Pus and Tubes at the Death Star

The tower looms up into the grey Vancouver winter sky. Fifteen floors of impersonal, cement general hospital. Endearingly known as the Death Star.

We see lots of ectopic pregnancies, miscarriages, and the most common thing I've seen? TOAs. Tubo-ovarian abscess. A big ball of pus wrapping your fallopian tubes in inflammatory angryness and your ovary in cozy adhesions. Causing you infertility and ectopic pregnancies in the future. Why all the pus? There's not enough condoms in the world. Why can't people just use a bleeding condom? Not gonna lie. I get the impression that Chlamydia is overated.

The drizzle falls. The pager beeps. I count up the days I have to go before I get to sleep in for a day... 1,2..... 18, 19.....26..... hmmmm... 26 days in a row. Mild nausea sweeps over me.

Three weekends in a row. On call.

Truth is, pus in the pelvis is fine... but I miss babies and the Happiness Ward.

First Rupture

No one was in labour, we were just waiting to go for a c-section in an hour or so (after the heart they were working on). So I thought it would be safe to go for a coffee on Davie street with my friend Kai when he paged me.

Just after having sat down by the steamy window, slurping milky goodness... beeping from my pager. Annoyed, I glanced down at the number. The emergency room, probably someone with a miscarriage, and I rolled my eyes groaning. At least I can finish my coffee. I called on my cell phone and got the emerg doc directly.

There's a lady here who can't keep her pressure, we think she has a ruptured ectopic. We're really worried about her and need you to come now.

Hmmm... drop coffee.... walk briskly thru the drizzle. Stroll into the trauma room. Pristinely calm and efficient on the outside. Heart pounding, thoughts racing internally.

She is crashing and has what looks like a belly full of blood on ultrasound. I order some blood right away, call my staff, and call the OR. Things are in motion.

The part that always gets me, is the fear and pain in their eyes. She didn't know she was pregnant. Just after dinner she felt the worst pain she has ever had and then passed out, to regain consciousness in the ambulance. Her husband leans his face close to hers, eyes glazed over, brimming with tears that won't come, scared. As we flow around them in our clockwork fashion, poking, prodding, sticking needles in, wiring her for sound. I realize I have no concept of what it would be like to look into someone's eyes who I love more than anything, not knowing whether they will live or die. I ask to talk to him to get consent for the surgery. The risks and complications reel off my tongue, 'her condition is very serious' I hear myself say, 'she needs an operation right now'. I'm sure he hears nothing, just signs the paperwork, nodding, thanking me again and again for nothing that I deserve.

The elevator creaks as it sweeps us up to the operating room, she is wheeled in and asleep in minutes. Her skin white as porcelain and cool to the touch even through my sterile gloves. My hand reflexively grasping the scalpel, slicing through the skin. I look at the incision confused. The normal bright red dots that appear on the skin edge and throughout the rich shinny fat are absent. The tissues gape open moist and bloodless. She has no blood left to bleed.

Through the peritoneum and instantaneously blood is everywhere. Dark red livery clots. Bright red pulsations. We suction out three liters. Digging to find what we're looking for, its no more than three centimeters, a little blob in her left fallopian tube. We end up taking the tube out since the pregnancy has completely ruptured through, destroying it as a future egg hose to the uterus.

I marveled at it all. This tiny gestation that nearly killed her in the course of an evening. Amazing as well that we could fix it. That she is one tube down but one heart still beating. Every moment of it exhilarated me. If the outcome had been different I hope my emotions would have been appropriately altered. I wonder.

I wonder how I roll my eyes when asked to see another miscarriage but get high during critical situations. Who is this person I am becoming?

La Lecheria Esta Cerada

The fiery Aussie nurse lent over the bassinet holding the hour-old infant whose mouth was rooting around looking for some nourishment. In her slurred accent, she said smiling, "Sorry mate, the milk ba's not open yet, but your mama will be back from the operating room just as soon as she can."

The proud father, brow furrowed and eyes serious responded: "Excuse me, I'm very sorry, but he only speaks Spanish." Lifting up his child, he cupped his tiny son's head in his hand, and in a gentle flowing voice translated what the nurse had said. La lecheria esta cerada, pero ahorita viene tu mami.

I love my job.

Hairball

Pop. Through fascia. Pop. Through peritoneum. Air hissing out through the trochar in the belly button. Gratifying glide of steel as the laparoscope slides into the abdomen.

Then the cathedral lays out before you, the roof an intricate pattern of vessels. Miles of tender pink bowel, adorned with glistening golden yellow pillows of fat blobs. With a twirl of the camera the smooth moist liver edge slides into view reflecting the light, taut gall bladder cozy within its shapely lobes.

Then the pelvis, the pulpit of the cathedral. The bowel is pushed and pulled out of the way. Pesky sigmoid eternally and annoyingly unattachably in the way. Uterus gleaming into full view as it is tenderly excavated from below the bowel. On the right a spectacular contorted cyst. Triple twisting around its pedicle is the right ovary, dusky in colour and the size of the uterus itself.

Flip. Flip. Flip. Oops, wrong way. Flop. Flop. Flop. My ovary flipping skills in the cathedral are neither smooth nor nimble. And the twisted mass is eventually revived of some milky pinkness under the ever patient eyes of my attending.

