HISTORIAS DE VIDA 16ª PARTE “UN RECUERDO, UNAS LÁGRIMAS”

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Estaba ese día en el hospital iniciando mi labor por el área de tocoquirúrgica, área de quirófanos destinada para atención de pacientes en trabajo de parto. Se les asiste en el mismo, se les vigila en el puerperio inmediato (cuando dan a luz) y se proporciona atención al recién nacido. Asimismo se atiende a pacientes con problemas de aborto y sus complicaciones; o con sangrados disfuncionales que se presentan por diversas causas. Está en comunicación con el área de cuneros y terapia intensiva neonatal, lo que facilita la atención inmediata del bebé.

El contar con quirófanos, estos se convierten en salas destinadas para la atención del parto, o en su caso para realizar cesáreas. Tocoquirúrgica viene de la palabra “tokos” que en griego antiguo significa “nacimiento” o “lo nacido”. Y “quirurgia” que significa la acción de operar, trabajar con las manos (“Quir“ es el prefijo que significa “mano”).

En aquel entonces estaba comisionado en un hospital del IMSS por la zona de Ecatepec, México. Cursando el internado rotatorio de pregrado, yo estaba nombrado por el Jefe de Enseñanza como coordinador de todos los médicos internos, me correspondía elaborar los roles de adscripción de servicios, sesiones, guardias y en caso necesario cubrir el servicio o guardia con alguno de nosotros ante alguna ausencia involuntaria o por permiso especial.

Esa mañana, pase la visita con el médico de base, un ginecólogo que estaba adscrito al servicio en el turno matutino de las 7 de la mañana a las 3 de la tarde, eran tres ginecólogos que cubrían todos los aspectos médicos que surgían en el servicio, posteriormente entraban otros tantos médicos para cubrir el turno vespertino y a las 10 de la noche llegaban solamente dos médicos que cubrían cada tercer noche, hasta las siete de la mañana. Las guardias para los médicos internos eran de 36 horas de trabajo por 12 horas de descanso sin interrupción. Así como se escribe 36 por 12, sin embargo, las hacíamos con agrado, cansados andábamos todo el tiempo, con hambre, con sueño, pero cumpliendo.

Las camas señaladas como de “trabajo de parto” eran ocho en total, y ahí se quedaban las pacientes que al explorarlas considerábamos que podían dar a luz en las próximas tres horas. Había momentos en que estaban todas llenas, otros en los que había una sola paciente y cuando esto ocurría, sobretodo por las madrugadas cuando las noches de guardia habían sido desgastantes, nos permitíamos acostarnos unos minutos, les decíamos a las enfermeras que nos cuidaran un “ratito” y que si llegaba una paciente nos llamaran de inmediato. Eran minutos de oro, dormir aunque sea 15 a 30 minutos eran volver a la vida. Ahí en esas guardias aprendí a dormir sentado en un banco de metal, recargando mi cabeza en la pared. Las horas que me han parecido las más pesadas eran de las 3 a las 5 de la mañana, eran “mortales” para mi; pasando de las 5 y media de la madrugada, era otro día ya y estaba listo para cualquier contingencia.

Fue alrededor de las 8 de la mañana cuando llegó una paciente de unos 22 años de edad, con 40 semanas de gestación, esto es un embarazo de término. Nos refirió que llevaba cerca de ocho horas con contracciones irregulares; pero que en las dos últimas eran regulares. Durante el trabajo de parto activo, las contracciones se presentan con un tiempo de menos de 5 minutos entre una y otra, duran de 45 a 60 segundos y el cuello del útero se dilata 1 centímetro o más cada hora, se necesita una dilatación cervical de 10 centímetros para considerar que está a punto de dar a luz la paciente.

Ana María que así era el nombre de la paciente, se sentía muy nerviosa, era su primer babé, su esposo estaba por llegar, había ido a avisar a su trabajo que iba a faltar para estar en el nacimiento de su bebé, y eso la hacía sentir más inquieta. En el rol le tocó a un medico de base ginecólogo y el a su vez me envío a mi para valorar a la paciente. Ya para entonces la enfermera le había tomado sus signos vitales, su presión sanguínea y temperatura. La enfermera además le tomó muestras de sangre y orina y le aplicó una solución glucosada al 5%. Entonces me acerque con el estetoscopio de Pinard lo coloque en su abdomen para monitorear los latidos de corazón del bebé y cheque sus contracciones, realicé el tacto vaginal y me di cuenta que estaba casi con dilatación completa, así es que le comente a Ana María que pronto la pasaríamos a la sala de partos; en ese momento se rompió el saco amniótico (bolsa de líquido alrededor del bebé), lo que se llama “se rompió la fuente”, le dije con toda tranquilidad que era natural este evento y que probablemente las contracciones se harían más frecuentes y más intensas en relación al dolor. Me miró con cierta resignación pero ya estaba ahí y venía el momento esperado. Llamamos al camillero, ella se subió lentamente a la camilla y la pasamos a la sala.

