Ward 5C - A tale of poop and professional growth

After working for 2 weeks on Ward 14, I felt ready to graduate to the next stage – Ward 5C, the high-risk labor ward. Rumor has it that it’s just like Ward 14, except with ten times as many patients, and half as much staff. You really have to know what you’re doing in order to not get lost amidst the chaos and turmoil. I’ve been well-trained by the midwives and Lauren. I was ready for the challenge!

I arrived on Ward 5C, fresh and ready to take on the world. Minutes after joining the team on morning ward rounds, a mother started screaming her 2^nd stage scream. Nobody else paid her any attention, so I rushed over to assess her. Yep, just as I had suspected. Her baby was crowning. I gave her strict instructions not to push (“TOSINDIKA!!!!” I yelled.) and ran around prepping the delivery set. When I was ready, I took up my position on the maternal right, ready to support the perineum as the baby’s head popped out.

Now, to truly comprehend the profound horror and irony of this upcoming moment that I’m about to describe, you have to first understand something about me. Throughout my medical career, I’ve gotten used to dealing with all sorts of nasty secretions and excrements that most people wouldn’t consider topics suitable for polite conversation, even for war criminals or rapist-murderers. Nothing really fazes me anymore. I’ve ducked from massive splashes of amniotic fluid exploding out of the uterus (sometimes not altogether successfully…), I’ve jumped back just shy of a giant gush of blood shooting straight out of an accidentally nicked vessel directly at my face, I’ve gotten urine sprayed all over my face when a careless doctor slip-shoddily pulled a catheter after surgery, scrubbed in on a surgery when a man’s complete intestinal contents (mostly in the form of fully-formed feces) spilled right out into his peritoneal cavity, and we had to wash it out with over 30 liters of warm saline, with most of that shit-soaked saline flooding out of his body, off the operating table, and onto my surgical scrubs – yes, it soaked right through the supposedly water-proof sterile gown and got to my scrubs; and yes, I went straight for evening rounds without changing my scrubs because the case had taken so long that we were waaaay late for rounds, and my chief resident deemed it more important to get the rounds done than for certain members of the team to not be a health hazard to herself or anyone around her. You could say that my tolerance for intense grossness is quite high. But one thing that I absolutely cannot get used to, that I absolutely detest, is dealing with human feces passing out of the anus.

From my experience so carefully detailed above, you would wonder how that can possibly be, wouldn’t you? Shouldn’t my month-long rotation on colorectal surgery, with all my varied experience with all the varied forms of products of digestion, have sufficiently immunized me against my personal disgust for shit? But you see, shit you encounter during a procedure or a surgery, while you’re fully dressed with layers of protective gear (which as we have already found out, may not be that protective after all), that kind of shit is enshrouded by a sterile, clinical atmosphere, which removes you from the usual connotations and associations that you may have developed with regards to human excrement. So what I’m trying to say is, the shit you visualize with your camera while doing a colonoscopy is NOT the same as the shit you visualize with your very own eyes passing out the anal canal of a woman who is pushing out her baby. The latter is infinitely grosser than the former, and I have not become acclimatized to it. Yet.

So back to the story. I’m standing next to the laboring mother, waiting to deliver her child. Imagine my surprise when instead of the head, it is the baby’s butt that’s popping out. When I had checked her, what I had thought was the head was actually the baby’s breech. This was a super-premature baby, and the “head” felt softer than it should have, but I figured, hey, it’s a premie, maybe their heads are just softer like that. I had also read the patient’s file, which listed the presentation as cephalic, and so, I guess I felt what I expected to feel, without really doing my job. Hopefully, I shall never make that mistake again.

“Breech! Breech! It’s a breech delivery!!! I need some help!!!” I started yelling, hoping to capture the attention of some senior medical personnel, someone who actually knows how to conduct a breech delivery. I was completely ignored, of course, my cries blending in harmoniously with the cacophony of laboring women’s shrill screams of pain. I didn’t know what to do, so I did what I was taught to do – support the perineum – not that this lady needed much support. The baby’s butt was so tiny it posed no danger to her perineum at all. However, as the tiny baby butt slowly moved out of the mother’s vaginal canal, it started passing meconium (fetal poop, for those of you lucky enough to be uninitiated into the world of medical euphemisms for poop), a slow steady paste, like toothpaste being squeezed out of the tube. At exactly the same time, the mother also started passing feces, perfectly in sync with the fecal motions of her baby. I was in total shock. I didn’t know what to do. How do I deal with this dual onslaught of poop? Whose bum do I wipe first??!

“Ok, MY,” I told myself. “Get a grip. You can do this. Breathe, just breathe, and do your job. Deliver this baby, damn it!!” I took a private moment to swallow my anguish and disgust, and sprung into action. I grabbed some cotton and brusquely pushed the maternal poop out of the way. I decided to ignore the baby’s poop. It seemed a little more innocuous. I continued supporting the perineum, and the baby was progressing along just fine, slowly sliding out of the womb. I had stopped shouting at this point, deeming it a waste of my time and effort to continue trying to draw attention to this maternal complication. However, I was still mumbling “Breech! Breech!” at a barely audible decibel, probably because I was still mentally stunted by the shock of this whole experience, more so than anything else. An American doctor working with Mulago to improve their maternal health practices happened to walk into the labor suite, and heard my feeble mumbles. She immediately realized the gravity of the situation, and that I was way out of my league, delving in unchartered waters. She donned a pair of sterile gloves, and took over from me, just as the baby’s body had been fully delivered, and proceeded to safely and successfully deliver the baby’s head.  

