Dream - Reality - 2

I don’t think there will be any person who had never experienced dreams in their sleep.  We dream of our fears, our aspirations and some are unexplainable.  I do dream many times, sometimes nightmares, some pleasant ones and some predictions which I could only understand retrospectively.

In the early days of my practice as obstetrician, I had a patient who had a complication of delivery.  It was her first delivery.  Delivery of the baby was smooth.  After the delivery placenta should be expelled within half-an- hour, the maximum period.  As the placenta was not expelled spontaneously I sedated the patient and tried manual removal.  It was adherent to the uterus.  I separated it and removed from the uterus.  When I examined I found that part of placenta – a cotyledon was left behind.  I tried my best to remove it manually under deep sedation but was not successful.  As it was a bit of placenta and more than 80% was removed and there was no bleeding I put her on further medication to not have any bleeding and contraction of uterus which incidentally can help in separation and expulsion of the retained bit.  To prevent any infection I also put her on antibiotics.

The retained placental bits when small are expelled spontaneously and without much problem.  Sometimes it can get infected and patient may have fever and excessive bleeding.  For first 24hrs I waited hopefully, praying god, that it is expelled.  Patient was continuously monitored for any problematic symptoms. After a day I started getting worried.  With increasing time the possibility of complications also increase.  I was remembering all the complications I have seen and read during the course of specialty education.  I was scared of surgical intervention in the immediate postpartum period for fear of infection and bleeding.  I wanted to consult my professor and take her opinion as to the management.  The whole of second day I was just thinking of my professor and when to meet her and request her guidance. 

It was more than 48 hrs and patient was quite normal but has not expelled the retained bit.  That night I could not sleep with anxiety.  I was just thinking about how to manage it.  Continuous monitoring of the patient was getting on my nerves.  Then I saw my professor and I explained her problem.  She said, “Don’t worry. She will be alright.  Nothing will happen”.  Then I woke up and realised it was a dream. 

That morning after examining patient I decided to meet my professor who is also a resident in the same city.  In the morning when I went to see the patient she said, “Doctor, in the morning I expelled a big clot”.

“Really? How big was it?”  I asked. 

“This much”, she cupped her hand and showed me.

“Was there any excess bleeding”

“No, it was normal”.

I examined her and found that uterus was appropriate to the period of postpartum and everything else was normal. 

I was relieved and thanked my professor for her reassurance in the dream and spontaneous expulsion of the bit. I kept her for another day and sent home.

She came for follow up after 2 weeks and found to be absolutely normal.

(In those days ultra sound scanning was not available in our city).