In the Realm of Hysteria IV

After surviving a mind-numbing weekend full of post-delivery "mum checks" - those repeated enquiries about bowels movements, pain, bleeding and contraceptive choice - it was with a sigh of relief that I returned to an afterhours floating shift following the directions of a more senior doc in confronting what comes through the door in any moment.

"They almost always throw up..."

We were scrubbed in, doing an emergency Caesearean section on a young indigenous woman obstructed in labour. The woman is awake with an epidural in her back, and she had told me with a fresh open face earlier whilst I held onto her hands during the epidural insertion that she already has three sons, one in her brother's care and two at home. She smiles shyly with liquid brown eyes and tells me she hoped this would be a girl, and that having a Caesearean was a new experience for her.

Her labour had progressed unexpectedly slow, especially for someone whose uterus was well trained in delivering babies, and the decision was made to proceed to a C-section because the tracing of the baby's heart rate was beginning to show signs of distress.

I played first assistant to the friendly senior doctor, and we were going well until she began to frown and remarked: "This is a really thick lower segment (of uterus)..." and asked for the more senior O&G trainee (scrubbed and sitting in the background) to step in. The next few moments saw him take hold of scissors, snipping away at the sides of the thick, pregnant uterus, adjacent to the yet-unborn baby's face, in order to make more room. And then with both gloved hands he reached in deep within the uterus.

I've always cringed at this part of the ordeal. Guts and gore I can generally tolerate, but fishing slightly (normally) blue looking babies out of a small hole in an internal organ, with the various twists and angles to assist in maneuvering its exit, is another matter altogether.

Somehow, the baby's head was stuck and not without difficulty and a lot of force for what seemed like frozen moments in time, the head was finally disimpacted and delivered, and the rest of the body slurped out of the uterus, as if nothing had ever happened. I had the honours of cutting the umbilical cord, relieved that the baby was safe, for now.

That was the cue for the anaesthetist, who gave the uterus-contracting medication, an intervention that has saved the lives of many women from the Grim Reaper's post-partum haemorrhage, a phenomenon that claimed numerous lives throughout history. Next the cauliflower-like placenta was delivered, uneventfully.

"...when the uterus comes out."

The senior doc swiftly dug his hands again deep inside the woman's body, and brought out with him, the now contracted down uterus which he placed on top of her abdomen. Fully one-inch thick in each wall, the strongest muscle of a woman's body now appeared like the body of a huge, firm octopus. Now my job was to hold it in position whilst they repaired the ragged bleeding edges. It was clear to see how good the blood supply to the uterus is, as more and more blood came from nowhere and oozed and filled the pelvis, frequently blocking the view for suturing.

And then she started vomiting on the other side of the curtain. Her belly heaved and heaved beneath the green coverings of the surgical drapes, the same long coverings that disguised her as an anonymous pregnant uterus that contained a baby that needed to be rescued, and took away her humanity, an individual with feelings, a past and a future.

My hand rode up and down with her uterus beneath a sterile cloth, and more blood spurt forth with each vomit. I feel uneasy and snuck a peek at the suction bottle, and it now contained a litre of blood lost. If she does not stop bleeding soon despite the medication and the suturing, we would be running out of options. My mind drifts admist the senior doctor's efforts, only to find my own discomfort at knowing that things weren't going well, that I felt helpless and unhelpful, and that the patient was awake and could hear exactly what was going on and our discouraging conversation. I could feel my objectivity slipping, and in its place the suffering of distress... perhaps my own, perhaps the patient's, perhaps the senior doctors'. It didn't even cross my mind that she could be in this moment rejoicing about the arrival of her wish-fulfilling daughter.

Luckily, things took a turn for the better. Eventually she stopped vomiting, and the blood loss was much lessened. The nightmare has abated, for now. A tube was put in, just in case, to drain any further bleeding in the area and the muscle and skin closed. From the outside, you could not tell what had happened or what sort of healing will take place deep inside her in the time to come. She would not be able to strain or undertake forceful activities for six weeks, not even able to drive, and that certainly should she have more children in the future, her uterus will be too scarred to withstand a normal vaginal delivery; a C-section will be the only way.

As I said earlier, I am frightened by Obstetrics. A place where the margin between life and death seems so unnervingly narrow, not just for one, but for two.