Building rapport

The first cut

Being a central hospital meant that most of the patients being referred to us needs to be delivered via ceserean section. This essentially means that a surgeon has to take them to theatre and cut open the abdomen and pull the baby out via this opening. Obstetricians who perfom these operations are known amongst the actual surgeons as 'bloody surgeons'. 

I have been working in labour ward for a week now and had learnt on my first day on the job that the ceserean sections were part of an interns job description. Ideally a c/s should be done by a registrar, but working in a hospital with limited human resources meant that interns naturally took on more responsibilities than normal.

My first theatre day had snuck up on me rather unexpectedly. I was rounding in labour ward when one of the registrars had come and asked me to go to theatre today. He had promised me that another registrar was already in theatre and that I will get a chance to learn. I would later find out in theatre that we had two anesthetists but only one nurse available. (We almost only had one anesthetist, having two on this occasion meant we could do twice the number of c - sections during the day. Lack of a second scrub nurse meant that I will get to play that role for the day)

Watch one, do one and teach one is arguably the best method of teaching. And so I proceeded to watch my first c - section with the eyes of an intern. I had watched one before as a student, being a student however meant that I had been standing at the back of a relatively crowded room and seen very little of the actual surgical field. This time around I needed to absorb as much detail as possible. More specifically I needed to watch the scrub nurse very closely, in a matter of minutes I will be doing her job and at this point did not remember the names of most of the equipment. 

I remember scrubbing in (there is a bunch of rules we have to follow in terms of hygiene to ensure strility and prevent infections) to assist for the first time. The theatre in charge, a woman with a reputation for being mean, had made me repeat the tedious hand washing procedure twice. An attempt 'keep her theatre sterile' she says and I wonder if she doesn't notice the rat in the corner. Surely me washing my hands for less than the recommended 3 minutes was not going to make much of a difference in this theatre. 

The registrar starts the c - section and I split my focus on handing the correct equipment to him and learning from him. At the thirty minute mark he has already sutured the abdomen closed and he adds 'I went as slow as I could. Hope you learnt something'. I was the surgeon and him the assitant for the next patient. It was a virgin abdomen (no previous surgical scars). My registrar was scrubbed in with me and that was all the assurance I needed. Doing this surgery wasn't as bad as I expected it would be. I finish in 50 minutes time and my mentor compliments me on my first c - section.

The next day I was sent to theatre once again to practice while the skill was still fresh. I walk into the operating room and realize that I have been pushed into the deepend after just one small lesson on swimming with floaties. I look to my scrub nurse, a man of my stature, and say 'this is my first solo surgery, I need you to tell me if I'm messing things up'. He laughs at first but realizes the weight of my words when he see that I am hesitating to make the first cut. He then says 'By God's grace nothing bad is going to happen today. A healthy mom will leave this hospital with a healthy baby'. I never told him that we believe in different Gods. Nothing bad happened that day and so I thank the Gods. 

I had done my first solo c - section in just under 65 minutes. I went on to do 97 ceserean section in the 5 months that I had spent as an obs intern. I would have mothers die on my table and I would pull out dead babies, I would call for help and I would teach others, I would deliver twins and I more shockingly I would learn most of my c/s skills from the 'mean' theatre nurse. She was mean, have no doubt, but she was a great teacher. 

P.s. the rat infested theatre was completely broken down and converted into a new state of the art rat free theatre.