Feature

Ward 17 is on the first floor of the prestigious Dhaka Medical College Hospital. Well-reputed to many, it is one of the places where anarchy and civility are separated only by a thin line. As part of the Department of Gynaecology and Obstetrics, it serves to women in labour or related difficulties. It has eight beds, sadly, for at least twenty four patients. And although the room is air-conditioned, the word 'cool' can hardly be ascribed to the atmosphere. Filled with groans of women in pain and the fishy smell of amniotic fluid, it is a world where only men step in. And the doctors who work there, mostly ladies, are nothing short of that. I, yours truly, am an intern at 17.

But wait, don't let my horrifying description horrify you. As chaotic as it might seem, in effect, it is a doorway between heaven and earth. Here nine-month old little souls packed in chubby little bodies transcend from paradise. And the women in pain are only suffering physically. Their minds are filled with anticipation that with every bout of pain, they are one step closer to seeing their baby, their fruits of love they have harboured within them for so long. And the smell, set aside how objectionable it is, speaks of a place where the definition of peace was written, a mother's womb.

Doctors work there in shifts. Our unit, Mat III takes admission on Mondays. We are divided into groups A and B. I being in group B, have my duty from eight in the night to eight in the next morning. We have a small resting room (room 150) where we keep our bags and change into our Operation Theater dresses. It was here that I met my senior who had just done the day shift. My flamboyance with words is known to all, and they don't seem to mind, I being junior most and all that.

“Come on, you are leaving already? The night is still young!”

“I am tired,” said she.

“Even for an hour with me?” I enquired with a grin on my face. She frowned. (I guess they do mind sometimes).

“There is a ruptured uterus on post-op, check her out. And go to ward 15 at least once tonight. Couple of our patients are puking the hell out of that place.” As such, she handed over her duties to me. I accepted.

Quickly I changed into my OT linens, blue pajamas and fatua. And when you tie the lace of the cap behind your head, you really feel ready to go into action. Armed with my blood pressure machine and my beautifully crafted Littmann stethoscope around my neck, I strutted through the corridor towards ward 17.

Past the corridor, ward 17 is on the right and the Caesarean OT complexes on the left. Dhaka Medical College Hospital is accommodated in a building constructed in 1904 as the Secretariat Building for the East Bengal and Assam. Hence, the design of the OT complexes for caesarean sections is not quite according to standard recommendations. However, in a country where many things are not what they should be, we manage quite well to serve despite these shortcomings. Most of the doors are wooden and have more coats of paint on them than an onion has skins. The light yellow doors of 17 are no exception. As I walked in pushing them aside, a gush of cold wind hit my face, misty with the smell of liquor, reminding me that my duties have begun. The doors swung close behind me, separating me from the rest of the world. Here, you leave your worries behind.

One privilege that a medical practitioner has is that he earns acquaintance of many different kinds of people. They come from different social, educational and economic backgrounds. And with each visit, the knowledge of the doctor about the diversity of the human population is enriched still further. This knowledge gives him a broader perspective towards life, a point of view that few people ever gain in their lives. As I walked towards the central table where my senior colleagues were sitting, little did I know that I was about to get my first glimpse of the real world.

It was late when I went to see the patient in the post-operative ward with the ruptured uterus. This condition is now very rare in developed countries. But unfortunately, we often receive this sort of patient during admission nights. The lady is usually a woman who had a few children earlier, most having had a previous caesarean section. What happens is that the mother's womb tries to expel the baby out so hard that instead of the baby being born, the womb bursts open inside the abdomen. Only a few moments short of seeing this world, the baby passes into oblivion inside the mother almost immediately. And the mother if not treated in haste can expire very quickly. The woman I was supposed to see was one like that.

She was lying flat on the bed, too tired to move. An elderly woman was sitting at her head. She looked too incapacitated even to take care of her own self. But she is probably the only one the patient has at this moment. I quickly checked her pulse and blood pressure, the two ushers of life in the fleshy tabernacle of the immortal soul that we attend to. As I was doing that, the old lady at her head told me a very sad story. I learned that the patient comes from the lower socioeconomic class. Her husband was a day labourer. One unfortunate day, when she was three months pregnant, her husband had gone off to look for work. He was hired by a construction company to work in one of their pits.

