PILOT

So let me begin by introducing myself. I am an intern (popularly called a House Surgeon too) working in a fairly good, old and reputed medical college of Karnataka. One of the perks of joining my medical college was receiving private education but being exposed to the atmosphere of a government hospital simultaneously – The best of both worlds to sum it up, a privilege bestowed upon only 2 Medical colleges in the state. That also meant that as an intern I got to work in both kind of set ups which probably would give me an edge over my contemporaries.

I have a story to narrate, one that I like to repeat often - I absolutely detested Obstetrics and Gynaecology through my undergrad days – Women wincing in pain, the nauseating stench of the post op wards, the horrifying sight of a big head stretching out a woman’s vagina and the utterly boring tiny-lettered textbook we had to cram to pass. Yet, when I got posted to the government hospital for 2 months of rotation in OBGyn department, I was really excited about possibly the only prospect of learning how to conduct a delivery. The very first day I was pushed into a tiny examination room where I had to palpate a woman’s tummy to gauge the gestation period based on the size of the uterus; the position of the baby – if the head was at the lower pole or the limbs. I couldn’t hear the foetal heart beat of even one case with my stethoscope in the first hour. None of the theory I had read to become a doctor helped me that day. I felt cheated and worthless. I vowed to hate OBGyn even more.

The ‘Government hospital experience’ honestly came as a rude shock initially. The hospital was full of people always trying to make quick money – nurses who’d take 500 bucks to hand over a male baby and 300 for a female (what discrimination even there!!), aayahs charging 30 bucks to change one ‘gulcose bottli’, a job that a nurse does essentially but aayahs did due to gross shortage of manpower and the one fat nurse who wouldn’t move her ass from the chair; OT boys who’d pocket 50 bucks everytime they wheeled a patient from one ward to another or the OT to the ward on a stretcher.

As days passed, I picked up. I learnt the art of counselling pregnant women who didn’t want their babies, dejected women who were trying hard to get pregnant in vain and hopeful mothers. We were about 7 doctors examining and counselling about 150 patients between 9:30am-4:30pm every alternate day in a room about the size of my 10^th grade classroom in school. You can probably picture the mad rush and the patients constantly fighting to be tended to first.

If Out Patient days were busy, OT days were draining in their own way. We, interns, would forever over work tirelessly to impress professors and residents because that meant more chances for us to scrub in on surgeries, even if we only got to be the ‘retractor girl’. If we were lucky enough, we’d get a chance to close up the abdomen, which was an achievement by itself. Post op monitoring was one of the more crucial things that is usually underrated – a job given to interns again. The post op ward had 7 beds in all, facing each other which ended in about 10 footsteps, poorly lit and dismally ventilated; and always brimming with the kith and kin of the patients breathing into each others’ faces.

My 15 day stint in the Labour Room really put life into perspective – 7 days of morning shift from 8am-8pm and 7 days of night shift from 8pm-8am. I witnessed and heard second hand stories about horrifying things that my residents did – injudicious over usage of Buscopans and Drotaverines to hasten labour, pinching a patient’s butt skin because she wouldn’t bear down, the sounds of a doctor slapping a patient’s thigh resonating through the room, giving unnecessary fundal pressure to push the baby out faster, using utterly foul language to converse with a woman about to deliver and ultimately a young doctor’s banter about how she hates her job.

None of that is really justified, I know. But here is the reality, another perspective that the world often chooses to ignore – there were about 4 doctors (3 residents and 1 intern) who needed to take care of 20-30 patients every day, half of who would possibly deliver. They required constant monitoring as they are in active labour which stretches upto 24 hours from the onset of labour pains. Labour pains are pains felt like never before in your life. Epidural analgesia to lessen the pain was ruled out because that would mean constant vigilance by anaesthetists, who were always busy running some emergency surgeries.

The labour room had 8 beds placed one next to the other with no privacy to the women whatsoever. One pregnant woman could see another deliver her baby. Before they deliver, every woman needed some basic investigations like Haemoglobin, blood group, HIV and HBsAg status and I’ll tell you why - Haemoglobin to rule out anemia which could cause severe post partum haemorrhage and death of the mother (Neonatal mortality is somehow more acceptable than maternal mortality even today); blood group to know the Rh status of the mother and avoid complications in her subsequent pregnancies; HIV and HBsAg status to ensure not only safety of the doctors who were risking their lives trying to treat them but also to save their baby from contracting it by administering timely vaccines and drugs. The ones who came with high blood pressure (about 30% of the cases we got) needed their own separate investigations and treatment to prevent them from throwing a fit during delivery.

