NIGHT SHIFT

3:00 hours.
The extension phone in theatre rings once. The theatre nurse stirs, but continues resting her head on the table. Her breaths are coming out in shallow regular spurts. She looks peaceful, comfortable even. The extension phone rings again. This time, the ringing is continuous. The harsh krr, krr, krr of the phone jolts her awake. She lifts her head. She is disoriented for a minute or two. she looks around, yawns, stretches her arms then stifles another yawn as she picks the receiver and places it next to her right ear.

“Theatre”, she croaks into the phone, then listens. “Okay”, she says and replaces the receiver. She has an operation to prepare for. She walks into the operation room and taps the other nurse. He is seated on a theatre stool, head resting against a wall. She taps him on the shoulder. He wakes up immediately. They start preparing the operation room for surgery. Then the extension phone on the nursing station starts ringing again. He goes to receive the call. He comes back just as the surgeon walks in. the anesthetist also walks into the changing room soon after the surgeon.

The second phone call is from maternity ward. They have two emergencies; two cases of fetal distress. The theatre nurse informs the surgeon about the maternity cases and the surgeon knows that his patient will have to wait and probably lose one testicle in the process. He has reviewed this particular patient. An eighteen-year old male with scrotal swelling and severe scrotal pain, admitted about an hour ago, a condition called testicular torsion. It is a surgical emergency. The earlier the operation is done, the higher the chances of saving the testicle.
At the entrance to theatre, the patient from maternity and the young male patient arrive at the same time, both wheeled in by nurses. they are both wailing in pain. One from labor, the other from a rotated testicle. Both of them have emergency conditions. But because there is only one theatre bed, only one of them can be saved first; the pregnant lady. She is carrying a life. So she gets in as the young man is wheeled back to the ward. He will be taken to surgery alright, but then he will lose his testicle. Because the longer the time taken to operate on a testicular torsion, the higher the chances of losing that testes.

Because of severe shortage of theatre staff and equipment, doctors every day have to make tough decisions. Every time you get three pregnant women in need of emergency cesarean sections, you have to decide who to take in first amongst the three. You are therefore indirectly deciding whose child to save now and whose to save later, something that doesn’t always work well. When you have done your best assessment, you might as well save all of them. But sometimes, “shit happens”. If you have a mother in labor who requires a c- section and a young man with a rotated testicle that needs to be fixed urgently, you will of course decide to save the mother and the baby and lose the testicle! Doctors are always playing god, not only on which patient who gets admitted into an intensive care unit, but also on who to be saved and who to deal with consequences.

Free Maternity: A big fat lie

It is all quiet except for the blip blip of the anesthesia machine and the chiming of the clock. Standing on the right side of the patient cutting through skin, fat, fascia et cetera, I almost feel alone with my thoughts.

It is three thirty six hours, and the four humans in theatre four are either too lost in their own thoughts or too tired for small talk. Soon, the fifth person arrives and without respect for the silence, announces his arrival with a shrill cry. This brings a tired smile on the human lying on the operating table. He is wiped and wrapped with warm and fluffy blankets then placed under a warmer. He kicks and throws tiny pink fists punching the air, and then realizing he has been ignored, breaks into a continuous monotonous newborn cry.

Nobody tries to soothe him. I am stitching the uterus, the scrub nurse is busy massaging it, the anesthetist is trying to maintain the pressures, preventing them from falling, and the circulating nurse is on phone, calling everywhere she thinks we can get even a single bottle of oxytocin. Her pleas for oxytocin are punctuated by calls to the lab for blood. This woman walked to the hospital to have her second child. Her first child was born vaginally but this one wouldn’t just come out. Her uterus won’t contract on it own, and the last oxytocin dose was used on the previous patient hence nothing is left for her. So she is losing blood slowly but steadily, in other words dying, becoming a statistic, one among the many face-less women who die while giving birth. Her baby is about to become motherless, her husband is about to become a widower.

Women from her village or estate will have too much to talk about caesarian section. For many, it will re-affirm their strong hatred for c-section. She will be used as a warning, and so most women will prefer delivering under the watchful eyes of their mothers-in-law and traditional birth attendants. Most husbands will warn their wives against signing those theatre consent forms and we all know that maternal mortality will remain high.

Free maternity is a good campaign slogan that is currently a big fat lie; it has been a lie for the last one hundred and Fifty one days that nurses have been out of work. It was a lie for the one hundred days that doctors were on strike. It is a lie in many hospitals that make women to carry their own water to the hospital, their own cotton, their own examination gloves and their own infusion fluids, oxytocin, sometimes even cord clamps!