Special OBGYN Experience Makes Indian Medical Student Reflect

In India, the department of Obstetrics and Gynecology is driven largely by women. This medical student shares his very personal reflections based on his intense experiences in a tertiary care center’s labor room.
OBGYN

Two shot of woman talking to her primary care doctor in exam room. Middle aged patient having appointment with female senior physician © Rocketclips, Inc. / shutterstock.com

There are a lot of things I feel I need to improve about my mindset, but I’m still relatively happy with my evolution when I compare it to the memory of my own past. There are often random episodes throughout the day when I suddenly remember my past states of mind or actions I took that those states produced, which leads to a surge of self-annoyance. What irks me about my past self the most is my laziness combined with a penchant for fantasizing. I didn’t work toward anything, but I wanted great things to happen to me. My mind would intermittently vacillate through a sort of delusion that just because of some arguably good things that I had done in the past, “I had set myself on a path to greatness.”

I know why I thought like that. It was all because of my addiction to passive entertainment: fantasy books, anime and superhero TV series. They were all the same. Young men or teenagers would rise through the world and impress everyone all along the way. It was so easy for me to fall into the trap. I was at a stage where most of my happiness wasn’t derived from the events in my own life, but from doing my utmost to identify with these fictional characters. My medical coaching life in 11th and 12th grade was boring; there was nothing to spark some form of excitement or bring out a sense of self-worth. It was bliss to escape into non-existent worlds filled with greatness. I’d imagine myself as the main character of the story and derive my pleasure from that fantasy. And all the while, I would tell myself that my life meant something deeper, that I was meant for something more, even though I wasn’t doing anything to work towards it. Looking back, it all seems utterly pathetic.

I had to force myself to climb out of that downward spiral. I had to remind myself of my goals and create new ones. I remembered my hobbies and passions, and told myself to persevere in those,   the things that actually mattered, as opposed to passive entertainment.

It’s why I now have a problem with inactivity, laziness and preaching without practicing. Words need to be backed up by substance. In fact, what might be better, is a lack of words, and just the actions being noticeable in their own right. Big talk and far-fetched unrelatable opinions about how the world should work that are not accompanied by a genuine interest in a potential better world make me want to instantaneously dismiss such expressions of opinion as a form of conceited self-indulgence.

I’ve noticed that a lot of people, including myself, give opinions of this type. This is probably the reason why I find it annoying when people do it – because I’m able to relate it to my past tendencies. I’ve noticed that this  unprovoked, superfluous opinion-giving tendency in people has now become quite prevalent, especially in my age group. I think that it’s especially  more common in social media addicts, which makes it an issue. To my mind, a social media advocate’s opinion isn’t worthy of notice. Regardless of whether or not it’s genuine — on the assumption that absolute terms of right and wrong exist —  such advocates in most cases probably haven’t thought deeply enough about it themselves, and are just regurgitating a popular trope of modern society.

I don’t like witnessing this phenomenon, but I’m particularly annoyed when girls do it. I know why I feel that way. I don’t really care about most boys. What they say and do isn’t something that affects the public perception of the stereotype surrounding their gender, and hence I don’t care. A common view in India is that boys are smart, and hence what they say will be given the benefit of the doubt in terms of logic, compared to girls. 

However, when a girl quotes some popular social opinion, especially if it’s something I think is dumb, it feels as if it reinforces the stereotype about the mental capabilities of girls. I keep hoping to hear a smart opinion from a girl in a conversation, an opinion that impresses me, something that can leave me in a state of awe and help me dismiss the gender bias stereotype. 

Perhaps this is the way girls seek to compensate for the obvious stereotype, in which case I can sympathize. Girls have probably been hearing anti-feminine comments for a long time from family and society, and defending themselves has become second nature to them. However I don’t think this compensation is healthy, or required. There’s a simple way for people to convince others of their capabilities, in my opinion. It has less to do with words, and more with hard work.

