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Training on the job

My mobile rings. It is switchboard. “Could you go to theatre doctor urgently!”

Offering quick apologies to the patient I had been repeatedly stabbing with a spinal needle I drop everything and sprint to theatre. Ok – brisk walk. It is hot. We have had a couple of near misses in theatre recently – “urgent” and “theatre” in the same sentence should be taken seriously.

I bang through the door to the male changing room and pull on the green trousers (much too small), top (voluminous, of the order of Queen Victoria’s nightie) and surgical wellies. I barge through into theatre. Sister instantly sends me out to get a cap – always forget that. I am reassured – it cannot be that urgent.

Inside theatre things are calm. A naked pregnant teenager is sitting on the operating table looking tearful. It turns out that she has become a little hysterical and is refusing to let anyone give a spinal anaesthetic. They have tried light sedation but she is determined and flails around enthusiastically at the slightest suggestion of an approaching needle. They obstetric team (i.e. my friend Marieke) wonder if I would like to try.

After another abortive attempt we have a impromptu team chat. The Caesarian has to be done – the baby is showing signs of distress – but the mother will not cooperate. We decide to give her a general anaesthetic. We have a new anaesthetic machine, a new ventilator, and the anaesthetist – me – has an entire weeks training. What more do you need?

I pull up all the drugs, question all the theatre nurses until I find one who once actually helped at a general anaesthetic before, get the equipment set up, check the machine and we are ready to go. There is something of a knot in my belly as I sedate the girl. But the tracheal tube passes easily and we quickly hook her up to the ventilator. Things go swimmingly. I feel, it has to be said, as pleased as punch. I look around to see if anyone noticed how clever I was. No one did.

The obstetric team (i.e. my friend Marieke) crack on with the Caesarian and I settle down to fiddling importantly with buttons and writing down blood pressures. Pity I didn’t bring a crossword.

Then, just as I am turning a dial particularly skilfully, there is an ominous electrical sounding clunk and all the lights go out. The hospital has been experiencing regular power cuts over the last few days. Maintenance says it is Eskom's fault (the delivery company) - they say it is not. It is, thankfully, midday so viewing is not a problem. The ventilator can run itself for an hour and the operation will be over before that – the baby is about to be delivered. The obstetric team looks up.

“There is no suction!” We need suction to clear the baby’s airway on delivery and remove any blood oozing from the uterus. The nurses leap into action and whip out a foot pump powered suction device. They switch the pipes from the electrical to foot powered device and hand it expectantly to me.

It is not, it turns out, a particularly efficient device. I watch as my energetic foot movements drag a few mLs of blood down the tube inch by inch. I double my efforts. The Lord is good – there is minimal bleeding and the baby cries almost immediately. I do not like to entertain the thoughts of what might have happened in a different scenario. The power comes on once again as the obstetric team (i.e. my friend Marieke) is closing up.

I wander back to once again stab innocent sick people in the back. I wonder if there would be a market for a bicycle powered theatre lights system for use in the event of back-up generator failure. If nothing else it might help reduce the impressive BMI of the nursing staff, and the cardiovascular risk factors of the doctors.

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