Mood:
accident proneIt started as any other 24hr shift in Labour Ward- as usual the babies had been born just before I got there. The day dwindled, the thermostat in my hypothalamus tangled up around itself in the confusion between icy theatres and tropical baby units. Another c-section, another assist, another procedure I'd logged too many of. Another I didn't get to close.
They walked in almost together. Three colours, three faiths. With only pain, a bump, and their medical student in common, the widowed refugee, the prostitute, and the married student each took to their own room and through the course of the night etched themselves deep into framework of my most vivid memories.
The primip refugee barely made a noise. My broken Arabic would have been an insufficient offering in return for the history I traced through her medical and psychiatric notes. And then I missed the baby; she fell asleep with an epidural at barely four centimetres and I went to assist on a laparoscopic ectopic pregnancy. An hour later I returned to meet her newborn. I asked if she'd named the baby, she shook her head and after a moment's pause asked me mine. "Mahim," I replied, with an Arabic accent that doesn't quite belong in a Persian name. She pondered, dismissed, and smiled. So did I.
Next door the prostitute was wailing for methadone. She was high, drunk, studded with track marks, and accompanied by all the aromas of street life with the attitude of a dissocial rottweiler. She was also in active labour for the fifth time, though she had no idea of the whereabouts of the fruits of the previous four. But she wanted this one, and the combination of heroin, drug-fuelled and logical paranoia, laced with the probability that someone was going to take her baby, was too powerful for any drug or team of medical professionals to overcome.
At 6cm she needed the bathroom. The midwife tried to get her to stay put for just half a minute while she examined her, to make sure it wasn't the baby coming. But there was no way to stop her. The woman made it back into the room as one person, climbed onto the bed on all fours, screamed. And then the baby fell out of her. Stunned, gasping, flaring, drenched in meconium. The placenta followed like a bullet. The cord was cut, the baby wrapped within 30 seconds of her having walked back in through the door. I don't think she knew what had happened. I ran to call paeds.
An attempt to inject the woman with Syntocin resulted in the needle and syringe being hurled at the midwife. Police, security, social services, paediatrics, obstetrics, the senior sister, the medical student watched as the baby was taken away, watched as the mother tried to struggle against "the greater good", watched the most painful sight I've ever had to endure, watched.
And then move on. One room further down and pretend the world is a wonderful place for a young married woman and her husband about to hold their first child while my mind hovered in the space I had walked out from. Eighth procedure of the night. Twenty-three hours into my shift. I knew she carried a blood-borne virus. I know what universal precautions are. But as I delivered the baby's head the world was bathed in red and I tasted blood. My heart stopped. I didn't. I completed the delivery, cut the cord, took the cord bloods, and delivered the placenta. Then I excused myself.
I had been splashed in the mouth and eyes with blood I knew to be H - positive. With trembling fingers I dialled the number for Occupational Health. I stepped out, shocked to find it was daylight. I waited for my eyes to adjust, be a little less blinded. And then I was the patient. Forms, questions, needles, blood, vaccines. Fear. It's easy to forget the latter when you're the (student) doc.
For me it ended well. Follow up was clear at six and twelve weeks. But being told how slim the chances were of my having contracted a disease by this mode was a pitiful means of reassurement; mostly it pissed me off. In my mind, the unlikelihood did little to quell the possibility. Perhaps I'll try and incorporate that into my patient manner.
I left London to go back to my family home after that shift and the Occ Health work up. I was met at the station by the Haematologist Daddy who only waited as long as it took my seatbelt to be fastened to ask whether I cared for the taste of meconium.
There's always room for humour.
