Monday, October 14, 2013

More Moments...

Do I dare
Disturb the universe?
In a minute there is time
For decisions and revisions which a minute will reverse.”
― T.S. Eliot

Not every moment is golden with a residual warm glow trailing after it. Would be nice, but, if that happened, one might wonder if they were really practising medicine.

Sweat beaded up on my forehead, partly from the desperation of the situation, partly from the physical exertion. It is not always easy – physically speaking – to treat sick patients, especially when it involves attempting to manually extract a placenta that remained stubbornly attached to the womb after delivery. In fancy medical terms, one could say, “retained placenta”; in not so fancy pidgin terms one could say “placenta ee no de com out!” Both descriptions are adequate, though pidgin is much more flamboyant about it and probably expresses the angst of the situation more appropriately.

“Out! Out! Out! Out!” Madam A shouted with great ardour and volume.  “In the name of Jesus, I command you, come out!”

Many of our patients have strong ties to their religious community. Many belong to churches that are ‘evangelical’ in their worship style – very exuberant; speaking in tongues; casting out demons; etc. Apparently Madam A belonged to one of these congregations. At least her energetic prayers helped to distract her from the pain.

For myself, I prayed silently for strength and knowledge to stabilise her situation. Trying to remove pieces of retained placenta from a distressed woman who was more than a little “fluffy” in her middle portions was not easy.  I typically consider doctoring to be fairly cerebral. There are a few times when muscular strength becomes quite useful though. This was one of those times.

“Doctor, please stop!” Madam pleaded and shifted away from me. My nurses gripped her arms and held her steady with unrelenting determination.

I wanted to stop; but I wanted her bleeding to stop more. This was one of those moments when one must suppress natural human inclinations to comfort and relieve suffering in order to accomplish the greater good. One looks past the immediate pain to the future benefits. In the midst of the struggle, these future benefits can appear rather murky and uncertain though.

A storm of self-doubts blew in and threatened to impede my efforts. Was I doing the right thing? Why did the placenta not detach like it was supposed to? Should I have done something differently? Was it even possible to manually remove the placenta? What about more anaesthesia? Infection? How could I know when I should stop and refer? Would my efforts help her or not?

Such thoughts, as you can imagine, are not conducive to performing a task with precision, skill, and mindfulness. The moment is difficult to explain. Certainly it was not a bright epiphany, nor was it a shining heroic inspiration. It was simply a moment when one chooses to forge ahead and put aside all that detracts from the effort. A narrowing of the visual field to include only the pertinent information required to remove Madam A’s trapped placenta. Doubts, external noises, the faces of Madam and my grim-faced nurses faded into the backdrop as I focused on winning the battle of doctor versus placenta. I suppose, in a sense, it was one of those times when new depths of human capacity are forged.

Suddenly, I felt a firm, strong hand on my head. “Doctor, stop,” the patient groaned. I was momentarily startled. It is not often that patients grip my entire head in their hand.

“Almost finished,” I consoled. “Just persevere a little bit more.” I shifted my head out of her reach.

“In the name of Jesus, I know you will succeed, doctor,” she prayed vehemently channelling her pain into intense pleas toward heaven.

“Keep praying,” I nodded to her.

“Bless you, doctor,” she continued. “I know you will help me.”

I attempted to ensure that all the placenta tissue was completely swept free of the uterine walls with my fingers. Internally, I begrudged my short fingers and small hands. 

“Stop, oh, doctor! Just let it be. It will come out. I know God will make it come out. Just leave it. Let me rest.”

The patient reached out her left arm to grasp my upper arm and pull me away. My nurse intercepted and valiantly held her back.

“Ok, done,” I straightened up and stretched my aching back. I surveyed the scene. Certainly having a baby is not a very clean process. Add in a retained placenta and haemorrhage and the mess multiplies exponentially. “I wonder if they make sterile gloves with longer sleeves?” I pondered this question briefly when I washed my hands in the sink.

“Thank you, doctor. God bless you.” Madam A sighed. Her forehead was drenched in sweat, more so than my own even.

“We will pray that all the bleeding stops now,” I held her hand briefly. “I’m sorry. Ashia!”

“I know I will be fine, doctor. Thank you.”

She was tired. I was tired. I wished I had as much confidence as she did. She was pale and had lost more than a reasonable amount of blood. I thought I had removed all the placental tissue but I wasn’t one hundred percent sure. I’d never dealt with a situation such as hers before.

I sighed. My shirt was soaked in sweat. The storm cloud of questions returned. For now, there was nothing more I could do. I turned and walked out of the labour and delivery room while the grey clouds let loose a torrent of mixed logic and sentiment. I felt overwhelmed and a bit numb from the onslaught. Not my most shining moment. Yet, even as the rain is necessary for new growth; so too, the moments with Madam A led to renewed courage, comfort, and confidence eventually. Even the dark times have their value.

“And He has said to me, “My grace is sufficient for you, for power is perfected in weakness.” Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me. Therefore I am well content with weaknesses, with insults, with distresses, with persecutions, with difficulties, for Christ’s sake; for when I am weak, then I am strong.”

2 Corinthians 12: 9,10