By Dr. James Appel - September 11, 2014

From far away I can tell I will find pus. The young girl’s left jaw is swollen with tense, shiny red skin over the inferior lateral aspect. Her left eye is swollen shut and she is in obvious pain. The mother confirms my suspicions that this is a periodontal abscess by saying it started a week ago with a tooth ache.

What really surprises and embarrasses me is that she came here to Cooper Hospital two days ago, saw a PA and was sent home with oral antibiotics and steroids (possibly the worst medicine to give under the circumstances.) I admit her quickly for an extensive incision and drainage.

I walk her upstairs and Joseph and Mr. Wezzeh help put her on a gurney and start an IV. I have them give Diazepam and then a couple milliliters of Ketamine and she is out. I take a scalpel blade and slice down over the center of the abscess and soon am into thick yellow pus mixed with blood flowing out into the large kidney basin. I irrigate the wound out and then pack it with diluted chlorine soaked gauze. Just then, the midwife comes into the room.

“Doctuh, come see dis woman, she hemorrhaging plenty.”

I go and see a woman who delivered two hours ago. She is sitting in a pool of blood on the post partum bed. I examine her abdomen. Her uterus is so floppy I can’t distinguish it from her fat lined abdominal wall. I examine inside and pull out two large menstrual pads that the nurse had stuffed in just after delivery.

“What is this?”

“To make the uterus stop bleeding.”

“This will only make the uterus unable to clamp down and will hide the bleeding so you will not recognize it until late. Never do this again!”

I then pull out handfuls of blood clots and dump them on the mattress between the patient’s legs.

“Get some more oxytocin.”

I finally am able to massage the uterus between my internal and external hands. The woman screams in pain and wants to grab my hand to pull it away.

“Don’t touch me! Do you want to bleed to death?! I have to do this to help you. I’m sorry, but you have to let me or the bleeding will not stop."

The nurse gives the extra dose of oxytocin and I continue to massage the uterus until it quickly firms up into a hard ball the size of a grapefruit and the bleeding stops. I go and quickly wash up with chlorine water. The woman will live.

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