I thought that once I started my post-graduation, I'd reel out tales of patients and my fellow surgeons and professors and OT gossip. But the first story to make it to my blog is one that does not concern my specialty.
On our last duty day, it was just going from drizzling to raining outside, and we were having a steady stream of patients. We got a patient with eight months of amenorrhea with pain abdomen, diagnosed with a perforated appendix with peritonitis and requiring immediate surgery. The patient was told about her chance of going into labour during the surgery and gave her informed consent for any eventuality. My seniors who were doing the surgery were ready for an on-table delivery, if needed. We had put a call for an obstetrician, who however hadn't come in time for the surgery and it had to start without her. The appendix was removed and the peritoneal lavage given, flank drains inserted. There were no signs of labour and the patient was shifted to the post-op recovery room. We monitored her vitals regularly and as soon as she gained her senses, she started complaining repeatedly of thirst and pain at the surgery site, and I was just getting a little tired of telling her the importance of staying NBM. She called me again to her side yet another time. And this time she said, 'Something's coming out!' I took a look and what do I find: the baby's head was crowning! Maybe she wasn't aware of it because of the previous anaesthesia, but the labour had advanced fairly fast for a primigravida. Me and my colleague were amazed and terrified at the same time, about having to conduct a delivery after so long. I am not really interested in OBGYN but you can't deny that delivering a new fresh soft fragile baby from a mother's womb into the world is a really happy and thrilling experience, and so long after our internship rotation, we were about to experience that again!
We got our gloves on and alerted our seniors who took over, and waited for the contractions. Only then did we realise that we did not have instruments for an episiotomy in that ward. I rushed to the emergency OT to borrow some instruments from the stern sister in there, and rushed back, to find that the obstetrician had arrived and was delivering the baby and there was no need for an episiotomy after all. With a semi-relieved semi-disappointed heart I got back to the patient's bedside. The baby was a cute pink premature baby boy, and he wasn't crying and had an APGAR of 4/4. We had absolutely no paediatric resuscitation stuff with us, no paediatric cuffs/suckers/masks/ET tubes/IV sets/catheters. Nothing. We tried to resuscitate him with thumb pressure and later the anaesthetist on call gave him oxygen directly from the pipe, trying to maintain a crude form of positive pressure ventilation. It was difficult keeping the baby warm in the cold climate and unregulated ward temperature conditions and he was turning blue. We put a call for a paediatrician and transferred him immediately to them. The lady's family was kept posted meanwhile. And we waited at our posts hoping for the best. After a long long time, we were informed that the baby was doing pretty good, and was going to recover from the respiratory distress. The mom was doing well too. We thanked our respective stars and got back to our routine again. Back to tending to our surgical patients. All in all, it was a happy ending. For our patient and her baby, and for us too. And I emerged from the experience feeling like I had been in an episode of Grey's Anatomy or ER. [Didn't get a House feel though!]
Life's so unpredictable sometimes and such surprises keep it spicy and interesting. They teach us to always be ready and keep us on our toes. And also keep us wanting more. ;)
