Note: The names have been changed to protect identity.
Maria came up to the floor in the middle of the night already at 5cm and pushing. Her and her husband spoke only Spanish and yet there was no available Spanish translator. I volunteered that I could communicate with them as I speak Spanish and introduced myself to Maria and her husband Juan. Between contractions and with Juan’s help we were able to get a brief history. Maria was a 34-year-old G4P3-0-0-3, all uncomplicated vaginal deliveries. We tried to calm her and get her to stop pushing until she was fully dilated but it was to no avail. Eventually she reached 10cm but by this point, hours later, she was thoroughly exhausted. With her permission we elected to pursue an epidural to see if getting her pain relief and rest would allow her to recover and push again. Just after the test dose of the epidural went in the fetal heart tones dropped into severe bradycardia and did not rebound.
A tense minute passed and then there was organized chaos. Nurses grabbed Maria’s bed and hauled it out of the room, someone was on the phone yelling for the operating room to prepare for a crash c-section. I tried to explain to Juan why all of sudden his wife was being rushed out of the room for emergency surgery. After showing him where he could wait outside the OR I headed in just in time to see the fastest “birth” I have ever witnessed. From initial incision to removal of the baby was under a minute. Examining the uterus the cause of the bradycardia was found. On the posterior aspect of the uterus was a gaping hole – spontaneous uterine rupture. The odds of this happening to a woman with no history of uterine surgery are infinitesimally small but there was no arguing with what had happened. The team worked valiantly to repair the uterus but could not control the blood loss. The massive transfusion protocol was activated and after 4 units of packed red cells the team elected to remove the uterus to save Maria’s life. By this point a Spanish translator had arrived but as they had to stay with Maria I was the one who would exit periodically to update Juan. His baby had been taken to the NICU and was doing well. We went to visit the baby but Juan’s attention was focused on his partner. He kept repeating that all he wanted was for her to come out of those double doors alive.
Two days later I was finishing up a last errand when I heard someone call my name from down the hall. I turned to see Juan and his three children. A big grin was on his face. He thanked me for being with them two nights prior and introduced me to his kids. They were on their way to post-partum to meet up with Maria who was being transferred there after recovering well and being discharged from the ICU. After helping them figure out how to get into post-partum I left, my face splitting into a smile. As a medical student there are many days where I wonder what if any contribution I am making. On that night though, I knew my contribution had meant a great deal to Juan and Maria. This experience reinforced for me the importance of communication with not just the patient but those that care about them as well. It also reminded me that as medical students, while we may not have much clinical experience yet, we can still be an important part of the healthcare team.
