Dr. Carrie was in trouble and she knew it. Jane’s surgery had been a routine until she was suddenly bleeding uncontrollably from multiple sites. To complicate the problem, Dr. Carrie was the only surgeon with her surgical research assistant, Dr. Ron, in the operation room, in that tiny five bed rural hospital. The blood bank was twenty miles away and no pharmacy nearby.
When Dr. Carrie saw the marginally equipped operating room, she was thankful that she had brought a bag from home, containing over thirty pounds of scalpels, suture materials, retractors, clamps, forceps, scissors, hemostat clamps, needles and syringes. As Dr. Carrie and Dr. Ron entered the surgical room, they saw a couple of overhead LEDs illuminating the rectangular room; the lights were bright enough to not provide any shadow. There was an operating table in the center of the room which was spacious and clean. The anesthesia machine was at the head of the operating table which had tubes connected to help the patient breathe. The anesthesia cart was next to the anesthesia machine with medicines, equipment and other supplies that the anesthesiologist might need. Sterile instruments were lined up on a stainless steel table. Adhesive patches to measure the heart rate were kept in a clean tray. There were viewing screens and monitors. The room was windowless and featured controlled temperature and humidity. In case of black-outs, there was support for back-up. Although, it was not uncommon for the lights to go out in the middle of an operation, in case of urgency they would simply move the operating table near the window, and the surgery continued as if nothing had happened.
“The oxygen tank will last only for two hours. We’ll have to set the timer right before we start the procedure,” Dr. Ron said with urgency. “I’m sure we’ll be done in two hours.”
“You bet,” Dr. Carrie said with little concern. “It’s not new anymore, this is our third week in this hospital. Let’s do it.”
Dr. Carrie had found to her amazement that even under such primitive conditions, her surgical outcomes were as good as in her modern hospital back home, but she always wondered if there was something more than good fortune behind those results.
It was Dr. Carrie’s regular routine trip to one of the outer islands of Papua New Guinea. All of the Papua New Guinea people who were suffering, including the affluent, wanted to see the “American” doctors, but the mission prearranged clinic visits only for the indigent who could not afford medical care. This was Dr. Carrie’s way of giving back, at least partially. With her obstetrics and gynecology speciality, most of her surgeries were for pelvic tumors and bleeding.
Dr. Carrie and Dr. Ron knew that Jane was one of the patients who waited in line for hours for her first clinic day. Jane had a natural beauty, with long, jet black hair and a shy smile, but she was so desperately poor that she could not afford to see a physician. Regardless of all adversities, Jane was a convivial young lady. She was a diligent mother who loved to care for her family despite suffering from chronically distended abdomen and intractable pain. To top it off Jane also suffered from herpes; a kind of viral infection.
As Dr. Carrie examined Jane, she confirmed that she had a large lump in her pelvis—there was no time to send her to the city hospital for ultrasound. Dr. Carrie and Dr. Ron immediately scheduled Jane for surgery. Dr. Carrie knew right away it would take about two hours to complete the surgery. The surgery didn’t seem complicated to both doctors.
“All set. Dr. Ron, let’s wheel in Jane.” They walked out as Dr. Ron gave a final look to the anesthesia table.
“Hello Dr. Carrie, Dr. Ron,” Jane greeted them with a calm smiling face, and walked towards the wheeled stretcher. Jane was wheeled inside the operation room. The paperwork had already been completed the day before.
Dr. Carrie did not even have a scrub nurse to assist her. She set the timer for five minutes to scrub her palms and fingertips. Dr. Carrie and Dr. Ron scrubbed all the way up to their arms and their elbows, until their arms were already aching.
Dr. Carrie thought about all the amenities she took for granted back in the U.S. Here there was no access to pharmacies either that would deliver drugs immediately to the operating room. Fortunately Dr. Carrie had brought essential drugs with her. The instruments were, ones she remembered using in her early training in the 1980s.
Everything was already prepped up. Dr. Ron was in charge of administering anesthesia which he carried on very efficiently. He started the timer for two hours right after anesthesia.
Jane’s surgery was to start in a few seconds.
Dr. Carrie opened the instrument packet. She held the scalpel blade properly in a pair of clamps on the handle. She clicked them together. Just then, the point of the scalpel went right into the end of her right index finger. She didn’t have time to think. She grabbed her finger and swung away from the sterile table, because she knew that the table won’t be sterile if she bled on it.
Dr. Carrie sat on the floor, head between her knees next to a red clinical waste basket.
“Are you all right?” Dr. Ron asked.
“I will be,” Dr. Carrie said. “I just need to sit for a few seconds until I stop feeling like I’m going to pass out. And then I’ll scrub back in and continue.”
“Fine. I’ve got this, but you’re going to have to scrub that.”
“I know I am not sterile anymore, Dr. Ron.”
“No, you’re going to scrub that now.” Dr. Ron asserted.
Dr. Ron was so persistent about scrubbing because Jane had herpes. This virus passes through fluid contact, and is too difficult to cure if it crossed the blood-brain barrier into the central nervous system. It could cause viral encephalitis and the person could die.
There’s a protocol in place for this. The first part of the protocol involves scrubbing the affected area for fifteen minutes.
“I don’t know what has gotten into me, I feel weak and woozy, Dr. Ron. I can’t get up right away to scrub,” Dr. Carrie said.
“Do you give me your consent to scrub it for you?” Dr. Ron asked.
