Jan 1997
9 days into Final Year
I am entering Labour Room tomorrow. This is a mythical place, a place where one can neither check out nor leave before our 14 day posting is up. I, along with 4 others will start our posting at 8 AM sharp tomorrow.
I am excited, yes, but mainly apprehensive and a bit nervous.
I spend my last evening of freedom staring at the ceiling of my room, knowing I should be sleeping, but also knowing that when I wake up, I will be entering Labour Room.
It's a posting one looks forward to it, and dreads, all at the same time.
The Next Morning:
There are 5 of us. We walk into the OG Corridor, past the Consultant offices and turn left opposite Ward 12, sharp at 8 AM, with white coats that will hardly be used, a textbook that will hardly be read and with stethoscopes that dangle authoritatively, either across the shoulders or straight down from the neck. Narayanan, Pakha Tesia (from Arunachal), Naveen, Pajanivel and me. The lambs walk down in silence.
There are actually two Labour Rooms. One is across from Ward 12 and is called the CLR or "Clean" Labour Room. Down the corridor and across from Ward 16 is the SLR or "Septic" Labour Room. Both are misnomers, I have come to realize, the CLR isn't very clean and the SLR is not septic. The names derive from the kind of labour cases that are kept there, with the CLR having normal non-infected cases and the SLR housing infected or potentially infected ones.
We walk to the CLR passing a room on the right labelled the "Eclampsia Room". This is a place which houses the Eclampsia or Pre-Eclampsia patients and a place I will be spending a few hours every day in. We also pass a few patients walking around or lying on the floor waiting to be called into the CLR. As a patient, one enters the CLR only when labour has started.
The 5 of us open the yellow fading double doors and troop in.
The Labour Room:
One enters the CLR into a small rectangular area which has the onmipresnt OT trolley-an iron trolley with a mattress, off to one side, work tables, chairs, tons of papers and forms and a wooden clothes rod on the wall with hooks for clothes and OT green gowns. Immediately to the left of the main door is one of the Delivery Rooms whose entrance is marked by a biggish floor freezer which contains human placentae. There are 3 other Delivery rooms, perpetually full, each with 2 beds and all of them are next to one another in a line starting from the first one with the freezer. A Red Line with a marking "For Doctors Only" divides this area from the working rectangular area.
There is chaos here at 8 AM, or atleast that is what it looks like. In the middle of running nurses, shouting doctors and screaming patients, there is a calm Senior Resident, a guy about 5 years senior who has finished his PG in OG and is now posted in charge of the Labour Room. And in charge of us. Dr Singh greets us, we introduce ourselves and then there is a short lecture on the do's and don'ts of this place.
Some Do's:
1. Be punctual.
2. Work sincerely
3. Learn to learn on the job
4. Enjoy the posting
5. Go to OT and assist whenever possible
And some pearls like:
1. Always be in the Labour Room at 8 on a Monday. That is Unit 1 Rounds Day. Be seen working in the CLR when Madam drops in.
2. Never, ever be seen in the Labour Room without a green gown or an OT mask
3. Make sure the partograms are accurate and up to the minute.
Our schedule will be as follows:
Enter at 8 and work till lunch. We take lunch breaks in shifts, with 2 of us going at a time for a maximum of one hour. Then, its work till dinner, about 7 PM with shifts again. At night, 2 of us work till 2 AM, handing over the shift to the other two who will work till breakfast.
One guy gets the night off (8 PM to 8 AM) and this happens by rotation, so I'll be off for a night once in 5 nights. Classes are off except OG lectures and Ward Clinics. This is when we will troop in, looking haggard and sleep deprived, trying hard to stay awake during the Air Conditioned lectures.
Visits to the room during meal breaks give us just enough time for a quick shower, a change of clothes and a 5 minute gossip catch up session.
That's it.
One more thing:
When one retires for the night (in the Duty Room down the corridor, NOT in the hostel), one can be woken up at any time if there is a need. This can happen if the case load becomes too heavy, or if there is an interesting case being operated on or for whatever other reason. And one has to go.