He never got out of there. A sudden collapse of the walls buried him and one other instantly. Ever since then, the widowed woman, had been alone; left without support in such a critical time. Even her own parents would not see her as she had angered them by marrying out of social class.

She carried the baby all through the remaining six months, suffering in silence. With the hope inside her that when the baby would be born, she could forget at least a part of her sorrows seeing its face. After all, her child was the only legacy remaining of her departed husband.

But fate took a turn for the worst. During labour, there was no one to hospitalize her in time. The delay was paid for by the life of her unborn child.

She opened her eyes in a narrow slit. Her hand moved very weakly, a sort of a tapping on the bed. She was trying to tell me something. At first I thought she was probably feeling a lot of pain and is complaining about it. So I asked her if it was hurting too much. She shook her head in disagreement. It was something else. She was still making the same gesture with her hands. This time also trying to whisper a few words. I leaned forward and put my ears very close to her mouth.

“Sit beside me.”

It was not a complaint, it was not a demand, neither was it a thanks. It was a desperate appeal for something far more precious to her companionship.

How could I forget? I should have understood. I knew her story that she was all alone. I was thinking about the physical pain, about surgical complications, about anaesthesia, about haemodynamics. But I overlooked the most important aspect of them all - the one about her being a person, an individual, a human being with weaknesses and strengths, a human being with emotional needs as well as the need for physical comfort. Given the background, my first duty was to recognize that before pain relief, before addressing the pathology, I was to make sure that she felt comfortable, secured, cared for.

I sat down beside her, thanking God for this opportunity to serve my fellow man. I could see before my very eyes how that helped her. All my five years study with heavy books, all my training of internship could not do what a small gesture of friendship did. It made her hopeful. I had learnt an important lesson.

I later came to know that she had survived, although after a prolonged stay in the hospital. One might question 'for what?' But sometimes, being alive in this world, by itself is a triumph.

Saddened by such a start to my working hours, I retreated to my station. I knew that the rest of the night would be a drag now that I have lost the anticipation with which I had walked in.

Fortune smiled. Walked in a rather good-looking man with a bunch of papers in his hand. Following him was his beautiful wife, with what looked like a full term pregnancy. I did not expect such a couple at DMCH. Relatively well to do patients go directly to private hospitals. However, I received them with a smile on my face and a list of the things they will need to procure (we have learned to save time).

It turned out that this was the couple's first child. They had been married for two years. The husband worked in a buying house and the lady a housewife. They were such a nice pair. As beautiful as she was, the lady had a radiance of competence in her face. She knew how happy she was making her husband. And happy he was! If one could isolate the feelings that shone in his face, one would find at least three things. First and foremost Pride; this was his wife, his child, his moment. Secondly Fear; whether anything would go wrong and take that pride away. And finally, glimpses of faith, that God was with him.

They had planned the pregnancy to take place when the wife turned twenty-five, a good age to have the first child. It is always safer to have the first child before the age of thirty. Statistics show that the rate of abnormalities of the child as well as the difficulties of pregnancy all increase with advancing maternal age. This is part of the reason why educated woman of now-a-days, who get married late, often have challenged children.

Mr. and Mrs. Rahman however had it all figured out. They had gone through all the routine tests before hand and had all the papers in order. Thanks to ever evolving medical technology, 4D ultra sonogram had confirmed that it was a girl. And I could tell, this was more to the liking of the father than of the mother.

A woman in her life gets very few opportunities to develop herself. She is always in the confinement of relations and responsibilities. She is a daughter abiding by her father's rules, a sister worrying about her brothers, a wife commanded by her husband and finally, a mother, exhausted and forgotten about. If a person has to acquire an independent school of thought, it is necessary that they find an adequate freedom to do so, something women never get in this part of the world. A lame excuse of security and protection has captivated women. Society has built fortresses awfully impermeable to protect the feminine of their kind. And the walls of that fortress have become means to an inadvertent deprivation.

Parents are only the means of bringing children to this world. Their thoughts and ideas will be developed by themselves, free from influence of religion, of cast, of ethnicity or even the pros and cons of society. Anyway, that idea is probably too far-fetched.

Every woman, whether they can express it or not, knows the difficulties they had to undergo. And when she bears in her womb yet another repetition of her own life, it is very difficult to be enthusiastic about it.

Let's get back to happy thoughts!

