Saturday, March 20, 2010

Dilatation & Curettage

She sits in her theatre gown next to a stack of gossip magazines. Her fetus is 17 weeks to date ... and 12 weeks to size. It is not small for its age – it has died. Five weeks ago. The lady smiles at me as I bring over the cannulation tray, looks away and grimaces as I insert the needle and thread the cannula into a vein in her hand. Looks down as a drop of blood escapes and drips onto her white hospital-supplied dressing gown, smiles through my apology and tells me not to worry about it.

I wonder how long she’s known. Apparently she’s had no symptoms of miscarriage – no pain, no bleeding. Did she feel any different? Did something happen five weeks ago? I wonder what her story is, but this is not the time or place to ask.

The nurse leads her into theatre, and she calmly greets the team and goes through the paperwork. She succumbs to the anaesthetic easily and without a hitch. I manage her airway, insert the laryngeal mask and ventilate her until her lungs remember what to do. It doesn’t take long.

The Obs & Gynae registrar gets to work on the “D&C” (dilatation and curettage). Immediately when she inserts the speculum, the whole theatre is overcome with the horrible smell. Even the theatre nurses, who are usually immune to bad smells, have to cover their noses. It is not death: it is decay. I am glad to be helping the anaesthetist as we get to stay at the lady’s head – the registrar must grit her teeth and complete the operation. Suction loosens the placenta and begins to dismantle the decayed fetus. The curette drags out tiny body parts – we recognise a foot, a head. The registrar finishes as quickly as she can, tidying up the uterus with more suction. The lady is at high risk of sepsis, so the anaesthetist hurriedly administers IV antibiotics, and they organise a script for her to take home as a precaution.

The operation finishes, anaesthetic is stopped, and she wakes up smoothly with tears in her eyes.

She is still crying when I see her later in Recovery.
Maybe she knew all along, but now it is real.

1 comment:

puddle said...

i found generally O&G to be a happy place with babies and happy mums and dads on the whole. but when its sad, it's real sad.