Jan 1997
I am now settling in to the routine that Labour Room is. Start at 8, work till 1 PM, lunch for an hour, work till 8 PM, dinner for an hour, sleep/work till 2 AM, then work/sleep till 7 AM...and so on. This is punctuated by an hour's bedside clinics in Wards 12 or 16 and that's the only time we prisoners are allowed to get out of here.
Dr RS is our Senior Resident in charge and is rumored to be quite close to Madam the Head. He's pretty OK actually, professional and all that, even feeding us some samosas and sweets one evening but we live largely in fear of him. One more such personality is Dr Anju, also a Senior Resident and coming to the end of her 3 year term. She is the seniormost of all the SR's here and one late evening, around 9 PM, when all is quiet on all fronts, she calls me to the SLR and asks me to dictate some names she wants entered into her OT diary.
So we sit there, me in scrubs and she in a Saree, me a slightly intimidated Final Year and she the "One with the Ear of the Dark Lord" with me reading out hard-to-pronounce Tamil names to her. I keep messing up the "ZH" sound in Tamil and after a few constant corrections, she turns around, all serious, and tells me that this incompetence at Tamil pronunciation, after 4 years in College, will have to be reported.
This was serious though she could have been joking. It's difficult to say.
The next morning, or rather really early morning, at about 4, while I am struggling with an episiotomy, there are frantic shouts from outside where someone has just thrown a fit. Eclampsia in Obstetric terms, this is quite an emergency and we rush out to find orders being shouted.
I start a line, not easy, and load up some Magnesium Sulfate, 14 g of loading, 7 in each buttock and then its more injections. I then have to wander across every so often to check tendon reflexes in the knee, a sign of possible toxicity. There is a whole room for these patients, just outside the CLR, and our job also involves keeping tabs on all these patients. So, when the CLR seems nice and quiet with no deliveries or impeding deliveries, there is usually some activity going on in the OT, the SLR, Eclampsia Room or when everything is genuinely quiet (a rare occurrence), some work is created for us.
Fill up the Birth Forms, Answer an impromptu viva, Do a Pre-op Round....We can't be sitting idle doing nothing...It's just not done you see.
The days are otherwise much the same. Deliveries, the odd panic in an emergency, lots of emergency Caesarians, some Caesarians which in hindsight could have been avoided, tension filled Morning rounds, muck covered babies, amniotic fluid all over the floor, blood here and there, lots of hands on placenta extraction and deliveries....routine.
I finally attend my first Section a few nights in. It's 2 in the morning, I've just arrived for my shift and am told to go into OT. This is my first ever time scrubbing and assisting anything and I'm tense as hell. Sections, even when not emergencies, become one when the uterus is cut. From here, it seems, the surgeon has less than a minute to get the baby out. And me, the greenhorn, is assisting.
We start, I'm supposed to give traction to the skin, catch some bleeders and generally be useful without getting in the way, the hallmark of a good assistant. It's not very smooth though, and my retractor gets a couple of raps from the surgeon.
"Hey, hold that thing at 45 degrees. Pull! Man! "
Then there is "Mop"...Or "Suck"....I keep mopping when I'm supposed to apply suction and vice versa. It's trying and traumatic but after a few minutes, there is a baby. Muck covered baby has arrived.
Oh the awesomeness!
The paediatrician has arrived too. A few taps and tubes later, the baby is handed over back to us and we get back into the CLR where I now have to write the notes and Live Birth Forms.
It's quite a kick to be honest. The scrubbing, the washing, wearing OT clothes, holding a retractor, cutting some sutures, seeing a Section that close. I should feel tired but the adrenaline has pumped me up. I feel energized and raring to go.
But with not much else happening, I sit and chill out, waiting for that dreaded phone to ring from the Casualty informing us of another walk-in in labour, an event that happens 24/7 all the time.
Another few days later and I have started resembling a zombie. 3 hour nights with constant mental and physical strain does take it's toll although I can safely say that now I can do a normal delivery pretty much anywhere. This posting is tremendous in what it teaches you, in terms of Obstetrics obviously, but also in time management, teamwork and stress management. This is also the posting where the basics of Patient Management are taught. How to start an IV Line, suturing, suture removal etc.
It's a fantastic posting but after 14 long days of no booze and little sleep, I'm dying to get out.
And just before we do, on the penultimate morning, where Narayayan and I decide to head for breakfast at 8 AM after a long, tiring night, hair dishevelled, clothes stained with fluid and blood, faces creased with exhaustion, we open the SLR door..
