That Fresh, Clean Feeling

Ok, so I don't know if this technically counts as a birth, but I don't care.  I got to 1st assist on a C-section today!

After morning rounds and report, my fellow intern and I divided up the 4 or so patients on the board from the night before.  She gave me the one that was the most dilated so that I could surpass my EM colleagues in deliveries with a guaranteed delivery.  As the morning progressed, my patient dilated to a full 8 cm (remember 10 is fully dilated.)  Her bag of waters was broken.  Two hours later she was still at 8 cm.  We started her on pytocin to increase her contractions.  Two hours later... still 8 cm.

It started to look like I would lose the delivery to a C-section, however we don't have any medical students (aka human retractors) these last couple of days since they are also at the end of their rotation and are taking their final in OB-gyn tomorrow.  At the beginning of today, I casually asked if I might scrub in just to assist on a C-section, and the attending and senior both said sure if it was ok with the intern since they have dibs on 1st time C-sections.

When my patient started to have issues and looked like she would need a stat C-section for failure to progress, 2 of the other intern's patients started pushing around the same time, and she had 2 consults in the E.D.  So, when I asked about scrubbing in for the C-section, she said to go ahead and have fun.  So I did. 

The best feeling was pulling out the surgical scrub brush and washing my hands and forearms.  I don't know that much can compare to that feeling of anticipation as you let the warm soapy water run over your arms and you scrub back and forth 20 times along the front, back, sides, and each finger, then up the arms on four sides.  Then comes the rinse.  The ritual was so ingrained in my head that I always used that time to run through the surgical procedure in my head while I scrubbed.  In this case, I tried to think back to third year medical school and the handful of C-sections I participated in.

When we were dressed, and we prepped and draped the patient, I thought I would be just holding retractors, etc., but the senior and attending let me participate in the section.  I didn't do any scalpel cutting, but I assisted in the dissection, then when the uterus was delivered I applied pressure to assist in the delivery of the baby (a boy).  I cut the cord and assisted the senior in removing the placenta.  They then started sewing the uterus closed from my end, and when the senior got halfway, he asked for another needle and suture.  He then passed it to me!

I got to sew the uterus from his end toward my end to meet up with where he had ended.  A few more sutures and the uterus was closed.  It was then returned to the abdomen, and we closed the fascial layer in the same manner, and I got to sew again.  The senior and attending were both happy with my sewing skills, and I was happy to see I hadn't lost my touch.

We cleaned and closed the skin, and all too quickly it was over.  But then came the paperwork, writing orders, adding the patient to the list, planning for the post-op check.  Flashbacks to a prior life.

We came out of the OR around 1630, and I was only working until 5.  I saw an outpatient with abdominal pain and got her discharged just at 5.  And, that was it for my day.  Amazing how fast it passed by.

Of interest, today was almost labeled "Social Work Thursday."  My patient that I operated on is a paranoid schizophrenic with developmental delay living in a group home.  The FOB (father of the baby, or baby's daddy as is the colloquialism) is also developmentally delayed and living in the same group home.  There was some question about her possibly giving the baby up for adoption.  Also, as to whether or not she would be able to manage to care for her baby.  She had given up her medication in order to protect the baby and seemed to be doing ok, but there are still a lot of issues for her to face.

Secondly, we had another patient who is a prison inmate with a history of drug use and five suicide attempts.  She is HIV, Hep C and Herpes positive.  I don't know how much longer her prison sentence is (we're legally not allowed to ask), but I did hear that the FOB was planning to take the child until she is released.  Her previous 4 or 5 children were in foster care since she wasn't able to take care of them.  I wonder if she actually will get to keep this recent one.

Tomorrow is my last day on L&D.  We'll see if I can, officially, get that last one or two more births in.

(on the soapbox:  the seal hunt starts tomorrow morning.  275,000 seals are in the quota.  the pressure continues on the canadian government to put an end to the hunt.  help support the HSUS' efforts by clicking on my link to the side.)

Tags: cesarean section, first assist in surgery, surgical scrub, protect seals