Written Stories

The Story of the Eighth CS

28 Sep, 2016 By: Dr Amogh Bahadur Basnyat

It has been 2 months since I came here at Kalikot. The CS we did this morning is the eighth one and I feel it needs a bit of retrospection. The Monsoon is on its full swing and the roads and the transportation are at their worst possible at the moment. Meanwhile, the locally produced electricity is also getting more and more unpredictable. Sometimes the voltage is high enough to fry the gadgets and at other times, light there is none. The thick cloud cover has been hovering over these gigantic hills for so many days now. No way for the solar batteries to get charged! And during such trying times we need to tackle the case of a primigravida of 20 years with short stature. During the entire night the progress of cervical dilation hasn’t surpassed the 6 cm mark and the contractions have been relentless. Thankfully the FHS (fetal heart sound) has remained stable, despite a huge caput and a second degree of moulding.

I get another call from Hari sister at 3:30 AM, and still the news is the same. So clearly the next step to go for is a CS for this CPD (cephalopelvic disproportion). With no light and uncharged solar battery, the only alternative is the old generator that I knew hadn’t been working for quite sometime now. No wonder, no one around here is expert enough to find out what’s wrong with the generator; still I decide to give it a try. I send to call a few hospital staff who might be able to kick start the old guy, meanwhile we in the IPD start our preparations for the CS.

Another call is made at the electricity office and the phone gets answered finally! “No, it’s not us; the power house itself is down.” I sincerely don’t know what it means, but what I do know is now the land line for electricity is something beyond our reach, not just for today but for may be a month or two. Wow, that’s simply great! The generator won’t start, as expected!

Now in the OT we are left with a solitary quarter power solar lamp, no suction, no oxygen concentrator, uncharged saturation probe and Doppler whose battery is getting lower and lower by the hour. Cautery, of course, I haven’t used even once since I came here. I resort to the only thing that I have been getting used to doing here so very often. I pray to my God. So then, let me leave everything at your disposal Lord. Let me attempt this one now... how dearly do I miss TUTH’s indoor CS OT by the side of the waiting room, the Tansen UMH’s all preparedness during all the hours, the Pokhara WRH’s availability of the resources...!

Being used to doing the CS with an extra assistant here is almost a luxury. Both the scrub nurse’s and the assistant surgeon’s job are taken over by a single person. Anaesthesia is obviously my share. What if the SAB (subarachnoid block) fails? I don’t really know what I would do! It came close to happing once, when the block was patchy the other time we did a case. Then, at least, Dr Rudra (government’s MBBS contract doctor) was here with us, to handle the minimal dose of opioids pre-delivery and the ketamine post-delivery. Today, I don’t have that fortune as well, as he too is out of station.

Well, here I go. Position, counsel, midline, quincke’s...and that’s ligamentum flavum....or is it? I am not quite sure...but the spinal fluid gushes out and the flow is steady. I slowly and hesitantly push in the bupivacaine 0.5%...! Thank God, it works! She is well anaesthetized below her T4-T5 dermatomes, not able to lift up the legs, her pain gone. One thing here is done.

Now, for the lion’s share of the beast. Scrub, gown, gloves. Skin, rectus sheath, linea alba....stretch sister stretch...! No that’s not what you think sister..the bladder doesn’t have a calculus..hehe! It’s the balloon you know. Foley’s balloon. That means the bladder is high up yet! Yes, and we need to open this peritoneum still higher up. Doyen’s. Yea, here we go...plain forceps..no it’s the toothed one..give me plain.. no it’s the artery forceps.. plain means non-toothed one..hahaha! Ok, now we push down the bladder. Nick at the LUS...stretchhhh slow and careful..Suction..SUCTION..oh sorry.. no suction today! What the...!

And there you have the head deep down, into the pelvis, well engaged..can I lift it out..sister, hello, someone..could you wear a glove and push it up for me..do you know what I mean..the head is too much deep into the pelvis..can’t get to it! Try, try..try..ok, leave your gloves..I have it now. And there it is..head, shoulder, torso, buttocks, and it’s the whole baby.. momma’s bundle is a boy!

Green Armytages, catgut 2s move in post CCT (controlled cord traction).. and there we have it.. closed uterus, haemostasis secured. Rectus sheath. Skin. CS is done! Sans light, sans suction.. the job is done!!

Leaving the baby and the mom in the post-op room I walk into the duty station. I can clearly remember the day our first, and the only one so far, hospital support committee meeting took place. The loud voices that complained about the absence of the x-ray service in the hospital. “Now, the doctors in the district hospital will treat akin to the shamans.. they shall diagnose by simply palpating your pulse”! Well, not only that...go and tell them, we even do major surgeries here in total darkness! Now, how about that?

Jokes apart, this one went well, hence not much to complain about. But, someday, something might go wrong. And at this pace and order it will definitely! What of then? Who will be held responsible? The District Development Committee that promised long ago to provide us a continuous three phase supply of electricity, but has turned us a blind eye since then? The electricity department that needs to divide the supply equally among the local leaders’ domicile hamlets? The hospital administration that is as clueless about the maintenance of its aegis as a crow in the mist? The office helpers who are never there to help? The NSI (nick simon institute) that sent me here to be responsible for things that I have no control and authority over? Or me... the doctor who ultimately is the very face of the visible mishaps and wrongdoings within a hospital system? It will be me, no doubt!

But, for the time being, the happy faces of the mom and the baby keep me happy as well! Love you God for this position you’ve bestowed up on me.

Dr Amogh Bahadur Basnyat
Kalikot District Hospital

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