A Series of Unfortunate Events...

I was tired yesterday, so I took a Sunday afternoon nap. Because of the nap, I couldn't sleep last night, and because I was groggy this morning from not sleeping, I got up late and was in a rush to get to the hospital before 7 a.m. All of this culminated in me deciding not to eat my normal breakfast of bread and jam before hopping on the motorcycle and making the 30 minute pilgramage to the local hospital, where I've been shadowing doctors for the past few weeks.

I felt fine as I drove around the winding hilly roads, despite the normal amount of self-consciousness that comes from being a freak (not only am I a mzungu in a rural area of Rwanda, but I'm also a girl on a motorbike and I've gotten my fair share of open-mouthed gawks). The doctors, nurses, and staff at the hospital have become accustomed to my awkward presence, and I zoned out for an hour during their staff meeting, which always begins with hymns, drumming, some kind of spiritual thought from the Bible in Kinya-Rwanda mixed with French. After the meeting I excitedly asked Dr. Samuel, the hospital director who agreed to allow me to impose myself on the hospital for a month, if I could visit the maternity ward today. He agreed and took me to Dr. Kikule, a very kind doctor from the D.R. of Congo, who usually works in gynecology but allowed me to shadow him as he assisted in the consultation department last week.

Dr. Kikule briefed me on the day's patients, two of whom required Cesarian sections. I first noticed a slightly heightened level of squeamishness while watching the nurses prep the patients by inserting cathetars, but I was too thrilled at the prospect of actually getting to observe the surgeries to pay attention. I followed the two ladies to the operating room and put on some scrubs. Another obliging and protective doctor helped me with my surgical cap and my mask, and arranged for some shoes for me. I was fascinated by the process, but a little unnerved by the use of local anesthesia. We'd seen this plenty of times in Cambodia, but I never got used to the idea of patients being awake for the auditory and olfactory experience of their own body being cut, ripped and cauterized.

The first cuts were quick and gentle, which made sense given the severe consequences of cutting too deep when there is a tiny baby down there. After dabbing away at the blood, the nurse grabbed the right side of the incision, the doctor grabbed the left and the two literally pulled the woman's belly open. That's when I knew I was in trouble. The sound made my head spin a little. Just then the anesthesiologist brought in a suction device, which was already half full of blood from the C-section that had just ended in the other room, connected a new piece of tubing, and began suctioning the surgical site.

I saw the doctor reach his hand into the cavity, pull a little on the head, and suddenly there was a baby lying on his mommy's legs. The doctor picked him up by his feet and the nurse wrapped him up and carried him to an inverted table, where he laid upside down as he was examined. About that time I decided it would be wise for me to close my eyes and concentrate on my breathing because suddenly everything in front of my eyes looked gray. I was resting the back of my head on the wall and daydreaming about something that seemed really important when I heard the doctor making a fuss, so I struggled to open my eyes and that's when I noticed my cheek was touching something cold. Somehow I'd ended up on the floor. The ridge over my right eye seemed to absorb most of the impact, and I'd managed to knock over a bucket on my way down.

A nice man named Martine came in and helped me up. He deposited me in the staff room, where I waited, bright pink from embarrassment, until the doctors were finished. I told them I was going home to eat something but I'd come back again the next day.

UPDATE: The following day I had to work pretty hard to convince Dr. Kikule and his colleagues that I was not a hazard in the OR. Eventually he agreed to let me observe his day of surgeries, but not before I was subjected to a half-hour of taunting in French by the circle of doctors that congregates in the hall after the morning staff meeting. I was a little nervous, but I'd eaten a big breakfast and was determined to regain a little respect from the staff members, so I watched another C-section. This time there were no problems. Not even a twinge of light-headedness.

Dr. Kikule cast me nervous glances every ten minutes or so, but when he saw I was going to make it he joked with me that the new baby boy was a mzungu baby because he was so white, and then he let me help a nurse wheel the patient back to the maternity ward.

His next surgery was much more gory - a woman had a complication from a C-section performed a week ago and she developed an instenstinal perforation. Stool leaking from the perforation had infected the site of the C-section, and Dr. Kikule had to repair the perforation, surgically remove the tissue infected by stool, clean everything, install a surgical drain to catch the extra blood, and sew everything back up. Again, I was OK, but the doctor I had fainted on yesterday developed hypoglycemia and had to lay down while the nurse took his place assisting Dr. Kikule! Afterwards he made sure to differentiate between his hypoglycemia, a medical condition, and my simple fear of blood (even though I was fine once I'd had a good breakfast), but I felt pretty vindicated.


As for the patient, it was a rough surgery but I'm hopeful that Dr. Kikule got the infection out. I can't imagine being awake for something like that, but that woman, as frail as she looked, was tough as nails. I'll be sneaking to the surgical ward to check up on her next week.