Tuesday, June 10, 2014

Skin to Skin

I meant to come home and write all about it. But of course by the time I got home my stomach was aching with hunger and I had a fridge holding wilted cilantro and questionable soy milk. So I had to make a dazed trip to the grocery store where I found myself staring at the nectarines and asking myself, "Do I really eat nectarines?" which then spiraled into an internal dialogue about the ethics of buying fruit that is shipped from a thousand miles away in order for me to have some variety in my snacks. This always happens when I am tired. I start to question everything I eat and try to convince myself that a diet of entirely chocolate and "Mary's Crackers" will suffice.

So now I am just standing there with my basket containing cheese, kale, and tuna and I am nowhere closer to having a normal dinner, showering, and writing up the day's experiences.

I did my first c-section! Let me qualify that statement. I have done all the 'steps' of a c-section in the past - but never all on one person. Usually the surgeon opens up to the uterus and then I go from there, or I open and they close. Or some other combination of events. But this one was mine from beginning to end, the reward for all my hard work, so I was told. I wanted to write it all down, remember every moment, however, many of the details are already starting to blur.

It was hard work rewarded with hard work. This was her third section which meant that the often easily identifiable tissue planes and regions become scarred down to one giant zone of adhesions. Meticulously dissecting the bladder can still result in injuring it or unknowingly cutting too low on the uterine wall. The tissue is also thinner which can be an issue when it comes to closing up, add in the friable bleeders, distorted anatomy, and the clock that is always ticking down on how long the spinal anesthesia is going to last.

My mentor was walking me through it, keeping the pressure on for time while ensuring I was being cautious yet bold. It's a weird combination. When you cut - CUT! Don't saw away taking little swipes! Go deeper...not THAT deep. 

Being new to all of this I still don't appreciate the different forces needed to cut through skin, fat, and muscle. I don't hold the cautery just right, I can't throw a fast stitch in a bleeder. I don't know when to dissect with my finger versus gauze versus a blunt end of a blade versus a blade. It's an entirely different universe suddenly, peeking out between the sterile blue drapes. I'm navigating with a mask that covers my mouth, connected to a plastic shield over my eyes.

Sweat is dotting the inside of my plastic shield and I can feel it running down my sides. The other surgeon is waiting at the dictation desk and his patient, a hernia repair, is waiting in recovery to come in. We are only a little behind schedule but the scrub nurse reminds me that the next surgery should have already started. The baby is out, I can't remember if it was a girl or boy. I can't even remember the mother's name or face. I would have never believed it if someone would have told me that I would forget the gender of the baby of my first skin to skin cesarean. But I don't. I remember green armytage forceps.

I remember being thrilled, scared, and sweaty. I remember having to change my scrubs immediately after, before going out to recovery. They were soaked from my chest down to my knees, as if someone had thrown a bucket of water at me. I remember being happy and surprised that mum and babe had an absolutely unremarkable course in hospital and that they were discharged two days later.

How could I have done that right?

7 comments:

Justin said...

Wow, congratulations. Sounds like a heck of a time. Well done.

rural_obgyn said...

I am so proud of you! Strong work.

Liana said...

I am still in awe of C-sections. They seem like some kind of crazy magic trick.

Good job, and congrats.

Anne said...

Wonderful! So happy for you.
Anne

tellingknots said...

Congratulations! What an awesome experience - well done!

charliesbird said...

Best feeling in the world, and the reason I became an OBGYN!

HereIamandwhereareyou said...

Chipping in late to say that I really enjoyed reading your description of this operation. I'm not a doctor but I enjoy reading medical writing. I hope you share more :)