Anyway, that all ended around one in the morning, and after all was said and done, the doc said "Don't call me at 8 tomorrow. Don't call me at 9. Maybe 10...." So, Nicole and I rolled up to mother/baby to round right around 10:20. Most of this doc's patients were in L&D, so we rounded on the few new mothers - everyone was doing well, and then we got the text. Sub-I girl is living with the OBGYN doc and his family; she's kind of attached to his hip, and I get in touch with the doc through her. We headed over to L&D, where one of his patients was already in labor. This was a fairly young mother giving birth to her first baby ( a nullipara), and so, since it was her turn, Nicole gloved-up and assumed the position right next to the mother. I hung back a bit; the father looked a little nervous having so many people around (he eventually got nauseous and had to leave). The baby started crowning, and the mom started pushing, and this big head appeared, followed literally two seconds later by her whole little body - it was just about the fastest birth I'd ever seen! The nurse weighed her and did APGAR scores, and the dad finally came back in, overwhelmed with pride.
Back out in the hall, we met up with the PA student (henceforth to be known as PA girl) who had spent the morning interviewing at a dermatologist's office where she'd been offered a job. We've got a great little group; PAgirl is absolutely hilarious, and peppers our down time with laughter and sound effects, and Sub-I girl is just as hilarious with a plethora of stories about little kids. Nicole loves telling stories, and I slip in a few when I can - the point is that we've got a group of four students who get along surprisingly well, and that helps to pass the time....because we spend a lot of time waiting. Initially, Nicole and I had brought our books in, to study on the down-time. After her delivery, Nicole took the books out to the car, but once the down-time reappeared, I went and got mine. Bad idea...I should have known I wouldn't get the chance to study.
If our night was late, the doc's was certainly even later - so he retired to his office to catch a catnap. Since he said not to go too far, the four of us grabbed lunch in the cafeteria and went to eat in the intense sunlight of the hospital's little garden. With opera music piping through the speakers, I almost forgot where I was - but I guess that's the whole point of the little place. We headed back up to L&D, back to our little nook -the end of a hallway in L&D where they stored extra wheelchairs, overlooking the hospital and downtown Miami - and chillaxed for a while.
Gradually, it became apparent that things were very tense; the families of women in labor were poking their heads out of the rooms wondering why some of the nurses were running. We heard one of them frantically calling for our doc, and knew something was up. I went and got out his surgical gear to streamline the process, and within 2 minutes he'd rushed into L&D. I couldn't tell exactly what was going on, but one nurse said something about the baby's heart rate being in the 70's (it's supposed to be 110 to 160), and that the mother had just come in from the ER - and that no one knew anything about her except that she was 39.5 weeks. Since things seemed so hectic, the four of us decided to wait and not scrub in, lest we find ourselves underfoot. The last thing I heard before the doors shut to the surgical suite was one of the nurses saying "and I can't guarantee the baby's even alive". And all of us were going "ohshitohshitohshit....."
We stood around nervously, waiting with baited breath as we stared at the doors to the surgical suite. I said a silent prayer for the baby and mom, and Sub-I girl went off to pray alone. Minute after tense minute passed - and finally we saw the doc walking down the hall towards us. Those were the most tense moments; knowing that we were about to discover the fate of one, possibly two lives. Fortunately, the baby and mother were ok - it turned out that she'd had a placental abruption, in which the placenta begins so shear away from the uterus, and the space in between fills up with blood. This can be fatal for both - but they got to it in time. There was some down time, then, and we followed the doc to Mother/baby, where we told stories about Dominica, the cows and crabs, lizards and food poisoning, while the doc dictated.
Next thing I knew, another mother was getting ready to deliver, and it was Sub-I girl's turn again. I believe this mother had had a few children, and so was an old pro. That delivery went smoothly, and we waited some more. Another mother got ready to deliver, and this time it was PA girl's turn - for this one, I helped hold the mother's legs. She had a small perineal tear, and the doc walked her through the sutures. That delivery went well also - halfway through, though, after the baby had been delivered and before the placenta had been delivered, PA girl's clamp slipped on the umbilical cord, and as they were banking the cord blood, a jet of it shot across the table. Fortunately, it missed me - but she wasn't so lucky, and went to change scrubs after it was over.