I breathed a massive sigh of relief. Everything was going to be fine. I had even managed to escape the situation psychologically intact, more or less. No situation involving a laboring mother and her poop will ever faze me again. Not after this – my first delivery on Ward 5C. Oh, and one more thing… All the horrible rumors you’ve ever heard about this ward – they’re all true.

Ward 14 - The knight in shining armor, aka nurse in cutesy scrubs

I’ve been clinically depressed for a while now. I made a self diagnosis a few days ago with the help of SIGECAPS. Why am I depressed, you ask? You may guess that it’s related to work, but you’d be wrong. It’s related to life. Our landlady is having some family problems, specifically involving her husband, and him not really contributing to this household. He has another wife, whom he stays with most of the time, and he doesn’t really support our landlady, as all his financial resources is poured into his other home. Our landlady fell behind in paying our water and power bills, and so we have not had running water or electricity since early September. Her husband had initially promised to help pay off those bills, but then started having financial problems related to his work, and so couldn’t contribute any money when it came time to foot the bills. Now, our landlady is sick and tired of her husband never supporting her financially, so she decided that since he had promised to pay the bills, he shall have to pay the bills – she won’t pay off the bills, even though she had the money to do so after collecting our rent. And us, the poor innocent tenants, find ourselves caught in the middle of this family drama, having to suffer the waterless, powerless conditions because of their stupid fight.

So at night, we do everything by candlelight, which only retained some romantic flavor for the first week or so. We go to bed super early, because there is nothing else to do. I charge my electronic appliances at the hospital, usually at the nurse’s station, and have to deal with the constant worry of having my electronics stolen while charging. So after a few weeks of these deplorable living conditions, I realized something important about myself – despite my career aspirations to help develop health infrastructure in third world countries, I could never work for more than a few weeks in a setting with no running water or electricity. I am much too spoiled for that. I have reached my personal limit that simply cannot be crossed. And I started to feel homesick in a truly bitter and miserable fashion.

Luckily for me, I started work at Ward 14, the low-risk obstetrics ward in Mulago Hospital. I LOVE Obstetrics, and enjoying myself tremendously at work made the miserable home life much more bearable. My days are filled with the joys and wonders that only the birth of new life can bring. Can you imagine a more fulfilling job? Also, on my third day at Mulago, I met a true life-saver at this crucial point of my Ugandan experience – Lauren Rogers-Bell. Lauren is a fantastic nurse newly graduated from the prestigious Johns Hopkins University. She is actually pursuing a dual degree – a Bachelor’s in Nursing and an MPH. The MPH is currently on hold as she’s spending the year in Uganda, building up her resume, but more importantly, spending some time with her fiancé, Cary, who is working for UNICEF in Kampala. What an international work oriented couple! Since Lauren is mostly interested in maternal health in developing countries, and envisions concentrating on that aspect of global health in her future career, she has been spending most of her time in Uganda working on Ward 14. She quickly took over most of the teaching responsibilities, guiding young students, both Ugandan and international, through many of their first vaginal deliveries ever. So luckily for me, Lauren showed up and really set me straight in terms of my delivery skills and technique. We got to chatting a bit about our private lives, and I told her about my deplorable living conditions. I needed a vacation in a first world country – stat! Especially now, when my room-mate was going to be away for 2 weeks on a work trip, leaving me all alone in the dark, dark apartment. Lauren immediately invited me to stay with her and her fiancé, assuring me that her home situated on top of a hill in Muyenga, the residential district favored by most expats, with glorious views over the city, hot water showers, almost constant access to running water and electricity, was as close as you can come the first world, while being physically situated in Kampala. So I happily packed my bags and moved in the very next day.

I stayed with Lauren and Cary for 3 whole weeks, living the high life, feeling like a rock star. I was staying in a 5-star hotel. Every day, I piled into their Toyota Rav4, catching a ride to Mulago with Lauren. At the end of the day, I would ride home with Lauren. We would cook (I can actually cook as they have a gas and electric stove, and I don’t have to mess with trying to light charcoal with a burning plastic bag) all sorts of great food, sometimes accompanied by wine, always shared over amazing company. It was the perfect vacation, the break from my hard, strife-filled third-world living that I desperately needed. I shook off the shroud of depression that had threatened to engulf me, slowly but surely, usually while sitting on their balcony overlooking Lake Victoria and the hills of Entebbe, sipping a refreshing cup of tea… or sometimes wine. By the end of my stay, I had completely recovered, and was eager to embark upon my great African adventure again! Since I had gotten my energy and upbeat personality back, (and more importantly, since my visa was about to expire), I even decided to jump right back into the saga with a solo trip to Rwanda (stay tuned for more details…)!!!

I have so much to thank Lauren and Cary for. Their kindness and generosity are the only reasons I didn’t cut short my stay and fly straight back to America in October. Without them, my great African adventure would have ended on such a negative note – in complete and abysmal failure. A little bit of kindness goes a long way. I shall never forget that, and will try in the future to repay their kindness by extending a helping hand to others in need, others like me in my sad, lonely, depressed state back in that fateful month of October.