My First C-Section

I did my first cesarean section today. The girl was already dead, as was her child. I say girl because she was young, just 21 years old. The story we heard at the hospital was that her mother was constantly berating her, unmarried and pregnant. So this morning, she poisoned herself. Her mother found her, at that point still alive but unconscious. She rushed her to the health center, but it was too late. The girl didn’t make it.
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Just a few days ago, a doctor I am working with here in Rwanda mentioned that I might be able to scrub in on a c-section at some point this summer. Interested as I am in maternal and child health, I couldn’t think of any surgery I would rather see. Though I got to assist with a number of births during my time as a Peace Corps Volunteer in Mali, I have never seen a c-section. Nor have I seen any major surgery, for that matter. In medical school, we don’t start clinical rotations until our third year, and I have only just finished my first. I spent the past year in lecture and lab, not in the hospital. Thinking about the possibility of scrubbing in on a surgery, I could barely contain my excitement.
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The moment is not what I imagined, however. Not that I spent all that much time imagining what my first c-section would be like, but I always assumed the mother would be alive. Instead, my patient is dead. I ask about the baby, and it too is dead. A double suicide.

As we walk towards the hospital, Dr. Claude, the Rwandan physician called to perform the cesarean, tells me I will do the procedure. I assume he is joking. It only dawns on me that he is not when we are all dressed in our scrubs and he places the special surgeon’s gloves in front of me to put on.

I slip my hands into the gloves, and a wave of panic swells inside of me. I try to breathe in and out slowly to calm my anxiety, and make sure to keep my knees bent to avoid fainting. When I imagined my first surgery, I pictured myself standing unobtrusively in the background as the surgeons did the cutting. At most, I thought I would pass a scalpel, not wield one myself.

The weight of the moment feels overwhelming. It is nothing like anatomy lab, where our patients were old, long dead, and had willingly donated their bodies for the learning of students. Looking at this girl lying there on the stretcher, her body covered but for her protruding belly, I don’t know if I can do it. I don’t know if I can actually take a scalpel to her body and cut into her so recently alive flesh.

I hesitate. “Dr. Claude, you know I’ve never done this before?”

He looks at me and smiles. Of course he knows. The cesarean is post-mortem, so I cannot make a mistake, he reassures me. All I can do is learn.

Before I begin, though, I ask to know her name. I don’t want to see her just as a body, but as a person who once had hopes and dreams like any of us. Someone quickly fetches her chart. Anne-Marie. I repeat the name to myself. Who was she? I wonder. How did her life end this way? What loneliness and desperation did she feel? Standing over her body with my scalpel, the whole experience feels so unbearably sad.

I make the first cut. Adrenaline courses through me, and everything feels surreal. Deeper and deeper I go, as Dr. Claude points out each layer of flesh. After the skin comes the subcutaneous tissue. Then the rectus sheath and the abdominal muscles. Finally, the uterus. Anatomy that I couldn’t keep straight just the other day, but I know I won’t forget it now.

As my scalpel pierces the placenta, the amniotic fluid begins streaming out. Anne-Marie’s belly now laid open, Dr. Claude instructs me to remove the baby. I stick my hand in, but I am too dainty, somehow afraid that I might injure something. Neither mother nor child can feel any pain now, however. Dr. Claude shows me how to take hold of the baby properly, and I try again. As my hand slides over its face, I realize that the baby is nearly full-term. Anne-Marie’s belly seemed so small, I expected the baby to be tiny. Somehow, knowing that the baby is big enough to have survived makes the whole thing feel even more heartbreaking.

After I clamp and cut the umbilical cord, Dr. Claude places the baby in a cardboard box on the floor. “It’s just so sad,” I keep repeating, and the doctors nod. There is no time for mourning, however, as Dr. Claude turns back to sew up Anne-Marie’s belly. He patiently shows me how to do the first suture, and then I am on my own for the rest. When I finally finish, I take a step back to breathe. I can sense Dr. Claude packing up behind me, and I am left with the realization that it is over. We have done our piece, and now the relatives will come to claim the bodies. I peel back the cloth covering Anne-Marie’s face to look at her one last time. Alla munna-en, a Fulbe benediction from Mali. God waits for us all. Turning to walk out, I hope that whatever her soul’s fate, it is now free.