There was a scheduled C-section, and this was my turn to scrub in. I helped arrange things, and set out my gown and gloves, and then hung around our Nook until they brought the mother back. I scrubbed in and gowned-up, watched the woman being anesthetized - and then every one except for the anesthesiologist, the scrub nurse, and I, disappeared. Minutes passed, and it got to be sweltering. 40 more minutes passed - I later learned that the doc had unexpectedly been called to another delivery that was hectic in it's own way; the umbilical cord was wrapped tightly around the baby's neck and couldn't be pulled over her head - and there wasn't a table prepared with scissors. So Nicole ran around until she found some, damn near livid at how slowly some of the nurses were moving, and finally found some scissors and saved the day.
Finally, everyone came back to the OR, and the C-section got underway - the sweat on my forehead and my headache forgotten. Apparently, if a woman has had a previous C-section, part of the standard of care is to remove that scar tissue, in effect giving the woman a mini tummy-tuck. Much like the woman from the C-section last night, this woman was obese, and had to have her stomach taped up and out of the way, to clear the surgical field. So the doc used electrocautery to slice through her voluminous flesh, delving down from skin, through fat, fascia, and muscle, to her uterus. With delicate scalpel slices he opened the uterus, and pulled out the baby. Someone told me to suction, and so I grabbed the bulb and suctioned amniotic fluid from her airways - and she started screaming in protest; always a good sign. The neonatologist whisked her away, and the doc prepared for the next step - delivery of the placenta. In C-sections, you can't just wait for the placenta to be delivered; it must be done manually. The doc essentially said "Get your hand in there" - and then I had my hand inside this woman's uterus. I've been wanting to say that I'd had my hands inside someone, but even though I'd assisted with a few C-sections, it just wasn't true. And then there I was - my hand inside her uterus, gently peeling away the placenta from the inside. Once that was complete, the doc asked for the sutures to close the uterus. He placed the anchoring stitches, and handed the instruments to me
This was something I'd been waiting for and looking forward to, but didn't think I was ready for. I figured that, like Nicole and Sub-I girl, I'd get to suture the fascial layer, or something not so quite so vascular - but the doc handed me the sutures, and I began sewing up this woman's uterus. There was perhaps a second in which I had to take a deep breath to still my trembling hands, but overall, it felt strangely normal. I'd expected it to be mind-blowingly exciting, but instead it felt natural, and right. The doc commented that either I'd been watching a lot of videos on youtube or just paying a lot of attention - I told him that youtube's videos weren't that great. I don't know what it was; of course I'd watched closely - this whole process is fascinating. Also, the instruments just felt right and proper in my hands, perhaps due to my extra time as an anatomy TA and the suture clinics on the island. My suturing wasn't perfect, but this was the first time I'd ever placed a stitch in living flesh.
It was awesome and fascinating, watching the bright-red blood well up and be suctioned away as I slipped a crescent moon needle through the bundles of muscle fibers and out the other side, slowly and surely sealing her womb. The amazing thing is that this is a completely commonplace procedure; this happens every day, and today was my day - my turn to sew up a person's insides. You know, I've noticed something - when I step up to the table, everything disappears except for the surgical site. It's like a hush falls over the room - everyone stops talking - and there's only the sound of the doc's voice, suction, and electrocautery. Once in a while, something will grab my attention, and I'll break through back into reality, catching snippets of conversation and songs on the radio (my favorite anesthesiologist loves Caribbean music) - only to quickly be pulled back under the concentration and complete focus on the person lying open before me. That sensation was magnified by a factor of ten when I actually had the instruments in my hands; there was nothing else.
We moved on to the fascia, and made sure that it was sewed up nice and tight - I did half of this layer as well. After that was done, the doc left - (apparently, he was very impressed with how comfortable I was with the tools...so Nicole says...). The surgical assistant and I closed up, and then the patient was wheeled into recovery.
So how was your day?
No comments:
Post a Comment