Prompt Day #312: Describe a surgical operation or autopsy that transpires in total darkness.
Most Obstetricians retire early. The lifestyle wears on you, like a professional athlete’s body, the obstetrician just cannot keep up with the sleepless nights and nonstop stress related to two-patient medicine. I wish I could have just retired, but I’d never been good about saving money and so, I had to try to find something else to do with my life. Many doctors end up working ER shifts so that’s what I did. I picked a small urgent care center in the middle of nowhere in the Upper Peninsula of Michigan. I figured, how busy could it be.
It turned out to be quite busy, given there was nowhere for these people to go. No hospitals anywhere near, no civilization even. We were basically a Band-Aid center until we could get the patients to a real hospital. I was overqualified for administering school nurse first aid, but I enjoyed the variety and the challenge of working with limited resources. But what I enjoyed most of all was leaving at the end of my shift and moving on with my life knowing the next shift would be a brand new episode.
The day I did retire, I was working the midnight shift. It was early summer and a cold rain pounded down on the roof menacingly. A short time after two, we heard the crash outside that could only be two vehicles meeting at high speed. It had thus far been a quiet night and we all ran outside. The rain was still coming down, hail and lightning now accompanied it. The first car I came to held a very pregnant woman who appeared bruised and shaken but otherwise well.
“Let me help you out of the car” I said and pulled on the door. I held out a hand and she took it. I let her put most of her weight onto my forearm as she eased out of the car.
“Oh.” She said in conjunction with a popping sound that I first attributed to more hail but turned out to be her water breaking. We both looked down at the ground simultaneously. The bright red puddle reflected the car’s dome light. That’s when the screaming started.
“I need some help here now!” I yelled. We managed to get her inside before the sky broke open as if along a fault line and a storm of mythological proportions poured upon our meager care center.
As an obstetrician, it was obvious to me that her placenta had been damaged in the accident and both she and the baby were losing a lot of blood. There was not time to investigate further, if either one had any chance at survival, we’d need to operate.
Get me the stat section kit and somebody try to start an IV. I assessed the patient’s level of consciousness. We did not have the equipment or the medication for sedation, she would have to undergo the surgery with nothing more than some lidocaine to numb the skin.
“Miss, listen to me. You are bleeding too much. We have to operate. I will try to numb the skin before I cut but chances are, you will feel most of it. I am going to have some of my nurse help hold you down but if we don’t get the baby out of you neither one of you has a chance. Do you understand me?”
She nodded, eyes wide, shocky. I didn’t know if she really understood or not, but there was no time to investigate further. I ripped open the large stainless steel basin holding basic surgical equipment and a bottle of lidocaine.
There was a male orderly named Jason. I yelled at him to get over here and help hold her down. With three people at her shoulders and two at her feet, I cut. Her screams were punctuated by the thunder outside and the cracks of lightning might have been working on her body in the way it had Frankenstein’s monster. She jerked and seized, straining involuntarily against her captors. I had just reached her rectus muscles when the lights went out, leaving me in a soft, warm pool of utter blackness.
I tried to keep going, feeling my way around the incision I’d made, but the damn surgical gloves made every tissue feel the same.
“Someone help me, I need light!” I called out to anyone in the room.
“I got both hands holding her down, doc, If I let go, she’s gonna buck herself off this table” Jason yelled over the screams from the patient who lay sliced open and wide awake under my care. There was no one to help. I had no choice. I ripped off the gloves and plunged my hands back into her body cavity.
I palpated the muscles, feeling for the subtle crease demarcating the midline between them. Using all the proprioception I could muster, I brought the knife down just beside my hand and made a slight cut. It was enough for me to worm a finger into the space and tug. Widening the opening, I put two thumbs inside and ripped the two muscles away from each other. Again, I poked at the space with a finger, forcing it through her thin, cellophane like peritoneum. I was so focused, I no longer heard her cries of pain or her pleading with me to stop. I could smell the blood and feel the warm trickle running across my shoes, soaking my sock.
I reached the enlarged uterus and followed it to its very top, now elbow deep inside my pain-crazed patient. Using only touch, I determined an appropriate place to make my incision. It would be much higher on the uterus than I would usually make it, but I had no time or tactile ability to separate the thin and fragile tissue between uterus and bladder.
“Almost to baby” I said out loud. In a normal, sterile and well-lit environment, this would be the code for anesthesia to tell the father of the baby to stand up in order to peak over the blue sterile drapes and the baby nurse to approach the table with a blanket to carry the infant away from the surgical field. There was no one to do that for me now, but I would worry about that when the baby was out.
I put a finger down to mark the spot where I intended to cut. I slid the knife—now very dull across the surface of her womb. I sounded the depth of my cut digitally. Slice, check depth, cut, sound, and so on. When the layer had thinned considerably, I threw the knife behind me and tore into the uterus bare handed so as not to inadvertently injure the baby. The bag of water suddenly ballooned out of the incision. I had assumed her water had broken out on the pavement, but there was only blood in all that fluid. Not good. I shouldn’t have thrown the knife. I tried to scratch at it with my fingernail but a good surgeon always keeps their nails cut short. There was no time to think about it, I had to act. I bent over and tore it open with my teeth.
Amniotic fluid flooded out into my nose and over my lips. It has a distinct smell when it is clear and unmarred by fetal bowel movements or infection; a chemical-like antiseptic smell. When something is wrong, however, you can easily lose your lunch if you aren’t careful. I turned my head and spat on the floor. I’d be lying if I said I had never tasted amniotic fluid before. It’s all part of the glamorous world of Labor and Delivery. But I had never tasted anything so foul as what ended up dripping from my lips that night. I could not stop heaving, it was involuntary. ‘Just get the baby out’ I told myself and stuck my hand inside her and down towards her vagina. I cupped my palm around a perfectly round head and shoe-horned it out. When the head was out, I ran my hand around it trying to find the face, so I knew exactly which direction to put my forces when pulling the rest of it out.
There was something that might have been a nose, but it was flattened and the nostrils stretched out and up like gashes. That when I felt them enter the mouth and realized this baby had bilateral cleft lips. The irregular nose pointed me to a single eye that sat just above it. I quit reading the braille of its deformities and pulled. This child came out stiff and unwieldy. Its extremities curled up like a dead bug. I laid the thing on the mother’s lap. It didn’t move and I realized she wasn’t moving either.
“Did she pass out?” I asked the darkness.
“No, Doc.” Jason said. It was all he needed to say. I knew why she was so still now. Lightning flashed and the sky lit up like an August midday. I saw the creature I’d killed a woman to save. Its pig-like snout exposing overdeveloped gums which split down the center revealing a deep black hole in the center of the thing’s face. A single milky eye stared blindly at me. I shuddered. Mercifully, the night returned.
I wiped my hands on my scrubs, cleaning off as much blood and stink as I could. I used the darkness to slink away, leaving someone else to cut the cord and close up the cadaver. I’ve never gone back. Sometimes, when a spring storm rolls in, and lightning illuminates the dark, I see that little creature’s face looking at me through a window accusingly. “You killed my mother” it tells me with its ghostly eye. Those nights, I don’t sleep. Yes, I‘ve retired from Obstetrics, but the lifestyle’s no better on the other side.