A Captain’s Journal

About 2 hours from the end of the shift a 38 year old lady from Balad was brought to us. She suffered a single gun shot wound to the right shoulder. However, the bullet ricocheted off her shoulder and traveled down into her abdomen significantly injuring her right kidney as well as her liver. The bullet came to rest in her lower abdomen. The major complicating factor however was actually in her uterus. It was an innocent 7 month old fetus. The ultrasound demonstrated that her fetus was uninjured and still very much alive. The problem is this woman was going to need to have her kidney removed and her liver repaired. But how to do this, while keeping the fetus from harm. Definitely a complex problem. Thoughts were racing through all of our minds about how we were going to manage to save this woman and her unborn child. We all began planning for each contingency, especially since we have no obstetrician and no facilities to care of such a premature baby should she go into labor, which would be quite likely given her current situation. In the end we discovered that Baghdad has an obstetrician and they were willing to accept her in transfer. We communicated to the woman our plan of care when she surprised us all. She responded, ‘I don’t want the baby. Please kill the baby.’ We were all stunned. How do we respond to that!? We decided to simply sweep that request under the rug and proceed with the transfer. But it makes one wonder where that request came from. Was the request because she thought she would suffer more if the baby were preserved? Did she think she had to choose herself or the baby? Was the baby unwanted from the beginning? Life can get pretty complicated, even before it starts.