‘What if we didn’t have this stuff’
Within minutes of giving birth to a healthy baby boy, Nancy is pale, vomiting and experiencing postpartum bleeding. Her obstetrician, Michael Greene, MD, chief of obstetrics in Mass General’s Vincent Department of OB/GYN, moves her to an operating room across the hall to determine the cause of bleeding.
Dr. Greene is joined by five OB staff and four OB anesthesiology specialists. Within minutes Nancy is asleep under general anesthesia, her abdomen is opened, and she is found to be losing an alarming amount of blood from a ruptured uterus. An anesthesiology and critical care team sets up a rapid blood transfusion, infusing at the maximum rate. It’s not enough. An expert in intraoperative auto transfusion is summoned. Nancy is transfused with her own blood as well as units from the Mass General Blood Bank. She is fighting for her life.
Facing complex abdominal surgery, Dr. Greene pages the gynecologic oncology surgeon-on-call. Racing to the operating room, Marcela G. del Carmen, MD, MPH, determines the uterine rupture extends to the pelvic wall, involving veins — as many as four — a rare occurrence in obstetrics. To survive, Nancy needs vein repair, a major challenge. ”When you stitch a vein, you have just one chance to get it right,” says Dr. del Carmen.
Preparing to close, the surgeons notice the drain removing residual fluid is still filling with blood. It’s coming from the right ovary. It is removed. The bleeding finally stops.
Two vascular surgeons, Michael Watkins, MD, and Virendra Patel, MD, arrive. Also Isaac Schiff, MD, the chief of OB/GYN, senior gynecologic oncologist Annekathryn Goodman, MD, the chief of the Surgical Intensive Care Unit and two hematologists from the Blood Bank.
For more than two hours, a seven-member multidisciplinary team performs vascular surgery. They successfully repair two pelvic sidewall veins, one uterine vein and one gonadal vein. But they’re still concerned. Has the trauma interrupted the blood supply to the ureter? Urologic surgeon Dianne Sacco, MD, performs a cystoscopy and places a temporary stent to resolve the issue.
Who saved Nancy?
In his characteristic low-key style, Dr. Greene reflects on the extensive Mass General resources available at a moment’s notice, including 34 staff from 11 specialties and subspecialties who together saved his patient’s life: “What if we didn’t have all this stuff?”