IN VITRO:

Dr. Mario Lopez felt all the symptoms of acute anxiety fast heart beat, cold sweat on his brow, churning nausea in his stomach.  He gazed down at the woman on the operating table and tried to reign in his emotions and marshal his thoughts.  This was an operation he had performed hundreds of times, a "C-section."  Caesarean.  He was reacting like an intern fresh out of med school.

After ten years as a OB-GYN specialist, Lopez knew this was a procedure he should be able to do in his sleep.  But this was different.  This was too personal. He shouldn't be here.  He shouldn't be operating on this woman.  An important factor was missing -- the objectivity of a good surgeon.  He was too personally involved with the patient.  How could he be objective with all the thoughts, memories, emotions, conflicts churning in his mind?

The conflicts.  The unanswered questions that he had asked all his life.  They had mounted and grown inside him until now they had become an overwhelming mental black cloud shot through with blinding, jagged shafts of lightning and soul shaking thunder.

He glanced around the make-shift operating room.  It was all wrong.  They should be in a gleaming white room with brilliant lights, the latest hi-tech monitoring systems, a skilled surgical nurse at his side, trays of glittering surgical instruments near by, a trained anesthesiologist, oxygen, blood, everything to cope with every possible complication, plus air-conditioning to dry the perspiration on his brow.  Instead, they were in this small, cramped room.  Rusty pipes criss-crossed the ceiling overhead, leaving stains down one wall. Some ceiling tiles were missing.  Paint on the sheet-rock walls was flaking.  A single window air-conditioner struggled half-heartedly against the heat and humidity in the room.

Silently, he cursed the room and especially the situation.  The surgery trays he had pilfered from the hospital held only the most basic instruments.  The drapes were primitive -- made of paper and not out of cloth as they should be.  He had no blood, only two 1,000 cc bottles of normal saline solution.  He felt that based on the amount of vaginal bleeding, the patient most likely had a placenta previa or an abrupto placenta.  There could be other causes, but those two were the most likely -- and the most life-threatening.

Mario's thoughts were consumed by the urgency of desperate situation facing him, racing over the possible causes of the severe bleeding.   The placenta, which supplies oxygen and nutrients to the fetus, is attached to the uterus.  Abrupto placenta is a condition where the placenta becomes separated from the uterus.  It can be a dangerous complication of childbirth that causes severe, immediate bleeding. The baby is deprived of oxygen.  The mother suffers massive hemorrhaging.  The patient and the baby can die in a matter of minutes.  But he had no blood, dammit.  Only the damn saline solution.  This was a room for treating minor first aid patients, not for a major operation.

Another cause of the bleeding could be placenta previa, a condition where the placenta is very low in the  uterus, in the lower uterine segment, and as the cervix begins to dilate, the placenta separates from the uterus and the same type of hemorrhaging occurs.  The way to diagnose for certain what was going on was with ultrasound imaging.  Mario cursed himself for not bringing a small, portable ultrasound unit from the hospital.  He felt like a midwife, trying to cope with a difficult birth with inadequate medical facilities and little