Obtuse : slow to learn or understand; lacking intellectual acuity.
Obtuse : of a leaf shape; rounded at the apex.
Bizarrely this term that popped into my head as I wrote the title was not what I thought it meant ... but it is profoundly more relevant to this posting than I could have imagined.
Last time I mentioned being a medical student attached to a "labour ward". Simply that term conjures a palpable sense of dread ... the reality reinforced a headiness to the point where it was intoxicating. It was mostly the smell. Only those who have been there before can understand the all-pervasiveness of that smell. There is no other place in the world that it can be found.
My role? I never really knew. The midwives were the gods of the ward. The three cubic metres around the exposed vulva of the woman (who somehow, despite being slung between stirrups, melded with the elevated delivery bed) was sacrosanct. Midwives and midwifery students ruled the domain with iron hand and stainless steel blade.
I was rostered to the labour ward to learn, to observe, to assist in the delivery ... in the two weeks of the shifts I shared with two other medical students I was present at the actual delivery of two women. Now, that was not because only two women delivered their babes in that two-week period. Far from it. Many women served their time in that labour ward while I was supposed to be there.
However, the midwives who considered their own training more valuable than our own (and why not, we did not rate in their eyes) conspired for us to never be around at the time of the delivery.
Now it was not that I wasn't present during the labour of many women. I was. I attended to as many of the labouring woman's needs as was socially acceptable. Helped change bedding, empty pans, comfort, hold hands. I don't remember a woman's partner ever being present ... maybe they were once or twice, but in an unnoticeable fashion. I do remember that partners who wanted to be present were discouraged from being so. With the same aplomb that the midwives diverted the attention of the labouring woman's partner, they crafted the absence of the medical student for the point of delivery. Not because it was socially unacceptable, but to ensure the ability of the midwifery student to perform the actual delivery.
Oh, it was not like I was ever not called to attend when I was encouraged to be absent from the ward to eat, or drink, or attend to the necessary personal ablutions, but it was always timed so I would arrive too late.
They always did that in this place of excellence ... and it was not just medical students treated this way, it was also the O&G Fellows who were attempting to become competent GP obstetricians. They too were "left out of the loop". A lifetime later when I did my own fellowship job (in another place more respectful of the needs of trainees) I completed my six-month logbook with over 120 deliveries performed. My colleagues who were blessed with an attachment to this very labour ward of which we now speak, struggled to get their minimum of 40 deliveries performed.
So what if I arrived late? ... well true. I was a medical student and should feel privileged just to breath the air of the labour ward. After the delivery ... it was here and now was where I appeared to be valued. It was here I could imagine a sense of personal worth.
I did the stitching. Stitching? Yep ... for the benefit of the training of the midwives (no one could ever convince me that it was for the safety of the woman delivering) every woman shackled to that delivery bed had an episiotomy. Everyone. So once the midwifery students had enough of the laboured, and now exhausted woman, I was called in to repair the damage.
Was I ever supervised as a student repairing this most precious of a woman's anatomy? "See one, do one" was the adage. So yes, my first time was observing the registrar repairing the gaping wound caused by the midwives' steel, my second time was my own with the registrar looking over my shoulder ... the rest was me, myself and I ... and this woman, placidly laying there legs still in stirrups with me sitting there (anonymously gloved, masked and gowned) in the sacred place vacated by the gods.
Did I feel like a god? No. I did feel privileged though. And terrified. The result of my handiwork was going to be a permanent reminder of that day for each of the women who I attended. Well, just a part of them repaired. I wondered if those women ever recovered from the experience of being in that place. At that time, I did not know that the profound physiological changes that occur in labour seem to have an amnestic effect. I soon learned that most women didn't remember much at all.
I thought that a beautiful (any woman who is pregnant and happy that they are pregnant, glow and are the epitome of the most beautiful creature in God's creation) .... I thought that a beautiful woman's genitals were supposed to be attractive somehow. The freshly bloodied wound, the swollen, bruised labia ... and that smell of fresh liquor ... I wished I too had the brain chemistry of that woman who exposed all to me. In retrospect, I could not have done a good job suturing an episiotomy as a student. I learned in another place and time, from a revered and respected consultant, how to do this task well. And as a doctor, I did do that task well when occasionally required. I still hope that those women I attended while I was a student were not left deformed by my hand.
I also discovered in this place that when a young woman signed a consent for a pregnancy termination, nowhere on that consent form was it written that she was giving permission for 6 medical students to perform a vaginal examination while she was anaesthetised. I know we had to learn. Somehow this just didn't seem right or proper to me.
This same place I also learned the feeling of professional impotence. In the emergency department late one night a young woman was brought in by "friends" and dumped at the front door. She appeared to be having a fit, but was fully conscious and her eyes screamed terror. While the nurse and ED doctor assessed and worked on the patient I observed. This young woman's eyes pierced my own ... and I did not know what to do. I was standing, in my white coat, at the side of the ED trolley she had been placed on, she looked at me as if begging me to do something unable to speak, body contorted in pain, eyes more afraid than I had ever seen before nor seen since. I did not know what to do. The doctor gave the woman an intravenous anti-dote to the overdose that she had taken and the seizure left her body and the fear left her eyes. I stood by watching, relieved this woman was no longer in such pain ... but she and I were both drained. The fear I shared with that woman that day was mine alone ... if only I had held her hand, it may have helped us both.
That same year, in that same place of excellence, I sat with my mother holding her hand as yet another of the gods explained to her and our family my mother's diagnosis of cancer of the cervix.
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