Remembering Why
Jon Snyder M'07
For two months this past summer I had the privilege
to work in a rural hospital in South Africa. The town of Klabisa offered little
in the way of the modern world except for a severely understaffed hospital
and an opportunity for a young medical student like me. I was able to live
and work as one of the 6 doctors assigned to this 300 bed hospital and learn
what it is really like to practice medicine for people in need. More importantly,
it helped me to remember why it is that we suffer through long hours and days
of class. I hope that you enjoy my story and that in some small way it helps
you in rediscovering what it is that first brought you to medicine.
Nothing is more sacred than bring life into this world and tonight I got my
chance to participate. My first cesarean section as a medical professional
came with a phone call at 7:15 in the evening. All of the other doctors were
off and Ruben, the one remaining community service doctor asked me if I would
assist him in performing the surgery. I had not been planning to sit in on
one for another 2 days but here was my chance coming up and smacking me in
the face. As we went down to the operating theater to check on the patient
we discover that the real on call doc, David had asked the nurses to wait
and see if she can deliver naturally. When the nurses call a doctor for a
C-section it usually means that it has to happen, the nurses are experts in
child delivery so if they think surgery is needed then that is more that likely
the case. In hindsight, Ruben's decision to take the woman into surgery probably
saved the baby's life.
Prepping for the surgery was simple enough
with the simple green scrubs, white rubber boots, apron, jacket, hairnet,
mask, and even a double set of gloves. In order to sedate the patient we had
to perform a lumbar puncture which I got to try my hand at. Even though I
failed to get into the spinal column, I would still consider my work a success
because at least I got to try. After the patient was numbed we went wash and
prep. Returning to the table to drape the patient and the area around where
we would be making the incision. Washing the entire area with beta dyne solution
we disinfected the surface before moving deeper. The patient was not sufficiently
sedated so we had to give her more medication in order to put her to sleep.
As the first incision was made I found myself holding my breath as if to preserve
this moment when some imaginary line in my life had just been crossed. I moved
from the study of life to the protection of it. Cutting through the skin and
the superficial layers of fascia, deeper into the muscle and through to the
pelvic cavity all the time my head was spinning with all of the images of
the anatomy that had so recently been dissecting. I was bearing witness to
the blood of another that had entrusted their life in our hands. The sense
of awe was overcome by the intense realization that I was not just here as
a precocious observer. I was here to work and that I did, setting out to sponge
away all of the blood that was being let with only gauze and suction. It was
a pitched battle in which there never seemed a way for me to gain the upper
hand. The remnants of a previous surgery had been the toughest part of this
current work as the scar tissue made the uterus very hard to approach. Finally
we visualized the engorged uterus with the waiting fetus inside. Slicing into
the waiting uterus we found that the anterior placenta would make our job
even more difficult. The child was waiting to be brought out into the world
and we had to fight through his only lifeline to get to him. Working though
this, a hand emerged followed by a foot and a leg, then after what seems like
an eternity the head came into view. The baby was born but there was a problem,
no crying, no screaming, in point of fact there was no movement at all. The
child was blue from lack of oxygen but we had no way of knowing for how long.
The decision to operate had been the correct one but would it make a difference.
The placenta was cut and the nurses took to trying to revive the child, while
we turned our attention to the mother who was still wide open on the table.
Taking the puzzle apart is always easier than putting it back together. We
waded into the field and attempted to shore up the bleeding by sewing the
uterus back together then trying to fit the pieces of skin flush with each
other.
This woman will live but what about her new son. As we were stitch
up I was sneaking a glance across the room where the nurse was working feverishly
in the incubator. Suction, tubing, oxygen, more suction and finally I see
it. The tube has been pulled and the chest heaves on its own. It is labored
but it is there. Life in its purest form is at this instant here with us.
Will it be fleeting or sustained that is the question. As every is coming
to a close and paperwork must be done they ask me my name and as I tell them
they write it down in this book. Under closer inspection is says "assisting
attendings" across from my name. I have just made a huge jump here. Forget
med school, forget residency, I am now at the top the food chain! It is humorous
because I have a long way to go before I get there. As one final piece of
good news the nurse report that the baby is crying and is going to be fine.
The breathing has stabled and heartbeat is strong. I can walk away from this
with a job well done. All the parties will live and a new life is brought
into this world.