blood

Delivery by GP at seven thirty p.m.. Called me at eight thirty. Bleeding. Not stopping. Had oxytocin, ergometrine, misoprostol, but possibly still some placental tissue in the uterus, so arranged removal of retained tissue in theatre.
Patient very pale but apparently blood loss is only a litre. I don't believe the measurement and ask for a blood transfusion asap. The anaesthetist agrees. Under anaesthetic a small piece of placental tissue is removed along with large blood clots. The midwife rings to say they measured a further three litres in the bucket. She certainly looks pale but there is no further bleeding and blood is on its way. I leave her with the anaesthetist and GP and go home.
I cannot sleep so I read my book - Birdsong - about the first world war. It is very graphic and gory. I feel as though I am soaked in blood. At one a.m. the phone rings. The bleeding has recommenced. More blood and misoprostol is ordered. Arrangements for transfer to the city are begun while I come in to to insert an intrauterine balloon.
The balloon is not easy to insert properly. It is inflated and deflated repeatedly until finally it is in good position. The bleeding stops. She has now lost over four litres. Blood is smeared on my white shirt. I sponge it off then go home when the emergency transport team arrives. She is pale but still conscious.
Later, reading in bed to wind down, the book ends in a mixture of bloody defeat and unlikely optimism. I turn off the light at five a.m..
At seven the city registrar rings for further information. The patient is still ok. I sleep for a little longer then  
go to work in the clinic. While I am seeing my first patient there is a phone call from the patient who had the cervical laser treatment. She started bleeding five hours after the treatment, hasn't been able to sleep and has soaked two bath towels with blood. I ask her to come in at once.
On the examination couch copious blood clots are removed from the vagina and the cervix exposed. I was hoping for a single bleeding vessel but there is just a general ooze which I oversew with a nylon suture then add Monsel's solution and silver nitrate. There is only a slight residual bloodstained discharge but I am concerned about a further bleed. She will ring me in a few hours with her progress.
The clinic continues without lunch.