Witnessing a C-section in a rural hospital

A U3 BSc student at McGill shares his summer experience shadowing Dr. K

Eleven thousand kilometres from home, I am about to witness my first major surgery. I am standing in the operating room of the KV Hospital in Himachal Pradesh, India, and around me preparations are taking place for an emergency Caesarian section. The senior gynecologist, Doctor K., is to perform today’s operation. A bespectacled, middle-aged man with a slight stoop, Doctor K. looks very much like a doctor. His manner is imposing and his temper short – he is a man with whom it would be unwise to argue. A person of authority, his very entrance into the operating room compels the people within it into silence and brings all preparations to a momentary halt.

Today’s patient is a young woman aged about twenty. She is visibly anxious: her dark eyes saccade from nurse to nurse, doctor to doctor. She is clearly seeking reassurance, but the ambience in the room is severe; there is no place for soft talk and comforting words. Two nurses, their faces implacable, transfer her onto the operating table, while another connects her to the cardiac monitor. The little grey box immediately begins to play out the tempo of her pulse at a rate of 115 beats per minute. Beep, beep, beep. “Good,” says Doctor K., glancing at the monitor. He orders his patient to sit up. She complies slowly. He then rolls up her shirt and administers an injection of clear liquid into her lower back. Startled, she jumps forward as the needle penetrates her skin. She begins to whimper, which prompts Doctor K. to curtly insist that everything is under control. “There is no need for anxiety,” he says. This belated remark serves only to heighten her sense of panic. “I’m losing sensation in my legs,” she cries out, to which Doctor K. replies, “It’s normal.”

A nurse rolls up the patient’s shirt to reveal her dilated abdomen, while another lowers the patient’s trousers. Doctor K. covers the patient in green sheets, leaving only her abdomen exposed. He then opens a set of freshly autoclaved surgical instruments. A nurse turns on a portable radio, and a Bollywood soundtrack immediately fills the room. It is the kind of music fit for a dance party. Doctor K., his head bobbing to the beat of the tune, picks up a scalpel. A nurse applies betadine, a topical antiseptic, to the patient’s abdomen. “Ready, Doctor,” says the nurse. Doctor K. nods, lowers his scalpel to the patient’s skin, and gets to work.

The surgery is nothing like the YouTube videos I’ve seen of delicate tumor extractions or meticulous rib reconstructions. I’ve always assumed, given the high stakes of this profession, that surgery requires a certain degree of patience and precision. After all, a scalpel wielded even a little carelessly can destroy a tissue, an organ, or worse, a life. Careful attention to detail and a slow, methodical approach must be important, right? I would like to think so, but witnessing this Caesarian section convinces me otherwise. Watching Doctor K. cutting into his patient is like witnessing an overly eager schoolboy tearing away the wrappings on a gift box to discover what prize lies hidden within. Doctor K. slashes through skin and tissue, muscle and fat, with an energy that leaves bystanders worried for the patient’s safety. I try to imagine what this young woman must be thinking as she watches Doctor K. cutting madly into her uterus, huffing and puffing as if racing to a finish line. In just two minutes, all of my naïve preconceptions about surgery have been blasted apart with a force that could register on the Richter scale.

With his gloved fingers now uniformly bloody and his green sleeves stained past the wrists to a shade of brown, Doctor K. continues to slash his way towards the unborn baby. It’s almost as though he’s on a mission to beat his personal best record for the fastest successful Caesarian section completed. He has now reached the uterus, and seems to be on track to reaching that goal. “Pressure, pressure!” he shouts to the nurses. The nurses spring into action. Each of them begins to push against the patient’s abdomen from different sides, applying a force large enough to merit considerable worry. The patient has long since closed her eyes in terror. Her cardiac monitor keeps time with the 140 beats per minute unce, unce, unce of the Bollywood dance track. “Push, push, push!” Doctor K. encourages. Suddenly there is a gurgle and a splash, followed by a volcanic burst of amniotic fluid. Even though I’m standing three feet away from the operating table, I still have to jerk my head to avoid getting hit by a few drops. “Release pressure!” Three sets of hands withdraw quickly. Doctor K. then extends a single hand into the patient’s uterus and pulls out a crumpled blue and gray baby. “A boy!” he shouts before depositing the newborn into a metal dish, as if he were handling a lab specimen. Both the mother and child begin to cry simultaneously.

Doctor K. turns to me and smiles. “I hope my urgency did not startle you,” he says in Hindi. “Oh, oh…” I stammer. “No, of course not.” How can I tell him that he has, in a mere ten minutes, so convincingly demonstrated to me that surgery is no more sophisticated, no more refined, than brainless butchering? The only thing separating the two is the instrument used to inflict the violence. Such is my conviction until we begin nearing the end of the operation. Slowly, Doctor K. begins to create order out of chaos, neatness out of untidiness. Tissues are sealed, flaps shut. Finally the skin is closed, and the result hides all evidence of brutality. So skillfully is the wound repaired, that the only evidence of its existence is a thin, eight-inch long red cut, entirely innocuous, held together at inch-wide intervals by sutures. That which had begun so violently had finished so gracefully – only an artist, and not a butcher, could accomplish such a feat.