Tiny scissors snip snip snip through the overlying stroma exposing the oozing speckled blood on the cyst. We decide to drain the cyst before fully freeing it from its encasement in the ovary.

Snip. Ooooooooooooooooooze. Slrurrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrp.

Creamy thick yellow custard pouring forth, forming puddles of floating fat on the mini-pools of watery blood around the peritoneum of the cathedral floor. It looks deliciously like someone is squirting out the insides of a dough nut. I insert the suction into the source of the pastry filling and pull out globs of black hair. Deliciousness immediately turns to visceral disgust to giggling. Cutting the cyst open for drainage reveals a perfectly formed incisor tooth.

Chewy hairball pudding.

The human body is spectacularly uniquely viscerally beautifully disgustingly amazing. Not gonna lie, dermoid cysts are kinda gross. The divine and the gritty sleep together.

Brilliant Rain

It was one of those consults you roll your eyes at. The emergency doc on the other end of the phone, "yeah, she's 22 and has quite a bit of vaginal bleeding, I haven't seen her yet but I was wondering if you wanted to take a look."

Uh... is she pregnant? Is it her period? Anything else you know? Maybe you could examine her and give me a call back.

I only had about 52 other things on my to-do list. It was a crazy night, several women in labour as well as a total of seven consults from the emergency department... and I didn't have a junior resident on with me... you forget how nice that is.

She was 22 but could have been 16. Terrified, and yes, bleeding heavily, passing large clots. The livery sight of which brought her to tears. She passed out from the blood loss in fact. I examined her, packed things solidly to taper the bleeding a bit and called the OR right away.

It had been her second sexual experience and she had a gruesome vaginal tear. Her first experience had been the week before, which involved a trip to the pharmacy for Plan B. Needless to say, it was a fairly critical time for us to talk about sexual practices, birth control, STDs, basically everything. Understandably she was anxious and scared, adamant that none of her friends that had brought her in find out.

After the repair in the OR, although I was saddened by the circumstances around the situation I felt like I had actually contributed something. That I had not only sewn up a physical need but soothed emotional pain as well. It was the first moment in a long long time that I was again glad I was where I was and who I was, doing this residency slog.

I crashed for most of the day. Woke feeling extraordinarily disgusting and went for an equally nauseating run in the rain. I was just going out to buy a red onion for supper (thats not the ONLY thing I ate, don't worry) and although the rain continued, the sun low on the horizon broke through the clouds. Rains drops shimmered through the air and a brilliant rainbow curved its arch across the sky. The fluorescent fuschia, orange, and yellow leaves glistened in the delicious evening light. It was a promise in the sky.

Strangely as I gazed at the sky (with red onion in hand) my exhaustion turned into a sense of accomplished contentedness.

Last Name: Mary, First Name: Virgin

There is a genuine look of intense concentration on her face.

So you've never had sexual intercourse?

No, never.

You're 25 weeks pregnant... that means...

Well... I guess maybe I've had outercourse?

Her brow is furrowed and she looks confused. Sex ed isn't what it used to be.

The Splinting of My Fractured Soul: A Case Report

"Listen, this rotation is hell, and its soul destroying, and you just have to get through it."

Why?

I don't wanna play anymore.

The end of my string is slowly approaching. I've been doing 1 in 2 call. That means every second day you stay at work for 26 hours or so. Which means everyday you go to work and it doesn't end until tomorrow. Its exhausting. Draining. Yes, it drains my very soul. So I've started a soul account. Trick is, you have to pay in more than you pay out.

You forget who you were before you were a forceps, vacuum, and C-section machine. Did I have a personality? Was I interesting? Did I care about life? Was I passionate about anything? Doubtful.

There was a big deposit into my soul fund last week. A dear friend from medical school stumbled into the Ass Room (i.e. Assesment Room at labour and delivery). His wife and him were a source of profound inspiration to me in school and all-around make me believe that there is in fact hope for the poor and marginalized in the world. They are passionate advocates of oppressed people groups, from Sudan to Kurdistan to northern Alberta. Eloquently they speak out against soulless corporations and the injustices that happen in the interest of financial gain. And they do it all with such incredible optimism and humility, all the while affirming and challenging those around them, that it makes me giddy with hope. As if that isn't enough, they throw some pretty incredible Kurdish New Year's parties!

They delivered a skwocking hairy little miracle of a guy. Rarely have felt such privilege in delivering a child as I did with them that day. It was indescribable. The lump of emotion in my throat chocked me. To deliver a new being, warm, squirming, and slimy, who, along with his two sisters will undoubtedly change the face of the world made me remember a little piece of who I am and who I want to become. It felt good to feel again. No mindless numbing, just raw and real.

Dee-der-doo-der-dee. Dee-der-doo-der-dee.

And then my pager went off. So I ran downstairs to the rotational forceps delivery in the operating room of the woman I had only met once, which failed and we had to to a C-section anyway.

Shoot. Maybe six billion little miracles is enough.

Before they were discharged from hospital my friends came to find me down at the delivery suite to give me much needed hugs and invite me over that evening. It was lovely. The nurses and attending obstetrician who were around to witness this asked me in quiet voices afterwards.

"Sheona, do your patients usually invite you over on the way home?"

Oh yeah, and I say yes every time. No professional boundaries here.