The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This time, obstetric anaesthetist Anushka Aubeelack describes the hectic environment of a critical emergency on the labour ward.
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I am an obstetric anaesthetist by trade and cover emergencies on the labour ward. The case that I can’t forget happened in the middle of the night, as they so often do.
The shift started like any other on the labour ward. It was busy but not unmanageable. The emergency buzzer had gone off only once so far, thank goodness for small graces! So, after checking with my obstetric and midwife colleagues that all was calm, I sought out refuge in the on-call room.
Twenty minutes later, my phone went off with the alarm ‘Obstetric emergency, Theatre One’. Cup of tea abandoned, I ran the short distance to the operating theatre room. On the way, I went through all the possible scenarios that could be waiting for me. Maybe the baby’s heart rate is too low? Or could it be that the umbilical cord has popped out first putting the baby’s blood supply at risk? Either way, I had my plan A and B and C going through my mind.
It is in these kinds of situations that I often see the healthcare team working at its best. Everyone has the same clear priority, get the mum and baby through this safely. And so I found everyone standing a little taller, eyes more focused and ready to face whatever the scenario was that was about to be presented to them. And oh boy, we hit the complications jackpot with this patient.
The obstetric doctor wheeling the young woman into theatre started the handover.
‘This is Ms Y. She is not booked at this hospital. In fact, she is not booked in the UK. She is here visiting family. She has presented with antepartum haemorrhage with an estimated blood loss of almost one litre according to the paramedics. She does not speak English and so the details we have are those handed over from the family to the paramedics,’ he rattled off.
As we listened for the baby’s heart rate, our patient started crying. The baby’s heart rate was dangerously low and so we took the decision to carry out a crash-caesarean section.
As the surgical team prepared, I gave our patient oxygen while trying to get as much information as I could to administer an anaesthetic as safely as possible. The neonatal doctors were doing the same as the baby was undercooked by two months.
So, there we were. Our patient was bleeding. She was also seven months pregnant, did not speak English and we had limited medical history – and she was about to have an emergency operation. Just for this patient alone, we ticked off several chapters from the obstetric emergencies book.
But we told ourselves, ‘We’ve got this.’ This team, that I am so proud of, is used to working like a well-oiled machine. We got through our pre-surgery checks then I gave the anaesthetic and the surgeons started the procedure. Within a minute, the baby was out and with the neonatal team. They quickly assessed and prepared the infant for transfer to the neonatal intensive care. The baby was showing signs of life and we felt a momentary wash of relief. Momentary because our patient was still bleeding and not yet stable.
The surgeons and myself kept updating each other over the drape as to how our patient was faring. As they fed back what they were seeing at the surgical site, I responded with what medications I was giving and how stable she was. At the end of the bed, the theatre assistant kept us updated with the amount of blood lost during the operation so far. I remember feeling deep gratitude to be working with a team that keeps talking to each other. The ‘them and us’ just didn’t exist in that moment.
After giving blood and lots of medications, and with some deft work by the surgeons, we were able to finish the operation with a stable patient.
You would think that after all that, we would be done. But no. Our patient had one more surprise left for us.
As we transferred her back to her bed, her blood pressure dropped to dangerous levels and her heart rate rocketed. What now?
On the auto-pilot that you develop as you train to deal with life-threatening emergencies, we ran through the potential causes and quickly discovered that her lower limbs were developing a rash. So another emergency ticked off out of that book – life-threatening allergy.
I administered all the medications to treat the allergic reaction and within a minute, we were back on track. A quick call to Adult Intensive Care to let them know that they had an impending admission and we safely dropped our patient off to them.
What is it about this case that stands out for me? Yes, our patient was a fairly unique combination of challenges that night and yes, it was all very dramatic. Thankfully, both mother and child did very well and left hospital without complications. However, what sticks in my mind is the team. In that room, there were almost 15 people who put everything aside to work together. They shelved their worry for the patient, the fatigue of the night shift, the low levels of equipment stock due to finances, the impending exams, the unwell child at home, the anxiety of debt…everything. Our training helped us focus and save the lives of that woman and her baby. And we did so well.
Cases like that one remind me why I love this job.
Anushka Aubeelack is an obstetrics anaesthetist