A tale of an emergency Caesarean section
Prologue
"You're the medical student on-call, right? There's an emergency Caesarean ready to start anytime now..."

I had only finished lunch moments ago. I was walking my way back to the nurses station when the charge midwife caught me on the corridors of the Birthing Suite. "But the registrar-on-call's held up somewhere else at the moment," she went on. "Can you scrub in and assist?"

"Yes," I replied a little too soon. I tarried a split second - at that instant I was more concerned if there still was food left in my mouth from lunch - and continued, "Although I've only observed Caesareans and haven't had the chance to assist in any yet."

"That's alright. They need you now."

Okayyy... but this is an emergency Caesarean, you do realize. Dang, I haven't even properly revised the layers of the abdomen yet! But as I started to stride straight towards the operating theatres, the charge midwife assuringly added from behind, "Don't worry, you'll be fine!"

Thanks for the faith... and I sure hope so!


A tale of an emergency Caesarean section
I saw the husband (hopefully soon-to-be-dad) sitting anxiously outside the theatre. I gave a polite smile while tying up my surgical cap and mask; we probably weren't too different in terms of nervousness, I thought. Entering the theatre, I wasn't even sure if I was in the right place. Amidst the nurses running around getting the surgical instruments ready, and amidst the anaesthetists flashing needles while trying to insert a spinal catheter into the patient sitting on the bed, stood the person whom I believed must be the consultant obstetrician - since the only other person in the theatre was a neonatology registrar whom I knew.

"I've been told that someone's needed to scrub in for an emergency Caesarean here," I said. Haha - I've got my mask on, so he wouldn't be able to recognize me in case I've walked into the wrong theatre!!

"That's right. Scrub in. Actually, I'll do it too now."

Fumbling a little with the chlorhexidine-soaked finger picks and sponge while trying to still look professional, I briefly asked what the situation was. So this was a women in her 30s, prima gravida, in inducted labour and 3cm dilatation when worrying immediate post-contraction fetal heart decelerations were consistently noted in cardiotocography. Fetal distress, that meant.

While we were halfway scrubbing in, the obstetric registrar-on-call suddenly entered into the theater. She must had put on hold whatever she was doing in the wards and rushed here - so I wasn't sure how she felt to see that I had already scrubbed in, taking her place. "That's alright. Good luck!" she replied very pleasantly with a smile, and went out, leaving me once again wondering just what I was actually doing, about to assist in an emergency procedure that I had no experience with.

We waited for more than a minute after the infusion of spinal anaesthetics, yet the patient was still able to feel the lower half of her body. The anaesthetist then tried to increase the dosage as the consultant obstetrician impatiently waited. With every tick of a second the danger surrounding the fetus was compounding, afterall. But for whatever reason, the spinal anaesthetics still weren't taking effect anywhere near fast enough - and immediately the decision was made to switch to general anaesthetics. Wait - Caesarean sections on general anaesthesia have a poorer neonatal outcome compared to spinal or epidural anaesthesia, right?? The criticality of the situation just doubled for me.

The very instant the patient turned limp and unconscious, the consultant obstetrician's scalpel had already made a swift lower section cut with droplets of blood seeping out. Instead of handing the clamps and retractors one by one to me to hold, they seemed like being thrown towards me with a "Hold this, and this, and pull it away from me"-warning only half a second in advance. While I was frantically catching the clamps and retractors mid-air, suddenly the consultant snapped, "No, just put these down for now and hold this here - the uterine artery's bleeding as you can see; she'll be in shock if this goes on!"

Shock?? My appraisal of the situation probably wasn't accurate enough! With the artery ligated, swiftly we made our way into the uterus, as the consultant sunk his hand deep inside and a moment later pulled a baby out -- silent, and almost purplish.

"He's still alive alright... Wait...," the consultant commented as he clipped and cut the umbilical cord, noticing the twist in the cord. "Is this a true knot? It is a true knot, a true knot in the cord! This baby's one lucky bastard to be alive," he shouted as the nurses rapidly shuffled the baby boy to the neonatology registrar on standby behind us at the resuscitation bench.

While the consultant and I were busy suturing up the layers that we separated on our way in, I soon heard the baby starting to cry from behind me. Good job, I whispered in my heart in admiration of the neonatologist. The cry began as a discontinuous weak one, but slowly grew stronger. From looking at the notes later, Apgar scores only got up to 10 by ten minutes.

I could definitely feel the pace of the whole theatre slow down, but it certainly wasn't time to "let my guard down". The consultant was quick to correct some mistakes of mine, saying something along the lines of "Your job as an assistant is to minimize the possibility of the surgeon making mistakes. Because if the surgeon makes a mistake, he'll get grumpy, and when he gets grumpy, don't think that you won't be in trouble."

I think I caught up reasonably quickly, thankfully - although it definitely was stressful having to struggle to predict every of his next actions and all the time desperately squeezing whatever knowledge of anatomy and surgery I had to help me with that. We finished the job fairly speedily, and by the time mom was awake and joyfully crying while holding her baby with dad sitting beside, I could finally exhale a breath of relief.


Epilogue
When I undressed from the scrubs attire and returned to the nurses station, I saw my on-call teammate sitting there. "You won't believe what I just went through," I said to her, still recovering from the nervousness.

Indeed, fetal distress during an induction of labour, general anaesthetics during an emergency Caesarean, and a true knot in the cord - let alone being pulled to assist in the procedure all of a sudden, working with a consultant obstetrician whom I had never met before - were thrilling enough for me as a medical student who, three weeks ago, had almost nil exposure to obstetrics and gynaecology!

Non-medical people say to me when I tell them this story (no, I haven't been going around telling everyone this), "See, being a doctor, you get to save lives!"

That surely sounds so grand and even self-magnifying, doesn't it? Hah.

Of course, I wonder what might had happened if we were moments late in pulling the baby out. But I too wonder semi-seriously if things would have been any different if the charge midwife hadn't caught me in the corridor -- keeping in mind that the registrar-on-call did show up while I was scrubbing in, so I'm sure she would still have made it in time.

All I know, however, is that I got a glimpse of how it felt when you know that your very actions may cost lives.

...And then the next thing I knew was that I was once again wondering, this time together with our whole group, about since when did exam-studying become so labourous.