Do You Want a Postmortem?

Sunday morning, I am on call. There are 2 “Caesars” to go.
Joseph, the intern, and I scrub for the first – a Para 4 (four prior deliveries) with obstructed labor – she has been 9 cm dilated since 3am, and it is now 8am.

There is routine blood loss with no complications, but as we are closing, the anesthetist, Sarah, starts to talk in Runyankole with English words thrown in.

“Runyankolerunyankolerunyankole she is anemic! Runyankolerunyankole probably malaria.”

I look at the monitor. Her blood pressure is 74/25, heart rate 125.

“Runyankole she will need blood. Runyankolerunyankole take some blood.”

She hands Joseph a syringe and a needle. He takes it and puts it down, continues to sew.
Blood pressure 44/22, heart rate 119.
Nothing seems to be happening, no one running for blood, but I can’t tell. Sarah is still talking in Runyankole, so maybe some one has been called to bring blood, who knows.
I ask Joseph if the patient is going to get blood. He says she is.

“Runyankolerunyankole take some blood! Runyankole I thought you were drawing blood and I am standing here runyankolerunyankolerunyankole. Do you want a postmortem?!”

Joseph stops suturing, puts down the needle and picks up the syringe. He exposes the patient’s right groin and palpates the femoral artery. He sticks in the needle, draws 1cc of blood, and hands it off to the circulator.

Sarah is still talking. She says something to the patient, who sticks out her tongue. It is white as a lab coat.
Blood pressure 64/27, heart rate 128

We finish suturing, and we clean and move the patient to recovery. As we are writing the operative note, a man arrives with 2 units of blood. 10 minutes later, we are ready for the next Caesar, and I check on the first patient. The two units of blood have been placed on her lap, but have not been hung.
I ask the circulator if they are going to give the two units. She says that they will give one unit. “She does not need two units, she needs only one.” I think again of her white tongue. I ask what will happen with the second unit. She says it will be brought back to the blood bank. She is sitting on a stool in the recovery area. No one seems to be moving to either hang the blood, or to return the other unit. I wonder if the second unit will make it back to the blood bank.

After the second Caesar, I come back to check on the first patient. She is gone, she has been moved to the ward already. I ask Sarah if she got the blood before she left. “No, not yet. They will give it in the ward.”