Polite Dissent

I should have known from the start that it was going to be a bad day. I woke up late, which is unusual for me, so I didn’t have time to shave before I had to leave for my OB rotation at St. John’s Mercy Medical Center. My overnight kit was in the student call room, so I knew I’d be able to shave at the hospital before rounds started.

As I was walking into the OB ward, a couple of the nurses I passed mentioned that I was looking pretty pale. I just smiled and said, “I’m always pale.” Not until I was shaving did I realize that I really did look pale. I had given blood the day before, so that probably explained most of it. I wasn’t worried; our routine was always the same: pre-rounds on the OB patients with the residents, a leisurely breakfast, then full rounds with the attending physician. I would have plenty of time to rehydrate and get a good breakfast.

Unfortunately, things didn’t work out that smoothly that morning. In the middle of our pre-rounds, an emergency C-section came in. The attending grabbed the two residents and me, and we all scrubbed in to the surgery.

The surgery went well, and the infant was delivered quickly and without any difficulty. The attending turned to the youngest resident. “Steve, have you ever sewed up a C-section?”

“No, sir,” he said.

“It’s all yours,” the attending replied, removed his gloves and gown, and stepped out of the room.

The trick to a C-section is that there are many different layers involved (OK, the real trick is to get the baby out – that’s definitely first). You need to sew up the uterus, the peritoneum, and then the skin itself. Sometimes multiple layers of suture are placed in the uterus or the skin. An experienced physician can do this quickly, and sew up all the layers in no more than 5 minutes. She will usually staple the skin layers, as staples heal well, and are fast to put in and easy to take out.

Steve, however, was anything but experienced. Slowly, very slowly, he began to examine every square inch of the uterus. He took the needle holder and suture and made a very small, precise stitch. He looked closely, and then took another stitch. This laborious process was repeated for the sixty tiny stitches he used to close the inner layer of the uterus. He then started on the outer layer, using a slightly bigger suture, but the same slow routine. By the time he was finished with the uterus and started on the peritoneum, we had been in the OR for over an hour.

I started to get very sweaty. The gown, mask, and cap that everyone has to wear in the operating room are always very warm, but this was worse than usual. I developed a cold sweat and then began to feel a little nauseous as well. I took a deep breath to clear my head, and took a firm grip of the table to steady myself.

Meanwhile, Steve continued his slow, precise suturing.

My sweats got worse. I started to shake and get a little light-headed. I gripped the table tighter, and concentrated on what Steve was doing.

He had finally finished repairing the peritoneum and moved on to closing the skin. Please, I prayed, use the stapler. Instead he picked up more suture and carefully measured the incision before he started in with another tiny stitch. He took a second stitch then stopped, eyed the incision critically, and pulled both stitches out.

Sweat was pouring down my face and my vision was blurring. I was feeling dizzy but I was determined to make it through the C-section. Steve had started again and placed three stitches in the incision. He stopped, measured, and placed two more stitches. Another pause, then another stitch. He stopped again and ripped the last stitch out before starting again. He had repaired barely one inch of the eight-inch incision.

At this point, it was taking all my effort to stand upright. I had visions collapsing face first into the operating field. I stepped away from the table, ripped off my surgical mask, gown, and gloves and bolted from the room. I stumbled down to the doctor’s lounge and collapsed on the couch.

After five minutes, I got up and crawled to the fridge. Opening it, I found a can of Coke and quickly drank it down. After another half-hour and another Coke, I felt strong enough to leave the lounge. I returned to the ward, where Scott had just finished the C-section. I walked up to him and apologized for breaking scrub and leaving the OR.

“You left?” was his puzzled reply. He was so intent on suturing that he had never even noticed that I had left. He teased me about leaving the OR for the rest of the rotation.

I should have kept my mouth shut.