We are shown the forms that we will be filling in the next 10 days. Live Birth Forms, Still Birth Forms, Death Forms. Investigation forms, from Bloods to Biochemistry. This is where I see these forms for the first time, the yellow Biochem forms and the Red on white Blood forms, forms that I will spend a LOT of time filling next year as an Intern. There are Ultrasound Request forms, OT "Call Slips", and Operative Notes forms.
The Call Slips, we are told, are sent when a patient needs surgery (usually a Caesarian here). It has patient details, when they ate last and what op needs to be done. The anaesthestist signs it and keeps a track so that they can "call' for the case when appropriate. It's a vital piece of paper. No Call Slip means the OT has not officially heard of the case.
We will essentially be conducting deliveries and doing all the stuff that happens around an imminent delivery, including monitoring, post delivery care, suturing wounds, assisting Caesarians, writing forms, and all and sundry. This is where we will learn to start IV Lines, take blood for investigations, monitor Oxytocin drips, do Per Vaginal exams, make out foetal heart sounds and know when the kid is struggling and when to initiate an urgent delivery. This is where we will learn to perform episiotomies-surgical incisions designed for easier deliveries and how to suture them back.
This is where we will be part of the miracle of birth.
We get a crash course in the later stages of pregnancy. There are 3 stages of labour. The first stage is a bit of waiting for the cervix to dilate fully. In this part, the patients are called in for quick regular checks to see whats happening with the dilatation and if something needs to be done. Once that is over, the second stage starts and that is really where we come in. Monitoring starts intensively now, with Blood Pressures, pulses, foetal heart rates, foetal positions (is it coming down properly or has it got stuck), various drugs to be given to speed things up etc. All of this monitoring is recorded on a graph-the partogram, which is stuck on the wall next to the patient and is inspected regularly by the Senior Resident, or rather more importantly by Madam A or the other Consultants when on rounds. Failure to maintain a proper partogram is a recipe for disaster in exams.
Such foul-ups are remembered.
There are 10 full days of this and how one survives depends a lot on how one takes it. It's there and has to be done. The knowledge that one will acquire, actively or passively will be tested severely in exams and even if one fails to answer some intricate question in Obs or Gynae, lack of Labour Room procedures is a sure way to instant doom. Ears have to be perked up, eyes have to be peeled, brains have to be alert and feet have to be quick.
A normal delivery is fine, but a complicated one can turn nasty very fast.
It's the first day, the first morning in fact and I, like the rest of my 4 classmates, are like babes in the wood. There isn't much time to settle in though, as the action starts off pretty much instantly. It would be fair to say that the action actually never stopped, we just happened to be a brief interruption and are caught up in it, stat, as doctors are wont to say.
Except that we are now saying things like "stat" and "IV Line" and "Synto drips" and Magsulf" but are nowhere near being called doctors yet. I put on my green OT gown, hanging on the wooden gown holder by hooks, and put on my mask. The others do the same and we are allotted "Delivery cubicles" and patients to monitor. Our task for the moment is to chart the progress of labour on partograms, as accurately as possible and hope that it turns out OK. The problem is that, in an ideal world, we would monitor these patients from start to finish, ending with a newborn baby in our arms and saunter off for the next one. But this is Labour Room, where on an average, I see from the huge Delivery Record Register, about 40-50 deliveries are conducted every day (and night).
So, in reality, the morning is spent monitoring one patient, rushing off to attend a delivery for another, starting an IV line for the third, running back to the first one to measure contraction durations and foetal heart rates and writing up Live Birth forms. I learn the core of any busy medical practice-how to mentally compartmentalize many patients and keep tabs on what is happening to each.
I am in charge of a patient who has just walked in for her delivery. I start an IV Line, get some bloods for baseline work-ups and off we go. I start a Oxytocin drip (Synto) and start counting drops. First 4 drops a minute, (very painful to count), then slowly, after a vaginal check has shown the labour is progressing well, I increase it to 8 (still painful to count). The patient is a "Primi"-first kid, so this is going to take some time. In the middle, someone comes along and applies some "Epidosin" that is supposed to get the cervix to dilate and efface properly. This is done thrice, 15 minutes apart.
