One of the Trainee Interns, a friend of mine doing his Obstetrics and Gynaecology (O&G) attachment here, got pulled suddenly by a nurse while floating around in the Emergency Department to the carpark outside. There he could see, in a normal sedan car just outside the hospital, a lady already starting the process of childbirth!!!

Maintaining supreme calmness that I can only admire, the Trainee Intern delivered the baby right there in the car. (He must have been thankful it was a smooth second stage of labour, haha.) Using the delivery kit that the nurse had brought with her, he clamped and cut the umbilical cord, wrapped the baby up, and then sent for the lady and her newborn child to the birthing suite for the passing of the placenta.

How heroic! We now call this Trainee Intern "The Deliverer".


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p.s. I still feel cold sweat when I recall this encounter I had when I did my O&G attachment!
Medicine trains your nerves, I say.

In Uganda, when I wasn't away on epic excursions, I...

( part t w o )

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(Finally, a much-delayed continuation from this post!)

Her beloved husband wasn't faring that well. For the past many years, due to PSP, he hasn't been able to comprehensibly articulate more than a few single-syllable words, but even so, she found no problem communicating with him everyday. Right now, he had a bad pneumoperitonium, in addition to an aspiration pneumonia that didn't seem to get better. Her beloved husband wasn't faring that well.

We discussed with her about resuscitation in the event of a cardiac or respiratory arrest. The chances of us being successful, in her husband's case, would be small. Even if we were to succeed, the quality of life gained back would likely be much reduced too. So carefully we asked if she would still like for us to attempt a full resuscitation on her husband, if that were the case.

"Yes," she replied with resolve, but her voice flickered a little afterwards. "We've discussed this before. I want full resuscitation for my husband. ...We believe in God."

I could very well see where she came from. What a difficult situation she must had been in.

Yet later, in the ward office, when we were thinking again about his resuscitation status, the elective student in our team echoed out my thoughts better than I could express myself - if they believed in God and His timing, "Shouldn't it be the other way round?"

But perhaps many times we won't know for sure. Tell me what you think.

She frowned with worry. Her elderly hands were lightly rubbing on her abdomen. "But this pain... can you do something, dear?" she pled.

How I wish the answer could be an easy and confident yes with a sparkling smile. Then and there I wasn't even sure about the exact cause of her complaints. It could be something relatively simple, or it could be something fatal too, especially in view of her co-morbidities. Co-morbidities - oh she definitely had a number of those, not the least of which was end-stage renal failure on CAPD.

I had thirty minutes left to go before the end of my seemingly everlasting night shift when I was called to see her. I struggled by her bedside to decide whether her symptoms warranted immediate investigation and aggressive intervention.

"What should I do?" she asked me. Her hands grabbed onto mine, as if not wanting to let me leave. But I had to.

"I'm not sure what's going on, but we'll do a blood test to help us find out what's going on. And I'll get your nurse to give you some pain-relief now, okay?"

"But what should I do in the meantime?" she asked again.

"Well, it shouldn't be too long, okay?"

She was talking fine - she wasn't cringing and shouting. Her abdomen was soft - she wasn't jumping when I touched her. Her vital observations were still within normal ranges. This wasn't severe pain, I thought - maybe she was a little too anxious. Maybe. Peritonitis in CAPD is the important condition to exclude, but it didn't seem to be too pressing at this stage.

I sent for some blood investigations to be done. I handed-over for the morning house surgeon to not delay in reviewing her. I expressed my concern that there there might be some sinister pathology going on - although none overt so far.

The morning house surgeon never got to see her alive, though. She died two hours later.

Could anyone have predicted? Did I do something wrong? About this I have thought for a long time. I remember being warned while in medical school about the inevitability of these questions. Of course I could have done better; I wish I had the experience to pick up the subtleties - oh I hate it when this happens. But if the deterioration was that fast - I wonder if the outcome could have been changed much.

Still, the worried, anxious face she gave me when I walked away haunts me greatly. I should have been kinder to her. There is no excuse. Really, I'm sorry.

It was Christmas eve and I heard a large group of people faithfully singing carols in the hospital. I don't know about the patients, but as someone working there I was quite moved. God bless them and their hearts, truly.

Much more than a group of lovely senior-aged people they were (I'm so embarrassed to have had that assumption!) - they were adults with guitars, teenagers with clarinets, kids with flutes, and people of all ages with a voice. They sang from one hospital ward to the other, "Angels we have heard on high / Singing sweetly through the night... Gloria in excelsis Deo / Gloria in excelsis Deo."

It was Christmas eve and I was working a full long shift till eleven at night, but I didn't really mind. I've only just moved to Palmerston North afterall - I had little else do anyway. Then in the ward office, the surgical registrar let off a frustrated sigh behind me. I turned around and I asked him why.

"It is very difficult to properly explain to someone," he half-complained, "about going for an urgent operation in which the risk of dying on the table is pretty damn high, when you have these people singing in the background."

I thought about it. I still don't know how to reply.