We had to be vigilant about a woman breaking her water and follow it up with a PV examination to rule out meconium stained liquor, which essentially means that the baby is starting to swallow its own poop and could possibly choke to death on it if we don’t intervene soon enough. If a woman was delivering for the first time and her body hadn’t created the required space for the baby to get out, we’d have to rush her to the Operation theatre to do an emergency Caesarean section. But if she had delivered before, her already roomy pelvis would make way for the baby’s exit faster and all we’d have to do is hasten the delivery. And then there were those who broke their water too early and still didn’t experience any pains, at the risk of contracting infections. The majority of the first time mothers needed an episiotomy – cutting a part of her vaginal wall to let the baby come out, the timing of which was extremely crucial. Too early and she’d bleed a lot, a tad bit late and the baby’s head would tear through anything that came in its way. Of course, that had to be stitched up following the birth of the baby and expulsion of placenta.

It’s therefore, easy to understand that pregnant women are easily one of the most vulnerable groups of the lot. Accurate decisions regarding their management is ever so crucial. I cannot even start explaining the various complications associated with pregnancy to the common man. We read about it for 4.5 years but were expected to take decisions within fractions of a minute. This ultimately put the doctors who were in charge of them under tremendous pressure. Every professional has work pressures but imagine the kind where one wrong move on your part can kill a mother or her dream of delivering a healthy, live baby. Experience can deceive anybody at times. It was therefore not too surprising that residents would often lose their cool. Dealing with anxious attenders, 20 odd women whose cries echoed through the empty corridors of the hospital in the dead of the night, unexpected complications in the last minute, sick babies popping out at 3:30 am when you’re trying to fight fatigue was all never easy. We have had cases where babies have delivered spontaneously into buckets because too many of them were delivering simultaneously and we were too few doctors. It is sometimes inevitable and beyond what we can do.

All I could do was go about my job honestly, be kind on my part to patients and treat them with the dignity any human being deserved irrespective of their socioeconomic status. It paid off in a wonderful way because 2 months later, my parents came visiting me. We were walking to a food joint. One old lady on the road smiled at me and asked me how I was. I didn’t remember her. But she remembered me as the kindest doctor in the labour room who delivered her daughter’s baby. I was overwhelmed.

In another incident, an old lady came and held my hands asking me to treat her other daughter during my emergency medicine posting in another hospital because I monitored her first one. Funnily, I remember her pregnant daughter who underwent a Caesarean section and ate right after the surgery despite instructions not to, causing her abdomen to swell. We had to insert a Ryle’s tube through her nose into her stomach to get all those contents out.

As an intern, we are at the bottom rung of the ladder. My job has ranged from stuff like examining my patient’s urine to feeding them, putting canulas and changing intravenous fluid bottles to catheterizing patients, arranging blood for my patients by actually roaming the city in the dead of the night to donating some myself, riding in the scorching heat to get some snacks for my professors to typing out part of my resident’s thesis, writing case sheets and drawing blood samples to monitoring patients hourly, scrubbing in on surgeries to actually doing tubectomies as primary surgeon skin to skin, doing Per Vaginal examinations (where you introduce your index and middle finger into a woman’s vagina to assess the status of her cervix and estimate the feasibility of a normal delivery) to actually conducting about 76 deliveries in 15 days.

Turns out that my 2 month stint in OBGyn was the best 2 months of internship so far in terms of learning lessons for life. It taught me tolerance, empathy and a thing or two about supporting pregnant women during the most important phase of their reproductive life. It has enabled me to take on my profession with a new found zeal and immensely respect my seniors for the effort they put in. So the next time some senior treats us badly or says “Aye intern”, let us remember that although we treat a patient and spend more time with them than anyone else, we’re less responsible for them than the higher ups. Ultimately they take the blame if something goes wrong.

In 4 months, I will be climbing onto the next rung. I am ready for a little more responsibility.