While I am counting contractions and synto drip drops, a shout comes from next door.
My first delivery is rather uneventful. A typical "Mutli"-now in her 3rd or 4th pregnancy, with the foetus in the normal "OP" (Occipito-Posterior position with a Longitudnal lie) is having solid contractions spaced about a minute apart, each lasting for about 45 seconds. A vaginal examination has shown a nicely dilated cervix and a full on shouting match is in progress.
It's the battle cry of Labour Room
"Mukkkkkkk Maaaaa"....."Mukkkkkkkkkkk".
"Push Ma...PUUUUUSSSSSHHHHHHH".......
With every contraction, the above shouts happen.
After a few minutes, the head shows (crowining).
At this point, the patient is in agony also and is screaming her head off, so the noise levels are pretty high. Then suddenly, the baby is out, all covered in muck and is quickly delivered, wiped and the umbilical cord is tied and cut. The baby is whisked off to be checked by a Paediatrician who has been hurriedly summoned from somewhere and the sudden cessation of noise is ghostly. The sheer relief on the patient's face is obvious.
The job is not over though. I have collected some blood from the cord in a small "Penicillin" bottle which goes off for blood grouping and I now sit ad wait for the placenta to come out. This is helped along by carefully pulling on the cord, almost as if not pulling at all, but just about in a manouvere called "Controlled Cord Traction". That done, we inspect the placenta for bits that might have been left behind and then (probably) proceed to dump this placenta in the freezer next to the main door.
In the meantime, the others are also at work, running about with various tasks. There really is no "allotted patient". Whoever happens to be around at the time a delivery is going to happen assists or conducts the delivery. We all have 10 deliveries that we must conduct independently and write in our Records and it seems like we will reach our targets on the very first day.
Lunch time happens, all too fast and we take turns. One guys has vanished into OT for an Emergency Section (Naveen who will soon develop an OT fixation) and I, along with someone else go for lunch. It turns out that going out for lunch or dinner in the first shift is not a great idea because one has to be back in 45 minutes to relieve the other two. On the other hand, if one goes later, time can be stretched.
One can go out of Labour Room for various things. Sometimes, it's to collect a Biochem report from the Lab on the 2nd floor. Or to pick up a form for something on another ward. Maybe to get the portable ECG machine lying around somewhere or some such thing. If one goes for lunch second, all this can be combined with the lunch break (mostly fictitious outings). Since there is no pressure to come and relieve anyone of us, these breaks may even last for an hour!
My Primi patient, meanwhile has reached 16 drops and is doing well. Screaming like crazy, which is good, and has good Foetal heart sounds. I place a hand on the abdomen during one contraction and I can feel the normally soft, flabby skin turn rock hard for a while. The patient knows this too and starts moaning a few seconds before the contraction hits, the decibel levels reaching sky high for a few seconds. It's said that Labour Pain has been ranked 10 on a Pain scale from 1 to 10 and I can see why. There's a baby squeezing hard inside.
I am keeping track of the labour on the graph and a Resident is doing regular vaginal checks on the state of the cervix and the descent of the head of the baby. At any point if the head gets stuck and labour does not progress, the whole thing may have to be cut short and expedited, either with instruments like forceps or a vacuum pump or by a Caesarian Section. In this case, things sail smoothly and towards the end, I am taught how to make an episiotomy incision.
"LMLE". Left Medio-Lateral Episiotomy is what it is called. One gloved hand in the vagina and after some local anaesthetic, a 6-10 cm cut is made to make more room for the baby to come out. The baby is out, and after the placenta thing, I now have to suture this freshly made cut.
I see someone doing it first. Three layers, muscle, mucosa and skin.
"Identify the apex".
Take continuous sutures".
"Three layers, interrupted for muscle and skin".
...and remove the tampon!! (If one does not say "remove the tampon" when one is asked "What will you do after suturing an episiotomy", one fails the exam.
