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 2nd
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.
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