El anestesiólogo, el pediatra y la enfermera estaban ya en la sala, mientras tanto yo me fui a lavar las manos en la zona de lavado pre/quirúrgico para colocarme la ropa estéril y atender el parto. Ya estaba el equipo preparado y me coloque los guantes para realizar la asepsia de toda la zona, coloque los campos estériles y le hable a la paciente para que me ayudara a llevar a buen término todo el procedimiento. El anestesiólogo checó signos vitales, le colocó a mascarilla para que recibiera Ana María un poco de oxígeno. Revisé el equipo en la charola: tijeras para el cordón umbilical, tijeras para realizar la episiotomía, suturas, gasas, compresas, equipo de sutura, en fin todo.

Cubrí con los campos estériles toda el área y empezó el parto, la cabecita del producto apareció, realicé la episiotomía, extraje primero un hombrito y realicé el giro para sacar el otro hombro y extraer al bebe, todo el procedimiento tanto en su fase inicial como en la final o alumbramiento transcurrió sin problemas, la paciente había dado a luz un bebé del sexo masculino, como de 3 kilos, rosadito, que lloró casi de inmediato; sin embargo, aún después de retirar la placenta y realizar la sutura de la episiotomía, la paciente seguía sangrando del útero; pasamos oxitocina para provocar contractura uterina, pero nada. Llamé al médico de base y le expuse el problema, él consideró que debíamos pasar más oxitocina, colocar una compresa a presión, y que le pidiéramos sangre para transfundirla en caso necesario. El problema era que no teníamos banco de sangre en el hospital. A pesar de esto consideró que todavía teníamos tiempo para valorar la evolución de la paciente. Los minutos transcurrieron y veíamos que el estado de la paciente no era del todo adecuado, su presión sanguínea empezó a descender poco, se le estaban pasando soluciones expansoras de plasma.

Ella estaba entrando en un proceso que se llama choque hipovolémico inicial en donde su piel estaba pálida, fría, sudorosa, el retorno capilar estaba lento, el pulso estaba elevado, había taquicardia, la tensión arterial estaba subiendo, estaba sedada, el anestesiólogo le había pasado medicamentos para evitar que se descompensara más.

Le volví insistir al médico de base que la paciente estaba entrando en estado de choque y que podríamos tener un problema mayor. El siguió en su posición de que la observáramos más tiempo. Era el momento para realizar una histerectomía de urgencia, pero tampoco aceptó mi sugerencia.

Media hora más tarde la paciente se puso más delicada, volví a decirle al ginecólogo que la paciente estaba grave, y ante mi actitud de reportar el hecho a la dirección del hospital, decidió en ese momento llamar a la ambulancia y trasladarla de urgencia al Hospital de la Raza (todavía en esos tiempos no estaba considerado como Centro Médico) para que ingresara a la Unidad de Terapia Intensiva, porque en el hospital en que estábamos no había tal tipo de unidad. La distancia que hay entre el hospital de segundo nivel y la Raza es de aproximadamente unos veinte kilómetros, sin embargo, en aquellos días, solamente había una salida sobre avenida Morelos (Ecatepec) solamente de dos carriles, para entroncar con la avenida de Los Insurgentes y después llegar a la Raza. Eran las doce del día cuando los ambulantes por fin subieron a la paciente a la ambulancia y el mismo ginecólogo me indicó que fuera con ella, se agregó un elemento más, una enfermera que estaba adscrita a tocoquirúrgica, llamada Virginia Vázquez, era una chica morena, con un pelo negro ondulado, ojos negros bellos, delgada, agradable, estaba estudiando la Prepa, y me acompañó en esa travesía que parecía nunca iba a acabar. Yo iba, sí como médico, tratando de que las dos vías de venoclisis no se salieran, de tener respirando a la paciente con un aparato tipo Ambú para dar oxígeno, la paciente sujeta a una camilla, ya no tan sedada pero en un estado neurológico deprimido, casi podría decir que en coma, la presión arterial descendiendo cada minuto, la piel fría y pálida, sus labios cianóticos y el pulso apenas perceptible. Iba rogándole a Dios que nos diera oportunidad de llegar lo más pronto posible a urgencias. El tráfico, las vías del tren, un solo carril para circular, los baches, parecía que todo se confabulaba para no permitirnos avanzar más velozmente