It is fun. Exhilirating. It does feel awesome to hold your first delivered baby, muck or not. All the cliches about awesome feelings and getting overwhelmed are all true, else they would not be cliches.
I still have not seen the Eclampsia Room or the SLR and it's already dinner time. I will go second this time...
...................................................................................................................................................................
It's been a very long day and it's difficult to digest that we've been here for about 12 hours only. There are 13 more such days to go and of course, since babies have no regard for tired doctors, 13 nights too.
But it's been pretty exciting.
It's also been a bit terrifying. In Labour Room, all our activity (or lack thereof) seems to be monitored, even when it seems like there's no one there watching you. Break times, time taken during those break times, partogram charting, accurate monitoring of the soon-to-be-mothers, whether one is wearing gowns, caps and masks....all of it. There is a Labour Room Team consisting of some OG Residents and led by a Senior Resident, all of whom can report to the Head and thus perhaps earn brownie points. Or maybe we're all getting paranoid.
She (the Head) also likes to pop in now and then and it's in everyone's best interests to be busy at those times.
In any case, after a day of deliveries, the odd panic attack, screaming mothers and crying babies, clothes with the faint smell of amniotic fluid and frozen placentas, it's time for dinner. When posted in Labour Room like we are, the door of the Labour Room is almost like the door of Hotel California. After 12 straight hours, it is beginning to get oppressive and when 2 of us take the first shift to go have dinner at 8 PM, we stay back, doing the usual Labour Room thing but in reality, looking constantly at the wall clock waiting for 9 PM to strike.
We also make a sleep schedule for the posting. 2 of us will stay on till 2 AM and will be replaced by the other 2. One person will have a Night Off every 5 nights. This system is pretty standard but the nights can get unpredictable and if there is a "good case", all of us will be expected to be there. The usual scenario is a complicated delivery or an Ectopic Pregnancy requiring urgent surgery. One hopes that it doesn't happen in the sleep part of the shift.
Dinner at 9. The feeling is liberating, even if for an hour. It's also great to go back to the Hostel because for many people, the Labour Room is a mystery, almost a mythological place and strutting around a bit is normal. In the beginning at least. Snappy is open and after a quick shower, I park myself there and find Rahul (who's already done this twice and is not interested in talking about it) and Vinay (who will go in about 2 months time, could not care less right now and is also not keen on a Labour Room chat) and so, inspite of dying to relate my exciting new experiences, we talk about some usual nonsense.
The minutes pass too fast. I am back inside at 915 and will go to sleep first.
Except that it's not so easy. When one is used to sleeping at 1 AM every day, 930 is too early for the body's clock to switch off. We go down to the Duty Doctor's room and bunk in one one of the 4 of 5 iron cots kept there.
This is my first experience of sleeping in hospital, the first of many obviously. For one thing, when I am woken up at 2 AM by my colleagues, I am in a sleep deeper than pretty much ever. However, I am also able to get up immediately, face washed and ready for Labour Room action in the span of 5 minutes. It's a paradox that will happen, on every night spent in hospital.
Quick notes are exchanged. The status of the Labour Room, who is expected to deliver soon, any Ceasarians planned for the night, how many deliveries waiting outside..all indicators of how peaceful the night is going to be.
Slightly groggy, we troop back to find relative peace and quiet. Half the team is in OT with 2 more cases lined up for surgery and not much else is happening.
This is still the first night and it passes off soon, periods of minor activity interrupted by visits to the shacks for some coffee and nicotine. It feels kind of senior and old to be in Stethoscopes and Aprons at 4 in the morning and it's not altogether a bad feeling.
Soon after, it's 730 AM. Time to wake up the others, get ready for rounds at 8 and for another day here. I'm getting used to it but there are still miles to go...
9 days into Final Year
I am entering Labour Room tomorrow. This is a mythical place, a place where one can neither check out nor leave before our 14 day posting is up. I, along with 4 others will start our posting at 8 AM sharp tomorrow.
I am excited, yes, but mainly apprehensive and a bit nervous.
