Cruel twists of fate

I was compelled to write this just after it happened, then realised that it was 2:30 am so sleep was probably a smarter idea. And good thing that I did, as only four hours later another action packed day began.

I was compelled to write this just after it happened, then realised that it was 2:30 am so sleep was probably a smarter idea. And good thing that I did, as only four hours later another action packed day began. I am realising that writing is a great way to process my thoughts, and break down my experiences into digestible events that won't haunt me later, hence the stories just fall onto the page. On a lighter note, my Dad will be very proud that I am making good use of my Pakistani work boots, the best type of work-safe footwear. Yesterday morning I started the day moving some large metal cupboards wearing them and could only giggle for his sake. But back to last night.

There are certain undesirable events that are likely to occur in the career of any doctor, and particularly for an obstetrician, it is the death of a baby on your watch that is most feared. Strong emotions gather around all those who are associated with the event. An event that is never to be forgotten by all those involved.

There are two ways that a baby can exit the womb, head first or bottom first. Therefore feet first, side-ways, one foot, one arm of any other weird way that a baby could think to try to come out, usually ends in the baby getting stuck. I was called just after midnight to review a patient. Not much was said other than "please come quickly, we can see a hand."

The patient was pregnant with her eleventh baby, and having had her labour induced in a private facility she presented to us after some rather blue lifeless fingers had appeared outside her vagina. I quickly performed an internal examination to attempt replacement of the arm, in a hope that she could still delivery vaginally, but the arm was firmly stuck and she was fully dilated.

This baby wasn't going anywhere. Although obvious that things were awry, I quickly performed an ultrasound to check the foetal heart rate as we could only find mum's using the external monitor. I made a rough calculation of a visually slow heartbeat; 60 beats per minute is agonising to watch when a foetal heart should beat between 110 to 160 times per minute. This baby needed to come out, quickly. Adrenaline surged through the midwives and I as we organised a caesarean as fast as humanly possible.

I have been in emergency caesarean situations many times before. When they are truly emergent, the world becomes a blur, each minute feels an hour. Every contraction the mother experiences reminds you that there is a life inside, teetering on the balance.

In the blink of an eye I have cut the baby out. I can stop, breathe, and take more notice of the world around me. My hands have been working on autopilot to incise, dissect, reflect, and extract. A perfectly formed newborn baby emerges from the womb, perfectly still. I could mistake it for sleeping, if I could help myself from looking at the clinical signs that tell another story.

I pass the baby to a neonatal nurse, ready to begin the impossible task of resuscitating a life already passed. I am forced to look away; in front of my hands is a uterus that requires repairing. I cannot forget the mother who deserves my undivided attention to ensure she does not bleed to death. She has ten other children at home to care for, but I hear in the background that this baby will never grow up. Resuscitation stops and the time of death is noted.

After the operation has finished, the mother is being transferred back to the ward and I peel off my gown and gloves. I begin to notice my surroundings. I begin to think. I am covered in sweat. It is impossibly hot. There is blood on the floor. It is two am. My body is tired but my brain is going at one thousand miles. Anger, disbelief and shock fill my head. Sure, babies die all the time, but this is the first one I have been so directly associated with. None has ever before died on my watch. Could I have done anything different? Could we have been faster? No. I realise this baby's fate was sealed long before she presented to our unit.

So I went home. I thought about writing but decided that it was more sensible to sleep. Ward rounds would start again before I had a chance to close my eyelids. In the morning I rose, I walked the few metres into the unit, and I did my rounds. I then headed to clinic in the hope for a better day.

People's life stories are what put a smile on my face. All day long women grab my hand, smile, start speaking in a language I cannot understand, but it warms my heart regardless. There is no danger here, these women are all so happy to see me, so appreciative of the care they receive. Beautiful girls, tribal women, and grand-multiparas alike told me their gynaecological problems and I began to regain my equilibrium. I text my family to tell them not to worry, I am fine.

In the afternoon, a heavily pregnant woman is seen in antenatal clinic for a routine check-up. A good strong healthy baby is inside with a strong heart beat. She is perfectly well, the consult ends and starts to walk home. Ten metres from clinic she starts to bleed. By the time she gets to the birth unit the baby has died. This could have happened anywhere in the world. The midwives and I are all visibly distressed. We did not need this today of all days.

Please, no more cruel twists of fate tomorrow.