Reviews

She's bleeding again

Obstetric haemorrhage is frightening, at least for the obstetrician. The woman's partner, however, views it calmly through his video camera. He knows there is always a lot of blood. When the norm is exceeded it is the professionals who sweat.

Life threatening haemorrhage occurs after one in a thousand births, so each NHS obstetrician should see a case every year or two. Not so. The play of chance means that in each hospital one consultant sees them all. The rest of us feel quietly smug, as if our good luck were of our own making. Then the wheel of fortune rotates and it's your turn.

An obstetrician's day job consists of balancing one small risk against another and trying to avoid both. Saving babies has become a matter of applying protocols. So when you help save a mother's life you feel liberated, but only briefly. Even while you are checking the drip and catheter, the partner is asking whether all this could have been prevented.

Emergencies have a way of telescoping your memory. You remember the last time and the time before that, as if they were yesterday. You hear yourself telling the trainee what the old prof did when you were a registrar. Then you realise that you are the old prof now.

These days there are courses that create the adrenaline rush under controlled conditions, so new consultants are well prepared. Still, some lessons only come through experience. Always empty your bladder, for example, and, however urgent the dash to theatre, never leave your credit cards in the changing room.

Immediately afterwards, there is a high. It has little to do with altruism. It comes from being part of a team and confronting something real. During an emergency there is no pretence. The team's rapport is instinctive. They read one another's body language. They tolerate foibles and feeble wisecracks but not indecision. And when the worst is over, they become phlegmatic.

The worst? That is when you have done everything and someone says, "She's bleeding again." At this moment, I recommend the Tarrant manoeuvrephone a friend. On call or not, colleagues won't mind. They will offer to come in but all you want is a reassuring voice. Believe me, it helps. Take the word of an old prof.

James Owen Drife, professor of obstetrics and gynaecology. 

Leeds