The labor room

That’s where the department of Obstetrics and Gynecology (OBGYN) comes in, what I now view as the gold standard for hardworking women. It’s a surgical branch that females tend to choose. The general perception in India, and I can see why it’s probably true, is that female patients will prefer females to examine their genitals. It is, after all, a logical conclusion to come to.

Because of this, the labor room in our hospital was full of female junior residents, female senior residents, and female nurses. As a result, the hallmark of this section of the hospital is high-pitched screaming. Pregnant mothers intermittently scream in pain, junior residents scream at them to push harder, and senior residents scream at junior residents for making mistakes.

I noticed that it was very easy to begin empathizing with people. This would result in losing the focus on learning, which had been my expectation before coming to the labor room. I felt bad for the mothers in pain, the overworked junior residents, and the dangerous responsibility borne by the senior residents. However, this empathy could become an inhibitory factor for my education, if I let it. If I worried too much about the mother I might feel like giving her privacy during delivery, and not observing the process. If I were to empathize with the residents, I might not be able to ask them to teach me, out of my concern about  increasing their workload. Of course, the solution was to shut such thoughts out. I put on my white coat and boldly strode through the curtains in front of a delivery bed. 

The pregnant woman lay on the bed with her legs wide apart. There were residents, some nursing students, and a few of my friends next to her. I wondered if the mother was feeling embarrassed by the fact that so many people were gazing intently at her genitals, or if she was in too much pain to care. I considered looking up at her face once in a while, perhaps to give her a comforting gaze, but then I felt that the eye contact might serve to further embarrass her.

I remembered the time when our clinical postings had just begun. I had just found out that in the department of obstetrics and gynecology, we would be seeing women naked below the waist. I had wondered if I would involuntarily get aroused as a result. I could recall a senior discussing this very topic with me but commenting that what one saw in porn, was not anywhere close to reality as experienced in the hospital. That was reassuring of course, because the very thought of experiencing involuntary arousal made me feel disgusted with myself. Then I comforted myself by recalling a much nastier question that had been in my mind during my first year of medical college. If a boy saw a naked female cadaver in the dissection hall, would they get aroused, and was the same situation possible for girls upon seeing a naked male cadaver? My dissection experience had taught me that the answer was an absolute no, and I realized the same also holds true in the OBGYN department.

It seemed as if the mother’s delivery was taking slightly longer than usual. The residents were scolding her, saying that she wasn’t putting in enough effort and that the outcome wouldn’t be good for her if she continued holding back. They then pleaded with her to push harder, urging her with so much emotion behind their words I began to wonder if it was genuine.

The duality of rudeness and selflessness

I have a theory. After an extended period of a doctor’s exposure to patient suffering, the phenomenon would become normalized. As a result, perhaps it would then become difficult for a doctor to empathize with a patient. But the residents here sounded so concerned, it was almost as if they were evincing a maternal instinct towards the pregnant mother.

And yet I couldn’t help finding some of the residents’ behavior annoying. There was one — I called her “Cranky” — who seemed to take delight in making us students suffer. She would jump to conclusions about our incompetence and lack of knowledge and threaten to mark us absent when there was nothing that she had to directly gain by doing that. I wondered, did this action reveal that Cranky was a sadist at some level?

In fact, she was supposed to take our class today. She had come to us in the residents’ sleeping room and told us that a delivery was occurring and the first five roll numbers could go and watch it. I had been in the first five roll numbers, but since I had seen deliveries before, I decided to give someone else a chance, so I declined. An instant later I realized my foolishness. If I had agreed to leave, I would have been able to avoid Cranky’s teaching. As if god had heard my prayers, she left the room for a few minutes and came back to inform us that there was another delivery happening so five more students could leave as well. I raced out of the room as fast as I could.

The multigravida strength question

I stood up on my toes and leaned over the resident’s shoulders to get a better look at the woman’s vaginal orifice. I couldn’t see the baby’s head nor any sign of it approaching. I asked my friends and they agreed that they too couldn’t see anything.

