In a state of Nirvana
25.08.2010 30 °C
So now I am well into my 3rd week of obstetrics and gynaecology here at the Sultanah Aminah Hospital. This is no ordinary department here, they are the busiest O&G department in Malaysia delivering an average of 50 babies per day.
I have seen babies delivered before, it happens in the movies all the time. A mother having painful contractions then out comes a beautiful crying baby all smooth and clean handed to the mother. I always knew this wasn't the real situation but just how far it is from the reality was some suprise. Here is what I witnessed the first time I saw a baby enter the world...
The first thing you notice when you enter the ward are the fathers anxiously sitting around the waiting room. After a threat directed at a doctor some time ago, all fathers are now banned from the labour rooms. A not-so-rare example of how one idoit can ruin it for everyone. The first case I saw was a young chinese woman who had clearly given up any attempt to push her baby out. She was exhausted and in agony and the baby just didn't want to come. The Malaysian staff (which in this labour room consisted of a specialist, an intern, 7 nurses, that's right 7 nurses and 2 students) have a way of dealing with this.
Method 1 - Yell at the patient. All 7 nurses at once. I would consider this a form of abuse but the nurses were really getting stuck in. "TWAY, TWAY, TWAAAAYYYYY" at the top of their lungs. Many of them standing right next to her and relentlessly screaming it in her ear. Like whipping a dead horse, she just had nothing left.
Method 2 - Put a sucker on the baby's head. Well this is technically a vacuum assisted birth which is not really all that uncommon. But just how much force they used was incrediblle. I thought the top of the baby's head was going to pop off. The doctor was putting his whole body into it. He was leaning back tugging in the vacuum cup just stopping short of using his foot against the edge of the bed for leverage.
Method 3 - cut her vagina open with scissors. There is a technical term for this called episiotomy. And it does serve a purpose in many births to avoid a much more severe tear occurring. But there is no judicious use of episiotomies here, they just cut them all. I am not a queasy boy, but I wasn't comfortable with the way this was done.
So here I am watching all this comotion going on. The screaming agony, the tway, tway, twaaayyyy, the strains of the doctor pulling and blood and amniotic fluid squirting across the room. But the icing on the cake was the doctor's phone. I have heard it before in meetings where doctors here are exempt form having their phones on silent. But this one is a stand out because everytime it rings the opening riff of "Smells Like Teen Spirit" cuts through the room. No silent in the labour room either and his phone rang no less than 3 times!!! So the head finally pops out and the doctor almost falls over he was pulling so hard. The baby's ears hear their first sounds "tway, tway, twaaayyy" to the tune of Nirvana and I was in the background humming the words "I feel stupid and contagious, here we are now entertain us....." No glamour in this labour room. And as much as the overstretched vaginas and bloody mucous (thanks for that status update Vinita) were a shock, nothing prepared me for the "just another day at the office" attitude of the staff. The ward and its 15 labour rooms are a baby delivering machine.
I can understand why fathers are banned from the labour room. If it was my wife, I would have punched every useless bystanding nurse and not felt bad about it. Much.
That is just the labour room and some of the cases that come through the anti-natal ward and operating theatre are just remarkable. Here are just a few of the more suprising cases:
--> A woman who is 36 weeks pregnant that was involved in a motorbike accident. Claims her husband was riding too fast when he took a corner with her on the back. The baby and mother were fine in the end, but I had to laugh.
--> A Malay girl who gave birth to a shrivelled still born in the back of her parents car on the way to dinner. Apparently she had never had sexual intercourse and didn't know she was pregnant. I believe she had 3 visitors bringing gold, frankincense and myrrh when she was rushed to hospital to deliver the placenta.
--> A case of gastoschisis where the baby's bowel is outside its abdomen. Not something you would see everyday which was evident by the 30 people swarmed into the operating theatre. We have been told there are absolutely no photos under any circumstances in any of the O&G wards. It seems someone forgot to tell the iphone paparazzi that night.
--> A case of twin-twin transfusion syndrome where one greedy twin takes all the nutrients. Like that movie with Arnold Schwarzenegger and Dannie Devito only these two little fellas are battling for their life rather than running for governor.
--> An open infected c-section wound being cleaned of dead tissue with NO PAIN RELIEF for the patient. The poor girl was crying in pain. The doctor muttered some excuse about local anaesthesia causing more infection and I didn't hear his excuse for not giving pethidine. I was too busy whincing in sympathetic pain.
And I am not even half way through yet, so we will see what is in store for the rest of my time. It really is a remarkable place the O&G department and I can understand now why so many female students have plans to work there. Still, it seems to me that they are the most stressed and moodiest doctors in the hospital. Even the male doctors seem to get PMS, probably just through osmosis. So as much as I love it, I don't think it is enjoyable enough to sacrifice my sanity.
This is pretty long already so I may put up another entry this weekend to tell all my stories about the year 5s that have just been visiting and the holy month of ramadan. I have no photos of the ward for obvious reasons, so here is a obligatory food photo. I'll write again soon.