Drama Queen

A few months into my surgery rotation, I reached a point where I could confidently do small procedures by myself. Uterine curettage, drainage of a variety of abcesses, washouts of compound fractures: these were all things I could do without supervision, things that the registrars in my department were happy to leave me alone with. I was also happy to do them, because I hoped that for every fifty uterusses I scraped out, and every hundred bums I decompressed, I'd be allowed to do something a little more interesting: remove an appendix perhaps, or suture a small hole in some bowel.

That's why, one Thursday night, at about eleven, I told my registrar he could could go to bed while I cleared up the rest of the list. It was full of the kind of cases that give these kinds of lists their special name around here: poes and pus. Yes, I know that's disgusting. And yes it's true, doctors are more foul-mouthed than the bartenders at your local drinking hole when you're not around to hear them.

I did a few evacs, I drained a breast abcess, and at about 1am I drained a Bartholin's abcess. A Bartholin's is a tiny but exquisitely uncomfortable thing that will only affect you if you're unlucky enough to be female: it's an abcess that grows from the Bartholin's glands on the vulva. It's a small thing, and we see two or three of them a week here. I drained and marsupialised this one without too much ado, and went to bed.

At six, I got up to do my morning round, and went to check on my patient's wound, hoping I could discharge her at the same time. Imagine then my dismay when I took off her bandage and removed the gauze plug I'd placed a few hours earlier, and she started hosing blood all over the bed. In retrospect, she wasn't hosing at all, and had in fact only sprung a minor leak, but I was still young and fresh and often had difficulty judging the severity of a given situation. As I squizzed closer at the drained abcess in the bleak ward light (the majority of the lightbulbs have been stolen - This Is Africa), I could just make out the steady blink of an arterial bleed.

Now, fellow doctors, students and laypeople, what's the first thing you do when you see something bleeding? That's right - you put pressure on it. That's not what I did. I panicked. The first thing I saw when I saw that blood was my registrar's livid face as I told him I'd managed to exsanguinate a patient via her labia minora. The second thing I saw was the clips and ties we use to tie off bleeders in theatre. I rushed to casualties for a suture pack and ties. I rushed back to my patient, to find she'd managed to soak an entire linen saver and sheet with her blood. I felt cold sweat running down my back as I groped blindly with my artery forceps in the tiny hole on her vulva (really tiny - about half a centimetre across), my patient yelling and cursing me as I failed repeatedly to catch the bleeder. Eventually conceding defeat, I took a deep breath and called my registrar.

'Yes?' he mumbled.

'Uh... remember that Bartholin's I drained last night?'

'Not really...'

'Well, I just took off her bandage, and she's hosing all over the bed.'

'Have you tried compressing it?'

'Um...'

'Oh, for God's sake Karen , there are no vessels down there important enough to have a name. Just stick another gauze down there and push on it while you count to three hundred. Stop being such a damn drama queen.'

I did as he said, and sure enough, when I lifted my hand after silently whispering 'three hundred' in my head, the bleeding had stopped. The patient's nightie and sheets and blankets were soaked in blood, but she just looked at me and pouted. 'Can I go home now?'