COTW: 2=4

by Rachel

Our time at Tenwek has come to a close, too soon as always.  Thanks to the support of my gracious husband, who stayed home with the kiddos so I could work, I spent 11 days and took 6 calls on maternity.  I performed about 20 C-sections (from perfectly basic to quite challenging), half a dozen hysterectomies (one ranks in the top 5 largest uteruses I've ever done), and an assortment of minor GYN cases, in addition to remembering lots of clinical decision making and OB management.  It was perfect.  I was initially a little hesitant about taking six calls when I have a 3 month old who isn't consistently sleeping through the night, but grace is provided to those who need it!  Due to some governmental changes in health care here in Kenya, Tenwek's delivery numbers are down from the last few years (free maternity care provided at the district hospitals).  I don't know if that played into my calls, or if my "white cloud" came through, but many nights I didn't get called after 10pm or so.

My last call was on Wednesday.  I rounded with my team in the morning and in the antepartum room there were three women pregnant with twins.  All were doing well, none were in labor (although all three had come in with contractions at some point in time, and we planned to induce one that was post-term), and it gave me a chance to provide some teaching to the interns on one of my favorite topics.  I joked with them that this was actually quite timely, since I was giving the lunch time lecture that day on Twin Management.  It was a nice practical application.  Around 5pm I got my first call.  One of the ladies pregnant with twins had shown her self to actually be in labor, and her twins were both breech.  So up I went to the hospital and pulled out two beautiful babies via C-section, one boy and one girl, both by their feet (although the girl kept trying to come out arm first).  What a deal, I thought...a 25 minute surgery resulting in two healthy babies!

Three hours later I got my next call.  The mom with twins who we had induced that morning was fully dilated.  Unfortunately, she had been so for several hours and the first baby was not yet delivered.  I came up to assess the situation and decided she too needed a C-section.  Back to theatre, where two little girls emerged into the world, one head first and one feet first.  Another 25 minutes, another two healthy babies.  That was my last call for the night.  How blessed am I to have this job?  Less than an hour of work and two simple surgeries resulted in four babies.  That's a good return for my work. :)