Emergency C-Section Night
I was thoroughly relaxed, laying on the couch like I was at home. Only difference, I was drinking coffee so old and strong that it had an oily sheen on top. The couch had spots and stains that a homeless person would shy away from and I was wearing fourteen hour old scrubs… otherwise it was just like home. Just then, Sheila called from the front desk to say, “hey John, I got an emergency c-section you need to scrub.” I blinked, “what… I’ve never scrubbed a c-section before… what do you mean… I don’t even know where L&D is, for crying out loud”
The charge nurse calmly said, ”you’re up next… and you have kids of your own, right?”
“There ya go then… you better get going, after all they said this was an emergency”
Stupified as to how I got myself into this, I got up and took off in a dead run and took the six floors to L&D. When I got there, the circulator was already popping lids and setting stuff out. Slightly winded, I called out my glove size and went on to the hand washing station. When I got to the room the patient was already draped and prepped and everyone else were already scrubbed and gowned, standing there huddled around a pregnant, sterilized belly. I worked furiously to get some organization to my pan of instruments, as I simultaneously loaded a 10 blade for the surgeon, counted the soft goods and handed over a lap sponge to dab with as he made the incision.
The attending said, “you’ve done enough of these, right? Right. Okay, then let the med student step up… you can make sure he doesn’t do anything horribly wrong.”
My pulse rate doubled. Oh crap, student teaching time in an emergency…what next?
The surgeon sliced through the skin and into the fascia, holding the lap to the belly in a maneuver to keep a straight line. “Hold here, as I took a retractor from the surgeon pulling in either direction on the rectus muscle, and there it was… the uterus. Inside that ball of a compartment is a tiny little human being. The resident made the cut through the uterus, fluid gushed and spurted, and we saw the head. Well, I guess they saw the head. I saw a lot of fluid and smooth surfaces, shiny surfaces, dark surfaces and blood. The attending reached in and grabbed the little greasy mass and pulled. I applied some fundal pressure on the upper abdomen while the resident pulled. Finally, a baby appeared. I was so wrapped up in things I forgot to notice what was going on in the field. The surgeon said in a loud voice (apparently for the second time) “I need another lap please” his tone was harsh and his eyes were blazing hot at me.
I looked up with a retractor in each hand and said in a soft, apologetic voice, “it’s a girl!”
Everyone in the room stopped, dropped their arms and stared at me with utter contempt. The circulator said, rather coldly, “is this your first?”
“I answered in a meek voice, “yes… yes it is”
“Oh, for crying out loud, let’s get going, we’re going to be here all night” the circulator said. I watched the doctor hand off the baby to the pediatrician and she washed off the little thing and swaddled it in a new blanket.
I was sweaty and tired and ready to de-gown but looked up and realized the abdomen was still wide open. Oh right, not finished. The surgeon pulled out the uterus and plopped it on her abdomen. I loaded a 2-0 Polysorb and he went to work. I handed off the suture scissors and pulled some tension so the stitches would be even and pretty. Closing a large abdominal would… his was starting to look familiar. I was as shaky as if it were a big trauma, but now I felt that I was in familiar territory. The crisis being suddenly over, the mood and tension lightened up considerably. The surgery team let loose as I was the brunt of all the jokes for the night. It didn’t matter, I felt really good. Things went well and I helped to deliver a new healthy little girl into this world. “Needle down” I heard the resident say just after the last skin stitch went in. “That wasn’t bad.” I said as I pulled my gown off. The bitter old circulator said, “Don’t get too cocky, newbie, they all don’t end like this. Here in L&D, the emergency cases are either extremely happy times or extremely sad times… there is no middle ground… remember that” I sauntered off, back to the main OR, to scope out a cup of fresh made coffee and wait for the next trauma.