Wednesday, May 25

Today was an absolutely fantastic day!  After another delicious breakfast of itly and morning prayer, Alex and I headed to OBGYN where we were informed that two C-sections and a D and C were scheduled. We then changed into the hospital’s scrubs and sterile flip-flops, put on our caps and masks, and headed into the OR for the first C section.  This C-section was complicated by the fact that the patient had severe uterine adhesions from a previous C-section. Dr. Chakko stated that the severity of the uterine adhesions was due to the previous surgeon not sewing up all of the abdominal wall layers. She wanted us to make a note of this because they would take care to sew up both the visceral and parietal layers of the peritoneum, a step which is often over looked, after the birth of the baby to prevent more of these uterine adhesions. While the uterine adhesions made the surgery more difficult, the birth of the baby went smoothly overall and was amazing to witness. One second you were still looking at the placenta and then all of a sudden there was a crying, healthy baby in the OR with us! After the C-section the surgeons performed a tubectomy. Dr. Chakko told us that in the tribal population of patients who have limited to no access to transportation that would allow them to quickly get to the hospital, a third pregnancy that requires delivery via C-section would put the mother at extremely high risk, so the physicians counsel these patients to receive a tubectomy after their second delivery via C-section. This procedure also went well, and we learned that to ensure complete sterilization the tubectomy needed to remove the portion of the uterine tubes that contains the fimbrae.

The next procedure that we saw was a D and C. Here the patient came in with a chief complaint of excessive and irregular bleeding, so the D and C was checking for malignancy. Once the uterine and cervical samples were collected, they are sent to a lab in Coimbatore to be tested and the hospital should receive the results one week later. We then had a brief tea break of orange fanta and cookies with Dr. Chakko before the second C-section scheduled for that morning. This patient was also undergoing a second C-section; however, she did not present with the same severe uterine adhesions that the first patient did. This did not mean that this second C-section presented with no challenges because half way through the surgery the power went out and the generator didn’t kick in for 2 minutes! However, this challenge in no way alarmed the surgeons. They remained calm and asked me to turn on the flashlight given to me by one of the scrub nurses and hold the light over the woman’s abdomen, so that they could continue with the C-section. After 2 minutes, the generators kicked in, power was restored, and another beautiful, healthy baby was delivered shortly afterwards. They performed a tubectomy after this C-section as well.

All of the surgeries were completed at 1:30pm, so after we changed back into our own scrubs we sat down to another delicious lunch and had some down time until rounds at 8pm. Alex and I decided to play card games during some of that down time, which mainly consisted of us trying to remember 2 person childhood card games. After rounds from 8-9pm, we joined up with the rest of the group to have dinner and then it was off to bed. But what an exhausting and exhilarating day! It was both amazing and inspiring to be in the OR of an 80-year-old woman, and this showed me how the passion and dedication that we need to bring to our practice of medicine in an effort to increase our patients’ quality of life should have no age limit.

-Annalisa