I spend my last evening of freedom staring at the ceiling of my room, knowing I should be sleeping, but also knowing that when I wake up, I will be entering Labour Room.
It's a posting one looks forward to it, and dreads, all at the same time.
The Next Morning:
There are 5 of us. We walk into the OG Corridor, past the Consultant offices and turn left opposite Ward 12, sharp at 8 AM, with white coats that will hardly be used, a textbook that will hardly be read and with stethoscopes that dangle authoritatively, either across the shoulders or straight down from the neck. Narayanan, Pakha Tesia (from Arunachal), Naveen, Pajanivel and me. The lambs walk down in silence.
There are actually two Labour Rooms. One is across from Ward 12 and is called the CLR or "Clean" Labour Room. Down the corridor and across from Ward 16 is the SLR or "Septic" Labour Room. Both are misnomers, I have come to realize, the CLR isn't very clean and the SLR is not septic. The names derive from the kind of labour cases that are kept there, with the CLR having normal non-infected cases and the SLR housing infected or potentially infected ones.
We walk to the CLR passing a room on the right labelled the "Eclampsia Room". This is a place which houses the Eclampsia or Pre-Eclampsia patients and a place I will be spending a few hours every day in. We also pass a few patients walking around or lying on the floor waiting to be called into the CLR. As a patient, one enters the CLR only when labour has started.
The 5 of us open the yellow fading double doors and troop in.
The Labour Room:
One enters the CLR into a small rectangular area which has the onmipresnt OT trolley-an iron trolley with a mattress, off to one side, work tables, chairs, tons of papers and forms and a wooden clothes rod on the wall with hooks for clothes and OT green gowns. Immediately to the left of the main door is one of the Delivery Rooms whose entrance is marked by a biggish floor freezer which contains human placentae. There are 3 other Delivery rooms, perpetually full, each with 2 beds and all of them are next to one another in a line starting from the first one with the freezer. A Red Line with a marking "For Doctors Only" divides this area from the working rectangular area.
There is chaos here at 8 AM, or atleast that is what it looks like. In the middle of running nurses, shouting doctors and screaming patients, there is a calm Senior Resident, a guy about 5 years senior who has finished his PG in OG and is now posted in charge of the Labour Room. And in charge of us. Dr Singh greets us, we introduce ourselves and then there is a short lecture on the do's and don'ts of this place.
Some Do's:
1. Be punctual.
2. Work sincerely
3. Learn to learn on the job
4. Enjoy the posting
5. Go to OT and assist whenever possible
And some pearls like:
1. Always be in the Labour Room at 8 on a Monday. That is Unit 1 Rounds Day. Be seen working in the CLR when Madam drops in.
2. Never, ever be seen in the Labour Room without a green gown or an OT mask
3. Make sure the partograms are accurate and up to the minute.
Our schedule will be as follows:
Enter at 8 and work till lunch. We take lunch breaks in shifts, with 2 of us going at a time for a maximum of one hour. Then, its work till dinner, about 7 PM with shifts again. At night, 2 of us work till 2 AM, handing over the shift to the other two who will work till breakfast.
One guy gets the night off (8 PM to 8 AM) and this happens by rotation, so I'll be off for a night once in 5 nights. Classes are off except OG lectures and Ward Clinics. This is when we will troop in, looking haggard and sleep deprived, trying hard to stay awake during the Air Conditioned lectures.
Visits to the room during meal breaks give us just enough time for a quick shower, a change of clothes and a 5 minute gossip catch up session.
That's it.
One more thing:
When one retires for the night (in the Duty Room down the corridor, NOT in the hostel), one can be woken up at any time if there is a need. This can happen if the case load becomes too heavy, or if there is an interesting case being operated on or for whatever other reason. And one has to go.
We are shown the forms that we will be filling in the next 10 days. Live Birth Forms, Still Birth Forms, Death Forms. Investigation forms, from Bloods to Biochemistry. This is where I see these forms for the first time, the yellow Biochem forms and the Red on white Blood forms, forms that I will spend a LOT of time filling next year as an Intern. There are Ultrasound Request forms, OT "Call Slips", and Operative Notes forms.