“Okay,” Dr. Carrie nodded. She felt her throat squeezed shut as if two hands of black fingernails were clamping on her windpipe.
Dr. Ron took Dr. Carrie gently by her hand and led her over to the scrub sink in the corner of the room and he started to scrub her hands. Once Dr. Carrie and Dr. Ron were done dealing with this problem, they quickly moved on to Jane’s surgery table.
The clock was already ticking, which has been set for two hours.
Jane was under anesthesia, lying unconscious and hooked to an oxygen tank.
An hour and a half was left before the oxygen tank would empty out.
Jane’s surgery started uneventfully with a midline incision, but as Dr. Carrie and Dr. Ron explored her abdomen, they found more than expected. The explanation of Dr. Carrie’s diagnosis of Jane, didn’t square with the current observation at all. In addition to the large fibroid tumor in her uterus, she also had multiple ovarian cysts. Everything was matted together with scar tissues from years and years of untreated endometriosis. This condition prevented access to the major feeding blood vessels behind the uterus that needed to be tied off to prevent excessive bleeding.
As Dr. Carrie and Dr. Ron contemplated what to do next, Jane’s surgical sites started to ooze. At first it was not serious, and they kept control with cautery, but then more areas opened up. They started working faster and faster to control each bleeder. Dr. Carrie looked at Dr. Ron and she could see in his eyes that he shared the same concern.
Dr. Carrie knew that Dr. Ron was relying on her to come up with a solution.
Instinctively, Dr. Carrie loomed over and said, “Dr. Ron, I think we will need blood from the blood bank.”
“The blood bank is twenty miles away,” Dr. Ron said hopelessly with his chin tucked in his chest.
By this time the bleeding had filled up Jane’s abdomen. Here Dr. Carrie was the only surgeon with Dr. Ron as the research assistant in a rural hospital, thousands of miles from home, with no trained help, operating on a young woman whose bleeding was out of control.
“Dr. Carrie, you will have to be extremely efficient and prioritize wisely, we don’t have much time left.” Dr. Ron broke out in sweat. “We are racing against the clock here.”
“I know, I know, every second counts. I have never faced this kind of challenge before.” Dr. Carrie floundered, not knowing quite what to do next.
Dr. Carrie was experiencing acute traumatic stress. She shuddered at the thought of negative outcomes. She was a woman, a mother, and a doctor and all those things together made her incredibly strong. She knew what was at stake if something bad happened to Jane. What needed to be done soon, and what couldn’t wait for a minute were the constant questions going through her head.
“We are facing the dilemma of decisions, priorities and multi-tasking, all at the same time,” Dr. Ron said, casting an oblique glance at Dr. Carrie. “I don’t see a way out here.”
Drs. Carrie and Ron started mentally calculating how much time they had before Jane literally bled to death. Dr. Carrie could not get the source of bleeding and could not work fast enough to forestall the impending disaster unfolding before their eyes. Dr. Ron stopped talking and the room fell into an eerie silence.
Dr. Carrie and Dr. Ron were trying very hard to wrest Jane’s life from the grasp of misfortune.
Dr. Carrie looked back at Jane’s peaceful serene sleeping face. She had no idea that her fate was now uncertain. As Jane kept getting paler and paler, Dr. Carrie knew she needed a miracle to save Jane’s life.
She closed her eyes and quietly whispered, “God I am your instrument, and you are the healer. This is your patient. I can not handle it anymore. Please take over from here. Amen.”
Dr. Carrie closed her eyes and sank back into oblivion only to open her eyes to the bright surgical light to witness something beyond explanation. The tissue planes that were obliterated by scar tissue had fallen open, allowing her to reach the major blood vessels behind the uterus. Quickly, Dr. Carrie tied off each one. The bleeding stopped! Dr. Carrie stood for a minute, trying to contemplate what had just happened. She looked again at her surgical assistant Dr. Ron, and could imagine the smile behind his surgical mask.
“Dr. Carrie, do you know that you have just performed something unbelievably incredible!” Dr. Ron said with his mouth agape.
He was correct. It was incredible. Dr. Carrie had never experienced anything like this before, but that afternoon she believed—in a tiny insignificant operation room in a rural part of Papua New Guinea, she simply became the first assistant— the assistant to an eternal Surgeon, God.
The operation took about an hour and fifteen minutes. They still had fifteen minutes left. The alarm clock had not gone off yet. In the remaining fifteen minutes, Dr. Carrie and Ron cleaned up the mess.
In these two hours, Dr. Carrie and Dr. Ron’s performance certainly rocked their world. They had saved Jane’s life. She was out of danger.
Both doctors wheeled Jane to the recovery room and then to her room, in a stable condition. The rest of the afternoon was spent on autopilot. Dr. Carrie and Dr. Ron had trouble concentrating after witnessing what had just taken place.
The next morning on rounds, Dr. Carrie spoke to Jane through a translator.
“How do you feel? Dr. Carrie asked.
“Tired but fabulous,” she said . “Thank you for performing such a great work for me.”
“Yesterday I was just the servant,” Dr. Carrie said. “The work was done by God, who saved your life when he took over in the operation room.”
Jane smiled. She continued to recover.
Several months later, Dr. Carrie received a grateful note which read,
Dear Dr. Carrie,
Thank you for helping me. I am doing well.
Dr. Carrie remembered using those same words in that operation room with Dr. Ron after Jane’s surgery when she had bowed her head and prayed, “Dear God, thank you for helping me.”
Dr. Carrie was also doing well.
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