I felt slightly annoyed when I realized that this woman was probably in this situation because she wanted to give birth to a boy. However, it was possible that this desire wasn’t even her own and was that of her husband or family members. In this part of India, I had observed that the women of rural families kept giving birth until they got a boy. I remembered the time during a rural posting when a woman who already had three girls had been giving birth yet again in the hopes of finally getting a boy. ‘Sadly’, she ended up with another girl. The woman’s mother-in-law who had been attending to the woman refused to look at or touch the newborn girl, even going as far as to deny providing a clean cloth to cover the baby. 

In a way, if I tried really hard, perhaps I could understand the mentality. In the rural villages, due to the social norms in place, only boys could be earners who might stay with their parents to take care of them. The girls on the other hand ended up getting married and leaving the household where they were brought up. Without a boy, no family could sustain themselves in the future. During the delivery of the rejected female newborn, a lady from our college who had been accompanying us tried to talk to the mother-in-law, saying that girls were of worth too, and pointed out how some of us medical students were females and would later go on to earn a good amount of money. The explanation did not sway the mother-in-law.

There was another mother I remembered, who also had three girls, and had finally managed to give birth to a boy. She had sounded so happy upon telling us that it was a boy that I momentarily felt disgusted. Was her happiness genuine, or was it a result of social conditioning? Or perhaps it was because she had finally got a boy, and now she wouldn’t be forced to go through the ordeal of giving birth again.

These were among many other signs I had seen indicating that women from the villages completely lacked independence. Once in the labor room, I found myself observing a three-way debate between a doctor, a pregnant woman, and one of her elderly female relatives. The mother was in severe pain and the doctor had been suggesting the use of epidural anesthesia. The moment the doctor explained to the pregnant woman what the anesthesia was, the woman turned to her elder and asked her what to do. That left me stunned. Yes, I could perhaps understand if the reason she was asking the elder was that the elder had more knowledge, but in terms of medical sciences, that clearly wasn’t the case. 

What I  concluded was that because the elder had the most authoritative position of those present, it was incumbent on her to make the decision. The woman giving birth probably knew that the decision wouldn’t be hers in the end, and so she instantaneously submitted to the elder’s judgment. What made matters worse was the reaction of the elderly woman, who seemed to be suggesting declining the anesthesia. This was probably based on some unscientific notions and would result in the continuation of the pregnant woman’s pain. It wasn’t a matter of whether or not the decision was right, but the principle that the final decision should have been that of the pregnant woman, taken completely voluntarily and not under familial pressure.

I wondered whether these women wanted to give birth so many times? I had difficulty assuming that the answer might be yes. While I knew that hormonal changes made mothers love their babies unconditionally, I couldn’t help but wonder about it after seeing all the pain they went through. Some of my friends, who were girls, had difficulty watching deliveries. One had said that she felt nauseous, and another that she felt dizzy. The reason was the same though, that they couldn’t imagine themselves in that situation. Or rather, perhaps it was an effect of their trying to imagine themselves in that position some time in the future. I, on the other hand, as a male, literally couldn’t imagine myself in that position, and maybe that made it easier for me to avoid empathizing or reacting to deliveries.

Were pregnancies and the associated deliveries a sign of strength? This doubt led to a concept I began to think of as the multigravida strength question. I had heard people claim that what a mother had to endure during a delivery, and even later as a homemaker, was in no way easy. Sure, that was probably true. But if all this was something that needed to be “endured” and not something to be desired, wouldn’t fighting against this childbearing culture be a sign of greater strength? Why was this conformity equated with strength? Or maybe the fact that the women chose to conform to this painful practice indicated strength? In which case, why would anyone voluntarily choose suffering if there was an alternative? Maybe it does show strength, but then wouldn’t it also indicate a lack of rational decision making?

Emergency action

There was an issue with the current delivery. The residents’ moods had shifted as they appeared to become more frantic. They shouted at the mother-to-be to push harder. The woman screamed, whether in an attempt to push harder or due to the pain of her contractions, I couldn’t tell. But it wasn’t working. One of the junior residents shouted at us to go and fetch Cranky. Wanting to be of some use, I rushed out of the room towards the area where Cranky was teaching. I burst into the room unprofessionally and announced that the others were calling for her.