The Call Slips, we are told, are sent when a patient needs surgery (usually a Caesarian here). It has patient details, when they ate last and what op needs to be done. The anaesthestist signs it and keeps a track so that they can "call' for the case when appropriate. It's a vital piece of paper. No Call Slip means the OT has not officially heard of the case.
We will essentially be conducting deliveries and doing all the stuff that happens around an imminent delivery, including monitoring, post delivery care, suturing wounds, assisting Caesarians, writing forms, and all and sundry. This is where we will learn to start IV Lines, take blood for investigations, monitor Oxytocin drips, do Per Vaginal exams, make out foetal heart sounds and know when the kid is struggling and when to initiate an urgent delivery. This is where we will learn to perform episiotomies-surgical incisions designed for easier deliveries and how to suture them back.
This is where we will be part of the miracle of birth.
We get a crash course in the later stages of pregnancy. There are 3 stages of labour. The first stage is a bit of waiting for the cervix to dilate fully. In this part, the patients are called in for quick regular checks to see whats happening with the dilatation and if something needs to be done. Once that is over, the second stage starts and that is really where we come in. Monitoring starts intensively now, with Blood Pressures, pulses, foetal heart rates, foetal positions (is it coming down properly or has it got stuck), various drugs to be given to speed things up etc. All of this monitoring is recorded on a graph-the partogram, which is stuck on the wall next to the patient and is inspected regularly by the Senior Resident, or rather more importantly by Madam A or the other Consultants when on rounds. Failure to maintain a proper partogram is a recipe for disaster in exams.
Such foul-ups are remembered.
There are 10 full days of this and how one survives depends a lot on how one takes it. It's there and has to be done. The knowledge that one will acquire, actively or passively will be tested severely in exams and even if one fails to answer some intricate question in Obs or Gynae, lack of Labour Room procedures is a sure way to instant doom. Ears have to be perked up, eyes have to be peeled, brains have to be alert and feet have to be quick.
A normal delivery is fine, but a complicated one can turn nasty very fast.
It's the first day, the first morning in fact and I, like the rest of my 4 classmates, are like babes in the wood. There isn't much time to settle in though, as the action starts off pretty much instantly. It would be fair to say that the action actually never stopped, we just happened to be a brief interruption and are caught up in it, stat, as doctors are wont to say.
Except that we are now saying things like "stat" and "IV Line" and "Synto drips" and Magsulf" but are nowhere near being called doctors yet. I put on my green OT gown, hanging on the wooden gown holder by hooks, and put on my mask. The others do the same and we are allotted "Delivery cubicles" and patients to monitor. Our task for the moment is to chart the progress of labour on partograms, as accurately as possible and hope that it turns out OK. The problem is that, in an ideal world, we would monitor these patients from start to finish, ending with a newborn baby in our arms and saunter off for the next one. But this is Labour Room, where on an average, I see from the huge Delivery Record Register, about 40-50 deliveries are conducted every day (and night).
So, in reality, the morning is spent monitoring one patient, rushing off to attend a delivery for another, starting an IV line for the third, running back to the first one to measure contraction durations and foetal heart rates and writing up Live Birth forms. I learn the core of any busy medical practice-how to mentally compartmentalize many patients and keep tabs on what is happening to each.
I am in charge of a patient who has just walked in for her delivery. I start an IV Line, get some bloods for baseline work-ups and off we go. I start a Oxytocin drip (Synto) and start counting drops. First 4 drops a minute, (very painful to count), then slowly, after a vaginal check has shown the labour is progressing well, I increase it to 8 (still painful to count). The patient is a "Primi"-first kid, so this is going to take some time. In the middle, someone comes along and applies some "Epidosin" that is supposed to get the cervix to dilate and efface properly. This is done thrice, 15 minutes apart.
While I am counting contractions and synto drip drops, a shout comes from next door.
My first delivery is rather uneventful. A typical "Mutli"-now in her 3rd or 4th pregnancy, with the foetus in the normal "OP" (Occipito-Posterior position with a Longitudnal lie) is having solid contractions spaced about a minute apart, each lasting for about 45 seconds. A vaginal examination has shown a nicely dilated cervix and a full on shouting match is in progress.