...and find 4 Consultants, led by Madam A, some Senior Residents, some Junior Residents, Interns and some sundry hangers on, all dressed in neat white coats, all in a long line, all fresh from a good night's sleep waiting to start rounds.
It's awkward. We just bob heads, and slide quickly past, wondering aloud if this scene will have any impact on our Final Year chances.
But just like that, it's all over. At 7 AM, 5 of us troop out of Labour Room, considerably more skilled and armed with more practical knowledge than I would have thought possible. We are replaced by 6 of my batchmates, all looking as lost and apprehensive as we did 2 weeks ago.For them it's an unknown, mythical place. In us, the transformation is visible. I have a new found confidence in OG.
But boy, it feels good to be out.
The previous evening was spent in a short but deep discussion about Labour Room-what it is (a cramped, noisy, full on introduction to Obstetrics,), what the stress levels are like (very high), how is the OT ( same as anywhere but with lots of activity and is 24/7), the expected behaviour norms (refer Do's and Dont's) etc. There is a lot of underlying apprehension, anticipation and fear. Labour Room does that to you.
2 weeks later of Labour Romm later, we are expected to rush back to the rooms, quick shower, breakfast (some barely edible oily stuff) and run back to class as normal. Time, Tide and Classes, it seems, wait for no one. We have a lecture at 8, followed by clinics till 1, then more classes till 5.
This is all theoretical for me, since I have decided, falling attendance and all, to skip all of today and just sleep in. I figure I deserve it, after 2 weeks inside.
My clothes are giving off a faintly sweet, slightly pungent odor of amniotic fluid and have not been washed for ages. I feel like I've been swimming in the stuff for 2 weeks and I'm sure I'm giving off this smell too. And boy, am I hungry for some Chicken Cecilia and Ghee Rice. All to be washed down with large doses of booze.
I really feel like I've achieved something major. I now know more Obs than most of my class. The problem I'm neglecting of course is that they know more about pretty much everything else. My Medicine, Surgery, Ortho and Paeds knowledge is abysmal. My Tamil is better but not enough to pass an exam yet.
All of this reality is pushed to the backseat as I take my bike to town after 14 long days. A few beers, a decent meal, some quality time with the sea and the crashing waves and much needed time just doing nothing. It's almost like Final Exams are over but I haven't even finished my first posting yet.
Back to reality the next morning and it's Clinics as usual in the OG Wards. We go to the OPD at 9, take a case, present it to the Residents and see a few Per Vaginals and generally look busy. By 11, we're off to the Wards where it's my turn to take the history of a Twin pregnancy, an important case for exams. I know what to ask, but I'm still getting stuck in the Tamil which is not a good sign, this being Final Year and all. A short while later, we are joined by the 6 who replaced us in Labour Room and looking at those still not-too-bone tired faces, I am grateful that I am out of there.
Madam A comes to take our class. 16 of us huddles around the bed, all in gleaming white coats, all of us with pens poised on our small green note pads and everyone looking very alert and hoping fervently that no questions are directed at them. I start with the history taking care not to say that the patient is X years "old" and stumble along with minor road blocks. Examination time and I thankfully remember to warm the diaphragm of the stethoscope, drape the patient, get a screen and take consent. If this is not done, we have been warmed, one might as well not turn up for the exam.
Class over, I'm about to say a silent prayer for a job done without major trauma when she says (with a slight smile)
"Nishikanta, I heard you still haven't managed to speak Tamil properly"......
...and with her characteristic giggle, says "Good presentation"
and goes off.
What am I supposed to make of that? I have no idea. At least it's better than when Shom was in Final Year when she said "So Shomeshwar, reading hard, or hardly reading"? (and then the giggle again).
Shom spent a few evenings analyzing that moment.
The posting goes off in much the same vein and all too soon, the Ward Leaving arrives. My First Final Year Ward Leaving. 2 years back, in the same ward, I had given my first Ward Leaving and it was quite OK. My parents had actually thought that a "Ward Leaving" is a kind of party organized by the Department to bid us adieu. I wish.
This time, it gets more serious. We only have 2 postings in OG in the year and each posting is serious business. So is the Ward Leaving. 30 minutes to take a history and examine. I manage to do OK and pass. It's a boost of confidence but I know there are gross inadequacies, lacunae that can be exposed in no time at all in an exam.
I have my own "Ward Leaving" party in the evening, more on the lines of what my parents imagined and look forward to my next posting-Orthopaedics.
And every day is bringing me closer the toughest set of exams I will ever face-The Final Year Exams.