Por fin llegamos a urgencias, la paciente fue bajada rápidamente, llevada a uno de los cubículos y el médico que la revisó tras algunos segundos de exploración, nos dijo: La paciente ha muerto. Fue como un golpe que recibiera en pleno rostro, que me produjo náuseas, coraje contra el médico de base que debía haber actuado a tiempo y con responsabilidad, incredulidad, angustia y una soledad absoluta. La sala de urgencias me pareció enorme, agigantada, las voces las escuchaba como eco, las luces casi me aplastaban, mi mente lo rechazaba. Ana María se me había muerto en la ambulancia.

Después de llenar los papeles de traslado y ver el médico de base que nos recibió, mi estado emocional, accedió a llenar el certificado de defunción y pasar a la paciente a la morgue para que después sus familiares hicieran todo lo establecido para la entrega del cadáver.

Como autómata, recorrí la sala de urgencias hasta el estacionamiento, subimos tanto Vicky como yo a la ambulancia de regreso al hospital, y ya dentro de la misma en el asiento en donde minutos antes estaba vigilando los signos vitales de una paciente grave; me puse a llorar de impotencia, de enojo, de rabia, porque yo había avisado a tiempo, había llamado la atención de que la paciente estaba grave y, sin embargo, el médico adscrito responsable, no me hizo caso. Vicky, a la que tengo en la memoria todo el tiempo era una mujer admirable, me abrazó y me empezó a hablar, no recuerdo sus palabras una a una, pero una cosa es cierta me fueron calmando y tranquilizando, entendí que no era mi culpa, que era (la muerte) un fenómeno con el cual íbamos a encontrarnos muchas veces en esta profesión que habíamos elegido y que teníamos que ser fuertes para soportarla. Muchas veces la podríamos vencer pero otras ella nos ganaría, nos arrebataría a nuestros pacientes, a nuestros seres queridos, pero que teníamos que hacer el mejor esfuerzo para ganarle.

Fueron esas palabras las que me hicieron sentir mejor, las que me hicieron comprender que tenía que ser mejor médico, y después de muchos años y de experiencias adquiridas, creo que soy mejor, gracias Vicky. Si alguna vez llegas a leer estas páginas, piensa que no fueron en vano y que te recordaré por el resto de mis días.

Ya de retorno en el hospital me dirigí nuevamente a la sala de tocoquirúrgica, le reporté al médico lo ocurrido y al final de mi exposición, me dijo tranquilamente: “Muy bien, te toca avisarle a su esposo que está allá afuera que su mujer falleció. Y que el niño se encuentra bien”. De verdad, quería golpear al médico, sentí tanto desprecio por él, que mejor decidí salir al pasillo y notificarle al esposo/padre que la mamá de su hijo había fallecido por complicaciones del mismo parto. El hombre se desplomó, era su esposa hacía un año y medio y era su primer bebé. ¿Qué iba a hacer ahora? Me sentí que había defraudado su confianza, sentí que no podría ser médico, que era algo más grande que no podría superarlo. No era, es cierto, mi primer paciente que fallecía a mi cuidado, pero esa muerte que bien pudo evitarse, me afecto mucho.

Ya no lloré, simplemente abracé a ese hombre destrozado emocionalmente, y le dije que tendría que ser muy fuerte y ver por ese hijo que nunca conocería a su mamá.

El incidente lo reporté a mi jefe inmediato, el jefe de Enseñanza, pero me dijo que no se podría hacer nada en contra del médico, que así dejara las cosas. De ese médico nunca quise saber más, el bebé si su padre lo llevó adecuadamente, debe tener ahora alrededor de 42 años de edad, todo un hombre. Quizá él nunca sepa que me tocó traerlo al mundo y despedir a su mamá. Quizá nunca lea estas líneas, pero el recuerdo de ambos seguirá en mi mente y ahora en estas páginas comparto esa historia de vida.

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