It's the battle cry of Labour Room
"Mukkkkkkk Maaaaa"....."Mukkkkkkkkkkk".
"Push Ma...PUUUUUSSSSSHHHHHHH".......
With every contraction, the above shouts happen.
After a few minutes, the head shows (crowining).
At this point, the patient is in agony also and is screaming her head off, so the noise levels are pretty high. Then suddenly, the baby is out, all covered in muck and is quickly delivered, wiped and the umbilical cord is tied and cut. The baby is whisked off to be checked by a Paediatrician who has been hurriedly summoned from somewhere and the sudden cessation of noise is ghostly. The sheer relief on the patient's face is obvious.
The job is not over though. I have collected some blood from the cord in a small "Penicillin" bottle which goes off for blood grouping and I now sit ad wait for the placenta to come out. This is helped along by carefully pulling on the cord, almost as if not pulling at all, but just about in a manouvere called "Controlled Cord Traction". That done, we inspect the placenta for bits that might have been left behind and then (probably) proceed to dump this placenta in the freezer next to the main door.
In the meantime, the others are also at work, running about with various tasks. There really is no "allotted patient". Whoever happens to be around at the time a delivery is going to happen assists or conducts the delivery. We all have 10 deliveries that we must conduct independently and write in our Records and it seems like we will reach our targets on the very first day.
Lunch time happens, all too fast and we take turns. One guys has vanished into OT for an Emergency Section (Naveen who will soon develop an OT fixation) and I, along with someone else go for lunch. It turns out that going out for lunch or dinner in the first shift is not a great idea because one has to be back in 45 minutes to relieve the other two. On the other hand, if one goes later, time can be stretched.
One can go out of Labour Room for various things. Sometimes, it's to collect a Biochem report from the Lab on the 2nd floor. Or to pick up a form for something on another ward. Maybe to get the portable ECG machine lying around somewhere or some such thing. If one goes for lunch second, all this can be combined with the lunch break (mostly fictitious outings). Since there is no pressure to come and relieve anyone of us, these breaks may even last for an hour!
My Primi patient, meanwhile has reached 16 drops and is doing well. Screaming like crazy, which is good, and has good Foetal heart sounds. I place a hand on the abdomen during one contraction and I can feel the normally soft, flabby skin turn rock hard for a while. The patient knows this too and starts moaning a few seconds before the contraction hits, the decibel levels reaching sky high for a few seconds. It's said that Labour Pain has been ranked 10 on a Pain scale from 1 to 10 and I can see why. There's a baby squeezing hard inside.
I am keeping track of the labour on the graph and a Resident is doing regular vaginal checks on the state of the cervix and the descent of the head of the baby. At any point if the head gets stuck and labour does not progress, the whole thing may have to be cut short and expedited, either with instruments like forceps or a vacuum pump or by a Caesarian Section. In this case, things sail smoothly and towards the end, I am taught how to make an episiotomy incision.
"LMLE". Left Medio-Lateral Episiotomy is what it is called. One gloved hand in the vagina and after some local anaesthetic, a 6-10 cm cut is made to make more room for the baby to come out. The baby is out, and after the placenta thing, I now have to suture this freshly made cut.
I see someone doing it first. Three layers, muscle, mucosa and skin.
"Identify the apex".
Take continuous sutures".
"Three layers, interrupted for muscle and skin".
...and remove the tampon!! (If one does not say "remove the tampon" when one is asked "What will you do after suturing an episiotomy", one fails the exam.
It is fun. Exhilirating. It does feel awesome to hold your first delivered baby, muck or not. All the cliches about awesome feelings and getting overwhelmed are all true, else they would not be cliches.
I still have not seen the Eclampsia Room or the SLR and it's already dinner time. I will go second this time...
...................................................................................................................................................................
It's been a very long day and it's difficult to digest that we've been here for about 12 hours only. There are 13 more such days to go and of course, since babies have no regard for tired doctors, 13 nights too.
