could not be saved." After saying this, he cried loudly.
I quickly stepped forward and told him that all the patients in the ward were resting now and asked him to control his emotions first. The group of people fell silent. The second-line doctor called the mother's husband and parents to the doctor's office and carefully explained the risks of the operation. At this time, the three of them nodded in agreement with the mentality of treating a dead horse as a living horse.
This uterine curettage lasted for more than 3 hours. During the operation, the mother was not in good condition many times. Doctors from internist and anesthesiology department were constantly involved in the rescue. The mother's uterus was soft and bad. Because it had been more than 20 days after giving birth, the remaining placenta had been tightly adhered to the uterus, making it extremely difficult to remove. The director personally came to the stage. The second-line doctor asked me to call the sonographer and ask him to come from home to help with intraoperative monitoring.
The day has begun to get brighter, and the light shines in from outside the curtains. By the time the patient comes off the stage and the doctor's orders are given, it is already 6 o'clock in the morning. The family members of the mother with puerperal infection last night sent wedding candies to the doctor's office. They expressed their gratitude to everyone and said that they are welcome to visit their village in the future. The apples and pears on the fruit trees in autumn are especially delicious.
■ Text/Adapted from "Notes of an Obstetrician and Gynecologist" (written by San Yeqiu and published by Hebei Science and Technology Press)
■ Pictures except for the book cover are all illustrations
■ Editor/Xu Shanshan
■ All rights reserved. No reproduction is allowed without permission
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