I am now settling in to the routine that Labour Room is. Start at 8, work till 1 PM, lunch for an hour, work till 8 PM, dinner for an hour, sleep/work till 2 AM, then work/sleep till 7 AM...and so on. This is punctuated by an hour's bedside clinics in Wards 12 or 16 and that's the only time we prisoners are allowed to get out of here.
Dr RS is our Senior Resident in charge and is rumored to be quite close to Madam the Head. He's pretty OK actually, professional and all that, even feeding us some samosas and sweets one evening but we live largely in fear of him. One more such personality is Dr Anju, also a Senior Resident and coming to the end of her 3 year term. She is the seniormost of all the SR's here and one late evening, around 9 PM, when all is quiet on all fronts, she calls me to the SLR and asks me to dictate some names she wants entered into her OT diary.
So we sit there, me in scrubs and she in a Saree, me a slightly intimidated Final Year and she the "One with the Ear of the Dark Lord" with me reading out hard-to-pronounce Tamil names to her. I keep messing up the "ZH" sound in Tamil and after a few constant corrections, she turns around, all serious, and tells me that this incompetence at Tamil pronunciation, after 4 years in College, will have to be reported.
This was serious though she could have been joking. It's difficult to say.
The next morning, or rather really early morning, at about 4, while I am struggling with an episiotomy, there are frantic shouts from outside where someone has just thrown a fit. Eclampsia in Obstetric terms, this is quite an emergency and we rush out to find orders being shouted.
I start a line, not easy, and load up some Magnesium Sulfate, 14 g of loading, 7 in each buttock and then its more injections. I then have to wander across every so often to check tendon reflexes in the knee, a sign of possible toxicity. There is a whole room for these patients, just outside the CLR, and our job also involves keeping tabs on all these patients. So, when the CLR seems nice and quiet with no deliveries or impeding deliveries, there is usually some activity going on in the OT, the SLR, Eclampsia Room or when everything is genuinely quiet (a rare occurrence), some work is created for us.
Fill up the Birth Forms, Answer an impromptu viva, Do a Pre-op Round....We can't be sitting idle doing nothing...It's just not done you see.
The days are otherwise much the same. Deliveries, the odd panic in an emergency, lots of emergency Caesarians, some Caesarians which in hindsight could have been avoided, tension filled Morning rounds, muck covered babies, amniotic fluid all over the floor, blood here and there, lots of hands on placenta extraction and deliveries....routine.
I finally attend my first Section a few nights in. It's 2 in the morning, I've just arrived for my shift and am told to go into OT. This is my first ever time scrubbing and assisting anything and I'm tense as hell. Sections, even when not emergencies, become one when the uterus is cut. From here, it seems, the surgeon has less than a minute to get the baby out. And me, the greenhorn, is assisting.
We start, I'm supposed to give traction to the skin, catch some bleeders and generally be useful without getting in the way, the hallmark of a good assistant. It's not very smooth though, and my retractor gets a couple of raps from the surgeon.
"Hey, hold that thing at 45 degrees. Pull! Man! "
Then there is "Mop"...Or "Suck"....I keep mopping when I'm supposed to apply suction and vice versa. It's trying and traumatic but after a few minutes, there is a baby. Muck covered baby has arrived.
Oh the awesomeness!
The paediatrician has arrived too. A few taps and tubes later, the baby is handed over back to us and we get back into the CLR where I now have to write the notes and Live Birth Forms.
It's quite a kick to be honest. The scrubbing, the washing, wearing OT clothes, holding a retractor, cutting some sutures, seeing a Section that close. I should feel tired but the adrenaline has pumped me up. I feel energized and raring to go.
But with not much else happening, I sit and chill out, waiting for that dreaded phone to ring from the Casualty informing us of another walk-in in labour, an event that happens 24/7 all the time.
Another few days later and I have started resembling a zombie. 3 hour nights with constant mental and physical strain does take it's toll although I can safely say that now I can do a normal delivery pretty much anywhere. This posting is tremendous in what it teaches you, in terms of Obstetrics obviously, but also in time management, teamwork and stress management. This is also the posting where the basics of Patient Management are taught. How to start an IV Line, suturing, suture removal etc.
It's a fantastic posting but after 14 long days of no booze and little sleep, I'm dying to get out.
And just before we do, on the penultimate morning, where Narayayan and I decide to head for breakfast at 8 AM after a long, tiring night, hair dishevelled, clothes stained with fluid and blood, faces creased with exhaustion, we open the SLR door..
...and find 4 Consultants, led by Madam A, some Senior Residents, some Junior Residents, Interns and some sundry hangers on, all dressed in neat white coats, all in a long line, all fresh from a good night's sleep waiting to start rounds.
