Indian Medic

Yesterday, I happened to read a very interesting post on one of the most popular medical blogs around, Fingers and Tubes in every orifice. I myself am a huge fan of that particular blog and of the author’s excellent style of writing; he can make you feel like you were present at the spot when things are happening. In his latest post A. McGyver, MD he enthralls us with an occurrence where he was forced to improvise in the face of lacking medical supplies to treat a case of Pneumothorax. A particular point where he says there was only one single sterile glove available, brought back memories of an incident during my OB/GY posting in internship, which was one of the first emergencies I had to face on my own. Even though it occurred well over two years back in my internship, one would think that the details would be a bit hazy, but I remember everything as if it happened yesterday. I suppose, it is one of those things you remember for a lifetime.
Here is the tale…


As Angry medic succinctly put it in his comment to my previous post ‘India IS after all one of the most densely populated countries in the world, and it's only natural that health problems are going to arise from that’, it is understandable that OB/GYN in any hospital is one of the most overworked departments. For an intern, it was the most taxing rotation; one and a half months of sheer exhaustion. We used to work over 100 hours a week including two 36 hr shifts. Social lives spiraled down to nil and any available time was spent in catching up with sleep. It would be easy to spot an intern currently posted in OB/GYN from his/her zombie like looks.

I was never particularly interested in OB/GYN as a career choice, as I did not want to spend the rest of my life ‘wicket keeping’ (as in Cricket!)for other people’s babies, as it was known in the intern world. But a couple of days into the posting and I was hooked! The sheer pace and activity of the place was like a drug that got me high. There was always something or the other to do, never a dull moment, it seemed like there was Adrenaline rushing through me 24x7 and the experience was totally hands on and invaluable. Considering that there was, as always, a staff shortage, interns got a lot of practical things to do, other than just scut work. We could assist in surgeries, mostly Cesarians sections and conduct uncomplicated deliveries under supervision. But what transfixed me the most was witnessing the birth of life. The babies who made it, came in all sizes from healthy 3kg ones to tiny 1.5 kg ones. And it gave me immense pleasure to see the rows of tiny human beings bundled up in the nursery. I was so hooked with the rotation, it was all I thought about and talked about and even dreamt about every night.

There were roughly around 40-50 deliveries conducted in our labor room in a 24-hour period and around 7-8 of them would be by LSCS or Lower section Cesarian sections. Our Unit comprised of one senior resident, 4 junior residents and 3 interns. However, our unit was famous for the number of ‘Cesars’ performed which were invariably double of what other units managed on their worst days, rouchly 12-15. Our Senior resident or Lecturer, I feel, did not believe much in the concept of Trial of Labor. Though she was an astute diagnostician and good surgeon, she had a penchant for sending patients to the OR for Cesarians for the slightest holdups in the delivery. The indications more often than not used to be from the ‘relative’ indications listed in the textbook. She would breeze into the labor room, conduct quick exams on all patients, and decide which ones could deliver on their own and which ones needed to be operated upon. Consequentially there used be a line of surgeries occurring in quick succession through out the day and by dinnertime, the labor room would be almost empty, which was a good thing. Residents operated and Interns assisted. We used to take turns assisting, but invariably the one who went into the OR wound up assisting 2-3 Cesareans at a stretch. Each surgery used to last for 45 minutes to an hour but if it were the lecturer performing the C-section, it would all be over in under half hour. She holds the record for the quickest LSCS conducted in our hospital, a mind numbing 21 minutes, from the incision to the final suture.

My tale happened on one such on-call nights. The labor room was virtually empty except for half dozen ladies, part of the late nite crowd who stagger into labor room after dinner around eleven PM and weren’t expected to deliver until dawn. It was around 2.30 AM the leanest time, activity wise. We had one on call room with two beds where all the female residents crashed including the lecturer. We interns managed to sleep where we could, including on tabletops and gurneys.

That shift, it was my turn to stay up in the later part of the night to monitor fetal heart sounds at half an hour intervals of the 6 odd patients who were scattered in the 4 delivery rooms in the labor ward. The Resident who had pulled the short straw was dozing behind nurses’ counter. It had been a hard day for me and after having assisted in a record 7 cesarian sections back to back in the afternoon I could barely stand straight on my feet. That was why I had opted to rest for a couple of hours in the earlier part of the night. Sleep, though, was out of question with the cacaphony of the labor room winding down for the night.

