At around 3 am, the Registrar, Priyanka, roused herself from her nap on the table and started her round. There were only 3 patients currently in labor, all in the latent phase – meaning that it would be quite a while before they actually delivered. Having taken care of their paperwork and blood-work, both interns on duty were enjoying a rare few hours of sleep during their 12 hour night shift. Luck had run out for one of them though.
A Resident prodded Akshay awake.
“Priyanka ma’am wants to shift that Varsha Tunkawale for a Cesarean,” Sapna, a second year resident, said to the groggy Intern. “Prepare her fast and come to the OT with me.”
“STAT!” she added giving him another firm shake.
The intern pulled himself up, grumbling under his breath.
He quickly secured a urinary catheter, scrubbed her abdomen and went to check whether her relatives had signed the consent forms. Sapna was explaining the situation to the relatives outside the Labour room.
“Her child’s heart rate is fluctuating and its life may be in danger if we don’t operate immediately, especially considering that she has already undergone two Cesareans,” she said. The patient’s relatives were from a nearby village. They couldn't comprehend anything beyond the fact that their child would need a ‘Caesar’.
“But Sister, nothing will happen to the child right?” mumbled the patient’s father.
“I’m NOT a Sister, I’m a Doctor,” shouted Sapna at the cowering parents. “We’re gonna do everything we can but we can’t make any guarantees.
They signed where it was necessary and the patient was shifted to the OT.
“Is the foetal distress very severe?” Akshay asked Sapna as they were scrubbing in for the surgery.
“I have no idea,” she said. “She seemed fine to me, Priyanka ma’am noticed the foetal heart rate is on the higher side and ordered a Cesarean.”
“Oh… Which criteria is this a part of?” asked Akshay eagerly, hoping to learn something useful for his PG Entrance exam.
“Her instinct,” grunted Sapna, as she pulled on her gloves.
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5 minutes into the Surgery, Akshay and Sapna were in a precarious position. The patient’s pelvic cavity was, to put it mildly, a jumbled mess. The previous 2 Cesareans had wreaked havoc on the patient's anatomy. A thick web of adhesions had spread through the pelvis. The patient’s abdominal muscles, uterus, bladder and bowels were all stuck together like a tangled web.
Sapna explored for about ten minutes, trying to make sense of it, to separate the muscle mass from the uterus.
“It’s no use. Call Priyanka ma’am,” she said to the anesthetist. “Akshay get de-washed and go tell the relatives the situation. Tell them that the patient may bleed more than usual and that we can’t guarantee the safety of the child either.”
Akshay pulled off his gloves and hurried to the door of the OT and called for the patient’s relatives. He told the relatives what was necessary, struggling to stay calm while finding the right words to use in the situation. Once again, only about 50% of what Akshay said was being registered by the relatives.
Priyanka ma’am appeared at that moment, yawning and stretching while rushing past them to enter the OT.
“Madam please, you do something for our child,” they called after her.
Priyanka cast a glance at them, nodded reassuringly and hurried to change.
Her small gesture put the relatives at ease for now.
Akshay got back as Priyanka was scrubbing in. As she rinsed her hands, Akshay could see the sleepy exhaustion under her eyes fading away to make room for a steely determination. Her posture straightened as she flicked the last few drops of water off her hands and donned her surgical gown.
She marched into the Theater, gloved hands folded in front of her and assessed the situation.
“Akshay call the Blood Bank and ask them to issue this patient’s blood. And I’m going to need a LOT of Chromic Catgut stat.”
As the Intern rushed to follow her commands, Priyanka grabbed a scalpel and a pair of forceps and dove in without missing a beat. Using precise, calculated movements, she started separating the rectus muscle from the uterus. Sapna was assisting her with almost unbelievable speed and precision. Together they separated the bulk of the rectus, splaying it open to either side like curtains to reveal the uterus.
Akshay watched wide-eyed; the wall of the uterus was stretched paper thin and the liquor inside could be seen in flux as the fetus moved. The scar on the wall of the uterus from the previous Cesarean had all but ruptured. All it took to open the uterus was a small jab with the blunt end of a scalpel. The uterus burst open like a balloon, spewing forth amniotic fluid in all directions as Sapna hurried to suction it off.
Priyanka reached inside and pulled out the baby, as everyone in the room held their breath. They clamped and cut the umbilical cord. The humidity and tension in the room reached a fever pitch. An excruciating moment passed before the baby gave a gurgling cry, proclaiming its survival to the world. All those present gave a collective sigh of relief.
Had the patient been allowed to go progress into normal labor in this condition, her uterus would have ruptured internally, causing massive bleeding and almost certainly ending the life of both mother and child. Priyanka’s instinct had saved the patient’s life.
The procedure that would normally take 30-45 minutes was finally completed 2 hours after it began. A neat 10 cm long scar was all there was to show of the chaos that had transpired in the last two hours. Priyanka finally walked out, pulled off her gown, breathed a huge sigh of relief and sat on the rickety wooden bench outside. She pulled off her sweat and blood stained scrubs and gulped down the water Akshay offered her.
“Thanks,” she panted as she rose and went to change. Akshay hurried to get the signature of the assisting Nurse, hoping to grab a cup of tea before the early morning rounds. A strong, familiar fragrance tickled his nose as he walked by the open window of the Nurse’s room.
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Priyanka was leaving the OT the same time as Akshay, they were both accosted by the patient’s relatives outside.
“How did it go doctor?” they asked looking at him, “Is our daughter fine? What about the child? And…”
“Things went well. It was a complicated procedure but we’ve done as good a job as we could. The mother and child are both stable now, we’ll be shifting them to the ward soon”
The patient’s mother had tears in her eyes.
“Thank you so much, doctor, you are like a Devi to us,” she cried and tried to touch Priyanka’s feet. Priyanka jumped out of the way, flustered.
“Stop please, you are twice my age and I’ve only done my job, take care of your daughter now,” she said and walked away.
“And what about the child, son?” asked the patient’s father to Akshay.
“You’ll have to ask the Paediatrician for the details but as far as I know, the baby is healthy. It’s a girl, congratulations!” smiled Akshay.
Akshay didn't miss their smiles fading and shoulders slumping. He stared down at them.
“Why do you seem disappointed now,” he asked the father.
“Nothing beta, it’s… her first two children were girls too so we were hoping…” his voice trailed off.
“At least we didn’t opt for the tubectomy. Maybe God will bless us next time,” added the mother.
Akshay detached himself from the pair and walked away, down the stairs and out of the building.
He realised what the familiar scent was now - Petrichor. It had rained for almost two hours. As Akshay breathed in the cool air, his thoughts turned to the child. The womb that was supposed to keep her safe had almost failed her, but they had intervened and brought her out safely. As he sipped his tea, he offered a silent prayer, hoping that the world they had pulled her into wouldn’t prove to be equally hostile.
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