Today is a National Holiday in Liberia. They call it Cleaning Day. It is like our Ching Ming Festival. People visit their relatives' and friends' graves. It has been a very bad day for me in Monrovia. If you can remember, I received a woman with a ruptured bladder, vagina and torn urethra from Benson Hospital around three weeks ago. We had successfully repaired everything for her. Her baby was born unexpectedly; She recovered uneventfully in our hospital and was discharged home last Saturday after removal of the urinary catheter and the splint in the repaired urethra. We decided to leave in the supra-pubic catheter for another week in case of any unexpected conditions causing retention of urine, and we taught her how to take care of it. Yesterday I received a call from Dr Laura, the Gynaecologist of Benson. She told me the woman had been admitted to Benson with respiratory distress. They thought she had a chest infection. They did not know what was the purpose of the supra-pubic catheter so I asked her to connect the catheter to a bag and send the woman back to us. The patient arrived at Mamba Point Hospital in the afternoon. Chest X-rays showed some haziness. There was no sign of any intra-abdominal infection. Her urine was clear. We treated her chest infection with antibiotics and oxygen therapy while keeping her in the ICU. I saw her in the evening. She looked better but still with fast breathing. Oxygen saturation was all right, she could even ask for food. Unfortunately, during my morning rounds today, I found she was missing. The nurse told me she had died in the early morning. It was very sad. She had deteriorated in the night. The doctor on call had treated her by himself, without informing us. We had remarked a few times, that the on-duty doctors always treat patients with a sudden change of condition without our notice. Once we are notified, it is often too late. I don't know the exact cause of death in this woman. Chest infection in young people should not cause such a rapid change in condition. She may have died of a pulmonary embolism about which we cannot do anything here, or heart failure with anaemia. Her haemoglobin was low on admission, around six plus, which was more or less similar with her post-op level. We had planned to have a transfusion for her the next day, after getting blood from family. But suddenly everything was too late. I am very upset. Although the operation had been so successful, we still leave the baby boy, Paul, motherless. Au Yiu Kai
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