But at 2.30 AM there was a still silence in the ward occasionally broken by a moaning patient or a newborn whimper from the adjoining nursery. It was a calm between two storms. I walked around checking on the patients, taking vitals and checking the FHS (fetal heart sounds). After writing notes I sat down behind the nurses counter and put my head on my arm. Just when I was about to doze off I was abruptly woken up. For a second I thought I had heard some noise. But the deep silence prevailed. Though I told myself to relax, I decided to check the patients out. Maybe it was intuition or maybe I had heard a sound after all, I walked to the delivery room farthest down the corridor. One look into the room and all my tiredness and exhaustion vanished.

The lone occupant of the room was a 34 year old female G3P2L2, i.e she was there to have her third child. Just about ten minutes ago, I had left her comfortably sleeping on the standard issue metal bed with a U shaped cut at the foot end, after having ascertained a good strong FHS. But now she was perched at the edge of the table, her face contorted in pain, her brow glistening with sweat, still not making any sound but obviously experiencing a massive contraction. One look under her dress and my worst fears were confirmed. The Baby was crowning.

“Somebody, get in here”, I yelled into the corridor.

What followed after that, seems like it was played out in ultra slow motion with dramatic music in the background, or maybe it was only my heart thumping wildly in my chest.

Dismissing the routine of wearing a plastic apron over my dress, I rushed forward to the supplies side table and opened the metal bin to get a pair of gloves. But to my chagrin, there were none. Another look at the patient and I could see that the labor was progressing very rapidly - the baby’s head was out. Going to another room for a pair of gloves was out of question I rapidly decided, just when I saw a rolled up glove in the corner of the table wedged under a kidney tray. I snatched it up and jerked it open…it was single. Another glance at the patient…the baby’s torso was half out…and I made the decision in the next split second.

I dropped the glove and lunged for the patient. I was not a second sooner. The baby was out followed by a gush of amniotic fluid, which spattered all over my dress and feet. I caught the baby in mid air with my bare hands, centimeters before it hit the metal bucket placed under the foot end of the table to collect the afterbirth. However, the split second in which the baby had hung by the umbilical cord had torn it and blood started gushing out from the torn ends.

Somehow I managed to hold on to the slippery baby with one hand and pinched the baby’s end of the umbilical cord between thumb and forefinger to stem the bleed. There was not a sound from the baby, but it was not fully flaccid either nor was it cyanotic.

By then people had come into the room and miraculously all of them were gloved. The Baby tray emerged from somewhere and I carefully placed the newborn on it, still holding onto the cord while the nurse tied it with a sterile string. While one resident waited to deliver the placenta, another took the baby to the nursery to resuscitate it.

What followed next does seem a bit hazy to me now, like a dream. The baby was resuscitated with partial success and transferred to the NICU. The neonatologist was saying something about it having lost some blood. Personally I feared I might have caused it some injury while handling it - Erb’s or Klumpke’s palsy, but that was not the case. Since the disaster had been averted, no blame games were being played but I received a few slaps of kudos on my back. It was only when someone pointed it out, that I realized that my dress was soaked in amniotic fluid and my shoes were making sloppy noises as I walked. We didn’t have scrubs in the labor room, and I wasn’t given permission to go back to my dorm to change. I had to spend the remaining four hours of my duty wearing the amniotic fluid soaked dress, which I had tried to rinse of as best as I could, and which later dried to form a stiff canvas. Luckily enough the amniotic fluid was not meconium stained (that’s fetal poop!) But I didn’t mind, after all I had saved a life that night. Nevertheless, it was the most thankful shower I ever had, when I finally got around to it the next morning.

As I said, no blame games were played, but the story of how I caught a baby with my bare hands and got showered with amniotic fluid in the process, spread all over the campus. I checked in on the baby about half a dozen times the next day in the NICU. Though he was severely anemic, underweight and struggling to breathe, he seemed to be improving; I even got to name him. His mom was all gratitude for my having saved her little boy. I named him Aditya, which means ‘Sun’ in Sanskrit. However, it soon became clear that little Aditya was fighting a losing battle. The third morning, on my way to work when I went to the NICU, I was told that he had died of respiratory failure in the night. I said a quick prayer for his soul and went off to bury my sorrow in work. The tears did come though, later that night.

I hold this experience close to my heart, coz I not only had faced my first emergency but also had lost my first patient in essence.