But it's been pretty exciting.
It's also been a bit terrifying. In Labour Room, all our activity (or lack thereof) seems to be monitored, even when it seems like there's no one there watching you. Break times, time taken during those break times, partogram charting, accurate monitoring of the soon-to-be-mothers, whether one is wearing gowns, caps and masks....all of it. There is a Labour Room Team consisting of some OG Residents and led by a Senior Resident, all of whom can report to the Head and thus perhaps earn brownie points. Or maybe we're all getting paranoid.
She (the Head) also likes to pop in now and then and it's in everyone's best interests to be busy at those times.
In any case, after a day of deliveries, the odd panic attack, screaming mothers and crying babies, clothes with the faint smell of amniotic fluid and frozen placentas, it's time for dinner. When posted in Labour Room like we are, the door of the Labour Room is almost like the door of Hotel California. After 12 straight hours, it is beginning to get oppressive and when 2 of us take the first shift to go have dinner at 8 PM, we stay back, doing the usual Labour Room thing but in reality, looking constantly at the wall clock waiting for 9 PM to strike.
We also make a sleep schedule for the posting. 2 of us will stay on till 2 AM and will be replaced by the other 2. One person will have a Night Off every 5 nights. This system is pretty standard but the nights can get unpredictable and if there is a "good case", all of us will be expected to be there. The usual scenario is a complicated delivery or an Ectopic Pregnancy requiring urgent surgery. One hopes that it doesn't happen in the sleep part of the shift.
Dinner at 9. The feeling is liberating, even if for an hour. It's also great to go back to the Hostel because for many people, the Labour Room is a mystery, almost a mythological place and strutting around a bit is normal. In the beginning at least. Snappy is open and after a quick shower, I park myself there and find Rahul (who's already done this twice and is not interested in talking about it) and Vinay (who will go in about 2 months time, could not care less right now and is also not keen on a Labour Room chat) and so, inspite of dying to relate my exciting new experiences, we talk about some usual nonsense.
The minutes pass too fast. I am back inside at 915 and will go to sleep first.
Except that it's not so easy. When one is used to sleeping at 1 AM every day, 930 is too early for the body's clock to switch off. We go down to the Duty Doctor's room and bunk in one one of the 4 of 5 iron cots kept there.
This is my first experience of sleeping in hospital, the first of many obviously. For one thing, when I am woken up at 2 AM by my colleagues, I am in a sleep deeper than pretty much ever. However, I am also able to get up immediately, face washed and ready for Labour Room action in the span of 5 minutes. It's a paradox that will happen, on every night spent in hospital.
Quick notes are exchanged. The status of the Labour Room, who is expected to deliver soon, any Ceasarians planned for the night, how many deliveries waiting outside..all indicators of how peaceful the night is going to be.
Slightly groggy, we troop back to find relative peace and quiet. Half the team is in OT with 2 more cases lined up for surgery and not much else is happening.
This is still the first night and it passes off soon, periods of minor activity interrupted by visits to the shacks for some coffee and nicotine. It feels kind of senior and old to be in Stethoscopes and Aprons at 4 in the morning and it's not altogether a bad feeling.
Soon after, it's 730 AM. Time to wake up the others, get ready for rounds at 8 and for another day here. I'm getting used to it but there are still miles to go...
You even remember the trolleys and mattress and tables im detailed.....after almost 15 years!!!
ReplyDeleteIts been awesome reading ur blog...hope this blog continues until Mayan calendar runs out... Duniya khatm nahi hua toh bad me fir padhenge...
Thanks RD. I hope I finish before the Mayas are proven right..
ReplyDeleteInvestigation forms first time in final year. ? ? You didn't have surgery clerkship posting those days. ? The best posting of third year. .
ReplyDeleteNo we didn't. Of course we saw the forms lying around but we didnt have anything to do with them..
ReplyDeleteI think I'm going to be saying Deja vu for all the posts i read:) nice to read such a well written and true to life account of the most intense posting of them all..
ReplyDelete