With rejuvenated anticipation, I received Mr. and Mrs. Rahman. As soon as she was laid down on a bed I performed the necessary examinations. I had to check three things: first, the mother's condition. Second, the baby's condition. And finally, the conditions that might interfere with a normal delivery.

The maternal condition is judged by the pulse, the blood pressure and an overall assessment of her health. We check the heart and lung. We also take history of any relevant disease like diabetes or previous hypertension, asthma, any heart abnormalities, any drug abuse etc. The blood group is a must know. Most of the women of our country are anaemic, that is they lack an adequate amount of haemoglobin in their blood. Any amount of bleeding after delivery then becomes a threat to the mother. And when the bleeding exceeds a critical tolerable limit, we doctors call it PPH (Post Partum Haemorrhage), an obstetrician's nightmare. However, there are also methods of dealing with such problems.

The fetal condition is most interesting to determine. We try to learn how much the baby has grown by measuring the size of the uterus, its height and roughly its circumference. We check the position of the baby inside the mother and how much it is comfortable. With our eyes closed and with full concentration, we listen to the tiny heart beating within the holy grail with our stethoscopes. It runs fast, fast with anticipation. The last but most important aspect of our diagnosis is the mode of delivery. It can be a normal delivery or a caesarean section, the later being increasingly common these days.

There are of course different types of normal delivery. Instruments can be used to aid the expulsion, drugs can be given.

Anyway, the caesarean section is probably the easier for both the mother and the doctor. There is no pain for the mother, no effort is necessary. And for the doctor, he remains safe knowing that everything is in his control, because if the baby is inside the mother for too long, it might get suffocated. Later complications however are more frequent with a CS. Subsequent pregnancies have to be regarded as more risky than usual.

Many of us think that Julius Caesar was born by a CS and hence the name of the procedure. But it could not be true. At his mother's time, surgical techniques were not that well developed that a mother should survive such a procedure. We know that Aurelia, his mother had lived through his birth, therefore ruling out the possibilities of a CS.

The term Caesarean is probably derived from the Latin word caedere, to cut. And the Roman law Lex Caesare stated that a woman who died in late pregnancy should be delivered soon after her death, and if the baby died they should be buried separately. It was all good news for the new mommy. She and her baby were just fine. But when I was trying to assess how long it would take for her to deliver, I was shocked to find the baby was just about to come out. She had previously stated that the pain had started about two hours back. So I was in no hurry. For a first time mother, it takes at least eight to ten hours from the beginning of the pain to the delivery. There was a misunderstanding about the time when the pain had actually started. I quickly readjusted my priorities. I had to do something very quick.

I shouted for the trolley man to take the lady to the labour room, which has specialized beds for delivery. We rushed her pass the OT complexes, expecting that any moment the baby would be born. The father was beside her all the way up to the labour room door, beyond which male attendants are not allowed. While he was helping us take the soon-to-be mother to the labour table, he was caressing her hair with such affection. Despite agonizing pain, she managed a smile for her beloved.

We conducted the delivery with minimum difficulty. It was textbook all the way. And a baby girl as pretty as her mother was born by my hands. I felt like I was God's right arm. It always appeared to me that the birth of a child, beginning from its conception to its delivery, was conducted by God himself. There were no intermediates involved.

I will never forget the moment when I handed the baby over to its father. Rapped around a cotton towel she looked like an angle, deep in sleep. Later, I had planned to ask the father a few questions about his plans with the baby, maybe give a couple of advices. But looking at them, a man and a woman staring at their baby together so closely, I decided to leave them alone. The spirits would not forgive me if I disturbed them. The remaining hours were more or less typical. There were patients of the usual distribution. We received some forty five patients that day. We managed them with efficiency. Fortunately, there was no maternal mortality during that admission. We took care of the paper works and prepared a summary of the events in the last twenty four hours. This summary was to be presented to the Professor the following morning the morning session. Decisions were questioned, procedures were scrutinized and we learned a thing or two about how we could improve ourselves further. It is a very good method of training the doctors when Professors criticize the work. Our unit head was one of the best in the trade. She was the youngest person to become a Professor of Gynaecology in the country. Training under her supervision was tough. We always had to be at the top of our game.

And that is our life. Same stories again and again. Some of tears, some of smile. But each time, walking back to my humble shelter after work, I, yours truly, feel privileged to be an intern at 17.