It's awkward. We just bob heads, and slide quickly past, wondering aloud if this scene will have any impact on our Final Year chances.
But just like that, it's all over. At 7 AM, 5 of us troop out of Labour Room, considerably more skilled and armed with more practical knowledge than I would have thought possible. We are replaced by 6 of my batchmates, all looking as lost and apprehensive as we did 2 weeks ago.For them it's an unknown, mythical place. In us, the transformation is visible. I have a new found confidence in OG.
But boy, it feels good to be out.
The previous evening was spent in a short but deep discussion about Labour Room-what it is (a cramped, noisy, full on introduction to Obstetrics,), what the stress levels are like (very high), how is the OT ( same as anywhere but with lots of activity and is 24/7), the expected behaviour norms (refer Do's and Dont's) etc. There is a lot of underlying apprehension, anticipation and fear. Labour Room does that to you.
2 weeks later of Labour Romm later, we are expected to rush back to the rooms, quick shower, breakfast (some barely edible oily stuff) and run back to class as normal. Time, Tide and Classes, it seems, wait for no one. We have a lecture at 8, followed by clinics till 1, then more classes till 5.
This is all theoretical for me, since I have decided, falling attendance and all, to skip all of today and just sleep in. I figure I deserve it, after 2 weeks inside.
My clothes are giving off a faintly sweet, slightly pungent odor of amniotic fluid and have not been washed for ages. I feel like I've been swimming in the stuff for 2 weeks and I'm sure I'm giving off this smell too. And boy, am I hungry for some Chicken Cecilia and Ghee Rice. All to be washed down with large doses of booze.
I really feel like I've achieved something major. I now know more Obs than most of my class. The problem I'm neglecting of course is that they know more about pretty much everything else. My Medicine, Surgery, Ortho and Paeds knowledge is abysmal. My Tamil is better but not enough to pass an exam yet.
All of this reality is pushed to the backseat as I take my bike to town after 14 long days. A few beers, a decent meal, some quality time with the sea and the crashing waves and much needed time just doing nothing. It's almost like Final Exams are over but I haven't even finished my first posting yet.
Back to reality the next morning and it's Clinics as usual in the OG Wards. We go to the OPD at 9, take a case, present it to the Residents and see a few Per Vaginals and generally look busy. By 11, we're off to the Wards where it's my turn to take the history of a Twin pregnancy, an important case for exams. I know what to ask, but I'm still getting stuck in the Tamil which is not a good sign, this being Final Year and all. A short while later, we are joined by the 6 who replaced us in Labour Room and looking at those still not-too-bone tired faces, I am grateful that I am out of there.
Madam A comes to take our class. 16 of us huddles around the bed, all in gleaming white coats, all of us with pens poised on our small green note pads and everyone looking very alert and hoping fervently that no questions are directed at them. I start with the history taking care not to say that the patient is X years "old" and stumble along with minor road blocks. Examination time and I thankfully remember to warm the diaphragm of the stethoscope, drape the patient, get a screen and take consent. If this is not done, we have been warmed, one might as well not turn up for the exam.
Class over, I'm about to say a silent prayer for a job done without major trauma when she says (with a slight smile)
"Nishikanta, I heard you still haven't managed to speak Tamil properly"......
...and with her characteristic giggle, says "Good presentation"
and goes off.
What am I supposed to make of that? I have no idea. At least it's better than when Shom was in Final Year when she said "So Shomeshwar, reading hard, or hardly reading"? (and then the giggle again).
Shom spent a few evenings analyzing that moment.
The posting goes off in much the same vein and all too soon, the Ward Leaving arrives. My First Final Year Ward Leaving. 2 years back, in the same ward, I had given my first Ward Leaving and it was quite OK. My parents had actually thought that a "Ward Leaving" is a kind of party organized by the Department to bid us adieu. I wish.
This time, it gets more serious. We only have 2 postings in OG in the year and each posting is serious business. So is the Ward Leaving. 30 minutes to take a history and examine. I manage to do OK and pass. It's a boost of confidence but I know there are gross inadequacies, lacunae that can be exposed in no time at all in an exam.
I have my own "Ward Leaving" party in the evening, more on the lines of what my parents imagined and look forward to my next posting-Orthopaedics.
And every day is bringing me closer the toughest set of exams I will ever face-The Final Year Exams.
It's quite the boot camp as you have so well recapped, Nishikanta... but wish the labour rooms were more airy, specious and well-lit.
ReplyDeletelove your narration..and not simply b'coz of being you know who.the whole scene comes alive..
ReplyDelete