When I went in I fully expected her to be waking the patient, but clearly there was something wrong. Looking back on it, Angi and I both believe that this patient had an undiagnosed clotting disorder which led to her great blood loss (I noticed several old bruises on her legs later during transport). Our GYN surgeon had been trying to complete the hysterectomy with the most minimally invasive procedure possible (via laparoscopy), but the continual bleeding made this very difficult and it was decided that they needed to convert to an open procedure to stop the bleeding. Several people joined us in the OR to facilitate the change in plans and give the best possible care, but despite these efforts, we were dismayed to see the amount of blood she had continued to lose. They were able to get the uterus out and stop the bleeding, but playing catch up with the fluids seemed to be an insurmountable task as we estimated over 65-70% blood loss when counting lap sponges and what was in the suction canisters, not counting what was on the drapes, surgical gowns and floor. Our general surgeon started a central line, but we knew that without blood products in our facility (something that the Red Cross controls in Honduras) she would have to be transferred to Tegucigalpa for treatment. This meant 2 hours in the back of a Toyota Highlander over a bumpy, narrow 2 lane road with sheer drop offs...in the dark.
As we continued to treat her low blood pressure with 2 different medicines and multiple lines of fluids, the patient was moved to a stretcher and transferred into the back of the truck, intubated, paralyzed, and sedated. It was determined that I would go since I speak Spanish and could give report to the medical team at the hospital where we were taking her. The whole team in the room wanted so much to come with us and care for our patient, but there was only room for one surgeon and myself in the back, so we loaded up with the patient and prepared to go. I remember telling everyone that it was a 2 hour ride to Teguc, and I expected they would be having a 2 hour prayer meeting, but honestly I was amazed that our patient was still responding to our medications to maintain her blood pressure. As we pulled away I thought of all the things I wished I could have brought with me to use, feeling woefully unprepared for the trip. My nerves sometimes get the better of me and I did what I often do when I am nervous, I decided to sing. I wanted to sing one of the praise songs we had been singing all week, "Holy Spirit, You Are Welcome Here", but what came out of my mouth unbidden was "Amazing Grace, how sweet the sound, that saved a wretch like me. I once was lost, but now I'm found. 'Twas blind, but now I see." I couldn't understand why I would sing this song, however after singing that one verse I felt a peace come over me. I knew without a doubt, "God has this. I don't need to worry, because He has this." The rest of the trip was actually pretty uneventful, at least whenever Dr. Keith didn't look out the front window to see a car passing into our lane and narrowly missing us. I told him not to look up front any more!
My previous problems with her pressure seemed to subside and stabilize, and I continued to give her medication to keep her sedated and paralyzed as the doctor and I took turns ventilating her with the ambu bag. When we finally arrived in Tegucigalpa at the hospital, we were somewhat dismayed to realize that although we had called ahead to tell them we were coming, they were not really prepared to receive our patient. We continued care as we asked about a ventilator, blood for our patient, an ICU bed, warm blankets, and lab work. I drew the lab work as we found out they didn't have blood either, but had to get it from the Red Cross as well. Dr. Keith found a warming lamp, a kind nurse found a comforter (the patient's temperature was 95 degrees), and it became apparent that the ventilator was not going to come, so we took turns ventilating the patient by hand. After over an hour of this I was considering the fact that coma and organ damage can occur with only a 40% blood loss, and wondered about our patient's neurological status. That is when Carol opened her eyes and looked straight at me. I spoke to her in Spanish telling her that she was OK, that her surgery was over, but because of a large amount of blood loss, we had to take her to Tegucigalpa. She closed her eyes. For the next 15 minutes as her sedation and paralyzing medicine wore off, I reassured her that Jesus was by her side the whole time. She nodded a yes in response. I'm not surprised she knew that, because I felt His presence the whole trip.
When she was strong enough and breathing well, I finally removed the tube. It had been almost 3 1/2 hours since we had left Guaimaca. She still had not received any blood products, and the labs showed the exact same values we had before we left Guaimaca 4 hours earlier despite the 4 additional liters of fluids I had given her. As I removed the tube I heard her say over and over, "Gracias, gracias, gracias!" but I knew that her gratitude was to the Lord. Her eyes were full of tears as she asked me which hospital she was in, and if she could see her husband. The blood arrived and I hung it up with a pressure bag telling the nurse she could keep the pressure bag and use it for all the blood they would give her.
The 2 hour ride back to Guaimaca seemed so much shorter, and I enjoyed getting to translate between our driver, Leo, and Dr. Keith. I looked forward to getting what I knew would be a good report the next afternoon. The next day a few people were sitting with me waiting for the group and asked about the trip, what it had been like, how I felt. I told them how nervous I was, but that I decided to sing a praise song and although I was surprised at the one that came out of my mouth, I felt peace when I had finished the first line. They asked me what song. When I said "Amazing Grace", everyone's mouths fell open. When I had been pulling out of the hospital compound the night before, the medical team had gathered in a circle holding hands and someone had started to sing as everyone soon joined in..."Amazing grace, how sweet the sound, that saved a wretch like me. I once was lost, but now I'm found. 'Twas blind, but now I see."...then they began praying.
Carol was discharged from the hospital after only 2 days. She is home now with her family recuperating. This patient should not be alive today but for His Grace, which is truly Amazing.
