Torn uterus complicates C-section surgery

Obstetrics is a damn bloody business.

The day when I went back home to our large referral hospital, I was met by Athenian shock combat. A terrible theatre list sneaked its way through my shift that night. My intern (I am no longer an intern, hahaha) was halfway through her shift when mine began. She was tired and broke, having not seen the fruits of her labour since she started her internship many moons ago. I gave her a small break to find some food, peace, and rest as I scrubbed for the next operation with the theatre nurse. I wanted her to find herself and a reason to go on. Medicine can be thankless.

A middle-aged June was already numb from the navel downwards. Her eyes rolled in fear and anxiety at the sight of complete strangers waiting to rip her apart and bring forth life from her womb. You know, folks, open surgery is deeply invasive.

June had had a previous surgery that made this next operation almost inevitable, one previous scar, with a history of fibroids, "Incision time,11pm. " My hands were steady and sterile as I sliced through June's swollen abdomen. The first part was easy; the problem was when we got to the abdominal muscles, they were tight and barely existent. Most of the fibers were scarred and stiff. A testament to the many visits we doctors had taken to her abdomen.

When performing a CS delivery, we gently separate the abdominal muscles to get through to the uterus. We did exactly that for this operation, but we had a challenge this time. The scarred muscles were adherent to the uterus. When we separated, a large chunk of the uterus came along, leaving a stream of dark red blood gushing on its path. The baby's hand rose above the bloodstream like a dying man clutching at straws in that frenzy. A usual small act of separation of muscles now created an unsolicited incision and a life-threatening situation.

I clamped the major vessel and got into trying to save the baby as much as I could. Due to prolonged labour, the baby was stuck deep in the mother's pelvis, threatening not to come out. I squeezed my hand in the womb, held the head, and gently pushed the baby up, aiming for delivery through the incision. Then I felt a sudden give and the baby was out. Not out of the woods yet, the sudden give was that of another tear of the uterus. Let the floods come.

So, the baby was out, crying loudly, but we had a uterus in shambles. We maintained our cool. I focused on my breath and felt how sweaty I was becoming. More loud breaths and quickly, my attention sharpened like a laser. I attempted to remove the uterus outside the abdomen without success. I tagged the ends of the uterus inside, close to the path of the uterine arteries. Then I made a few stitches to control the bleeding. Adrenaline is a hormone that you don't want to befriend.

"More oxytocin please," my assistant shouted, trembling. This was surely not going to be another heroic moment. The uterus is the uterus, and it tells a different story each time. We struggled for a little more time till the uterus contracted slowly to quell our fear. The time that had stood still now started ticking with the hurry to catch up. I felt the sweat trickle down my chest, carrying away the tension of that moment.

And that is how I was introduced to life as a medical officer, always on the brink of tragedy. There is always something at stake.