Remembering why - an experience in rural South Africa

By Jon Snyder MD/MPH '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 one night I got my chance to participate. My first cesarean section as a medical professional came with a phone call at 7:15 one 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 discovered that the 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 most 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 to wash and prep. We returned to the table to drape the patient and the area around where we would be making the incision. Washing the entire area with betadyne solution, we disinfected the surface before moving deeper. The patient was not sufficiently sedated so we had to give her more medication 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 had 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 we had so recently been dissecting. I was bearing witness to the blood of another that had entrusted her 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 was 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 seemed like an eternity, the head came into view. The baby was born but there was a problem, no crying, no screaming, 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 did 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 and then trying to fit the pieces of skin flush with each other. As we were stitching up, I sneaked a glance across the room where the nurse was working feverishly in the incubator. Suction, tubing, oxygen, more suction and finally I saw it. The tube had been pulled and the chest heaved on its own. It was labored but there. Life in its purest form was at that instant there with us. Would it be fleeting or sustained was the question. As everything is coming to a close and paperwork must be done, they asked me my name and wrote 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 was humorous because I have a long way to go before I get there. The nurse reported that the baby is crying and is going to be fine. The breathing had stablized and heartbeat was strong. I could walk away from a job well done. All the parties will live and a new life is brought into this world.