You're not going to faint, are you?

Back in the fall, I shadowed at a women’s health clinic that provided abortions. The idea was to follow a patient through the whole process—the initial counseling, the paper work, the procedure itself, and then the recovery. As I was about to enter the procedure room, the obstetrician turned to me. “You’re not going to faint, are you?” I didn’t think so, I reassured her. But then lo and behold, barely half way through the eight-minute procedure, I did just that. A nurse had to put me in the recovery room with the patients, and the girl whose abortion I had just witnessed inquired with concern about how I was doing when we both came to. No matter that she was the one who had actually had surgery (and pretty emotional surgery at that)—she was worried about the idiot med student who couldn’t keep it together during her D&C.

Needless to say, I left the clinic feeling pretty dejected and at least a little embarrassed. Is this going to happen every time, I wondered? What if I’ve gotten all the way to med school only to find out that I can’t handle blood? That I can’t handle medicine? The feelings of self-doubt plagued me the whole way home.

As the year progressed, my concerns regarding my fainting tendency faded as I found other things to worry about, such as whether I would pass biochem. But today’s events brought these fears roaring back. The day began with a phone call from Dr. Claude. He had a cesarean section. Would I like to assist? Clearly, I jumped at the chance. This time, the mother was doing fine. The baby was in the breach position, however, which is why the cesarean was necessary.

As Dr. Claude began the procedure, I was engrossed. Just like the other night, he pointed out each layer of tissue as he cut through it. Some layers he sliced through daintily, but at other points, he would make a small incision and the rest we had to pull open with our hands. I felt like we were tearing our patient open, but the technique, called blunt dissection, allows the incision to open along the natural lines of the tissue, making for better healing.

Finally, we got to the delivery. Because he was in breach, the first part of the baby to emerge was his butt. It took less than a minute for Dr. Claude to extricate the rest of him. Happily, our patient now had a healthy baby boy.

Not so happily, however, I start feeling a little dizzy. I try to shake it off. Please, this cannot be happening again, I think to myself. But it is. I’m going to pass out. Trying to keep my composure, I tell Dr. Claude that I’m going to have to sit down. A minute or two pass by, and I start to feel myself losing consciousness. I need to lie down in order not to pass out completely. In a last ditch effort to retain consciousness and avoid a scene, I stumble out of the chair, out of the operating room, and towards a door. As my consciousness dissipates, all I can make out is what appears to be light on the other side of the door, and I’m desperate to get outside where I can breathe. As I escape through the doors, however, I realize that they do not lead outside at all. Rather, I have exited onto a ward of post-op patients. In other words, a delirious muzungu lady, with streaks of blood all over her gloves and scrubs, has just catapulted herself into a room full of recovering patients. Before I have time to realize any of this, however, a hand grabs me and pulls me back out, guiding me to a stretcher onto which I collapse. I only broke onto the post-op ward for a moment, but I can just imagine how it looked to those who saw. If I weren’t so out of it, I would be horrified.

Eventually, however, I start to feel better and Dr. Claude finishes the surgery. But the feelings of self-doubt return. I want to deliver babies, do c-sections, perform abortions. How am I ever going to be able to do any of this if I pass out every time I see a surgery??? Dr. Claude offers some words of comfort, but I am not reassured.

As the day progresses, pretty much everyone hears about what happened. Each time it comes up, I cringe. But slowly, it starts to get better. As it turns out, everyone seems to have a story about passing out in the OR. Our medical interpreter fainted at his first cesarean, and a doctor from the Brigham tells me that she has lots of surgeon and obstetrician friends who did as well. Perhaps more comically (or disturbingly, depending how you look at it), one of the nurses tells me about a kid he went to school with who was handed a severed limb during their first time observing an amputation. Not surprisingly, he, too, got dizzy and passed out.

Though my friends and coworkers do a good job of cheering me up with their stories and assurances that many doctors were once fainters, I can’t help but still feel insecure. It doesn’t help that everyone’s story involves the person in question making it through their second cesarean. What if I don’t? What if I’m that girl who always faints? It’s not a fate that bodes well for the rest of medical school, not to mention life as a physician…

So when Dr. Claude called me again this afternoon with news of yet another cesarean section, it was with no small amount of trepidation that I headed to the OR. I chugged some water on my way there and downed the last of my stash of Goldfish snacks in preparation. “Are you going to faint again?” our medical interpreter teases me. He’s being good-natured, but the question hangs over me like a dark cloud. I don’t know what I’ll do if I faint again.

As we begin the procedure, I try all sorts of strategies to keep from passing out. If I keep my legs moving, I tell myself, I will increase my venous return, which will increase my cardiac output, and I won’t faint. I can thank physiology class for this idea, but I’m pretty sure that the only effect it had was making me look like I desperately had to pee. Other strategies I try include: breathing deeply (not that helpful since the operating room smells of bodily fluids), looking away from the surgical field at strategic moments (the Brigham physician recommended this one, but Dr. Claude catches me and thinks I’m not paying attention), and keeping my knees bent at all times (helpful but looks super awkward and adds to the impression that I’m a five year-old in need of a bathroom).

In the end, however, something must have worked because I didn’t faint. That’s right. I made it through my second cesarean section fully upright and conscious, just like the many fabled doctors cited by my colleagues earlier today. As Dr. Claude placed his final sutures, a sense of euphoria enveloped me. I did it! I’m not the girl who faints anymore! I can be a doctor!

Okay, so maybe one successful cesarean observation does not necessarily mean I’m destined for greatness in the OR, but making it through my second live cesarean section without losing consciousness still feels pretty good. Now I just have to make it through #3…