She shot up and rushed towards the door so quickly that I had to take a few steps back to give her space. By the time I regained my footing, she had disappeared into the labor room, and when I entered it, she had already put on a green apron.

A nurse quickly approached with two vacuums in her hands. I’d read about this in theory, but I couldn’t recall all the indications for a vacuum delivery. I wanted to ask the residents but now didn’t seem like the right time. The woman shrieked as the vacuum was inserted and switched on. My friends and I watched expectantly. By this time, I was beginning to get a little jittery. Out of all the deliveries I had seen, I hadn’t seen one as complicated as this one.

I watched Cranky perform a mixture of hollering and pleading with the pregnant woman and I almost had to remind myself that she was the resident we students disliked. Watching her, I found myself easily being tilted towards forgiving her for her actions towards us, perhaps even all the future torture she would undoubtedly inflict upon us. There was something extremely touching about how she was helping the patient so earnestly. I had trouble imagining that there was some sort of explanation that could bridge her two mentalities. Perhaps she was concerned about the patient because it was her job to get the delivery done. In case of complications, her workload, stress, and liability would increase. Maybe it was her own life situation she was worried about. 

With this thought in my mind, I suddenly felt like common non-medicos, the ones who criticized doctors and spoke as if a doctor’s entire life’s purpose was directed towards patient care and that they should have no desires of their own. I told myself that there was no issue if Cranky was doing this because she was concerned about herself rather than the plight of the woman giving birth. Plus this thought allowed me to accept her sadistic personality more easily, in contrast with that of imagining her to be a self-sacrificing angel.

A lot of residents and professors were simply not good teachers. Sometimes I even doubted if they were good people. But looking at situations like this, where Cranky — someone I didn’t like — was helping someone and did so daily, made me wonder if it mattered. Why should anyone care that she wasn’t a good teacher when she was doing so much good? Perhaps it was all justified.

Cranky announced an emergency c-section, and everyone burst into motion. My friends and I moved away a good distance. During our retreat, no less than three people told us to make space. A nurse ran out to get a wheelchair, and another went to give the order to prepare an operation theater (OT). There was so much orderly chaos that there was no way I could make sense of what everyone was doing.

That was when my friend told me to suit up. Well, what he had actually done was just run out of the labor room, but I understood that he was rushing to put on sterile scrubs. When it came to entering an OT, the most difficult part was finding OT-designated slippers. As usual, there were none on the racks. We entered a resident resting room and miraculously found exactly two pairs of slippers unguarded. We nabbed them, as well as a pair of scrubs, a head cap, and a mask before hurriedly changing into them. We couldn’t have taken more than three minutes in total, but by the time we entered the operation theater, the preparation already seemed complete.

This time I counted, and found that there were twenty people, excluding my friends and myself, all shuffling through the OT and preparing different sets of equipment. The patient was already lying down and anesthetized, since as soon as we entered, we noticed that Cranky was getting ready to make an incision at the lower portion of the patient’s abdominal bulge.

She kept cutting and the skin, fat, and rectus sheath just kept stretching away from the incision due to the tissue tension, almost as if it had understood the severity of the situation and was cooperating. The uterus was exposed and cut. I had studied the procedure the day before and I found myself appreciating each step.

Cranky reached inside the bleeding uterus and pulled out a floppy arm. Then she pulled out the other arm. Next, she began pulling out some part of the baby while applying so much force it seemed as if she was leaning backward and was using her own weight for it. I was afraid that the baby might get dislocated at various joints or that something might burst, but my friend commented that it was probably because the fetus’s head was stuck inside the mother’s pelvis and the body had to be removed first. He must have been right since the torso and lower limbs of the baby suddenly came out, followed by the head. Drops of blood flew into the air and splashed onto Cranky’s mask. I hadn’t checked the time, but the entire sequence of events couldn’t have taken more than two minutes.

I watched the neonatologist take over the baby and place it in a designated area covered with a sterile green cloth. I looked at the baby for any sign of life, but it didn’t seem to be crying or moving at all. In fact, it didn’t even look real. The doll-like and plastic appearance of a newborn baby was still something I was getting used to. It was bluish, with a crumpled scalp with hair. Its face was constricted almost into a grimace, though immobile. The neonatologist suctioned its mouth and at that precise moment moved into a position that blocked my view. But when he moved away, I saw the baby moving its arms, its face further scrunched up in a grimace as it cried silently for a few seconds before a soft sound was audible.

One of my other friends turned towards me in relief. I almost wanted to comment upon her immaturity, as I’ve seen her react openly to something emotional in front of patients multiple times even when we had been advised not to, but this time, I couldn’t find it in myself to do so. I smiled back through my mask, genuinely.

Worthy of respect

So many people had been involved in saving this newborn. I couldn’t help but think that today’s baby would be wise to appreciate this fact when it got older. It had caused so much commotion and for a while altered so many emotions that it even made me like Cranky. The baby had better learn to appreciate this feat.

I watched Cranky place the placenta in a tray before she put her hand inside the uterus to search for any remaining membranes. She was probably feeling relieved at how everything had turned out. But she was also probably exhausted by the effort it had required.

No matter how seemingly rude some of the residents in the OBG department tended to be on other occasions, at this moment they radiated what I liked to think of as true feminism. They were strong, authoritative, knowledgeable, and most of all, extremely hard-working. I think what made me instinctively respect them the most was their ability to cope with stress: to be able to handle all the pressure and keep at it while trying to come out on top. That pursuit of perseverance truly inspired me. This degree of stress was one that people claimed was seldom seen in other medical or surgical departments, except perhaps in emergency medicine. And the fact that this department was run almost entirely by women reassured me.

I like to believe that inherently there are very few differences between women and men and that fundamentally each can live a lifestyle or adopt a personality that they want to set for themselves. While males and females have differences in their physiology, I don’t like the idea that they have organic differences that condition the makeup of their minds. It’s hard for me to assimilate and accept the concept of built-in deficiencies in one gender.

This is why the idea of privilege tends to annoy me. I’m pretty sure I’m quite privileged in terms of financial status, opportunities and lack of social obstacles to the achievement of personal goals. It isn’t an issue for me. So where does that leave me? I’m certainly not an underdog. If I accomplish anything, how much of it will be because of what my parents gave to me as opposed to my own effort? My father would tell me jokingly that everything good about me is because of him, and anything bad is of my own making. I’m scared that it might actually be true. Isn’t my personality, forget social wellbeing, at the base level just a product of my parents?

When I interact with people, my mind is always on autopilot, comparing their characteristics to mine. I want to know who has the upper hand with regard to a variety of factors. But when the thought arises that for some people I need to take into account a cultural or social predisposition for being incapable, it becomes difficult for me to judge them effectively. That’s why I don’t like doing it. Additionally, if I need to consider that some people are inherently predisposed to be bad or incompetent at something, then my being better than them in the same department has no meaning, since it isn’t a true comparison.

That’s why I tend to reject the idea of subjectivity concerning capabilities defined by the developmental environment and gender. If a boy can do something, surely a girl should be able to do it as well. If they aren’t achieving their goal, perhaps it’s because of their lack of trying. If I think a girl isn’t hardworking, then I want to hope that it’s because she hasn’t worked hard rather than because she’s predisposed to be like that. I don’t want to believe that everything is simply preordained. 

It’s these experiences, as with the OBGYN residents, that reassure me that at a base level, everyone, including boys and girls, probably have the same inherent potential and that there’s an interplay between cultural and social factors and hard work that explains the final outcome. And hence, if I achieve something in life, perhaps it’s also due to my hard work and not just an inherent advantage that carried me forward.

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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