A Negative Positive
Everyone in an operating room has a role. There is no place for bystanders. The bright lights, the cool air, the beeping machines and the familiar feel of sterility. A porter, wheels in the patient just upto the door of the OR — in order not to contaminate holy ground. In quick succession, the scrub nurse arranges surgical instruments according to the steps of the procedure to be carried out. The anaesthetist and his team, test the machines to ensure they are working at optimum level. He counterchecks his drugs and their dosages. Then there is the surgeon, who stands steady, ready to explore, resect and realign tissues as close as possible to their original form. It’s exhilarating; if you are an adrenaline junkie like I am. Only this time, I wasn’t the surgeon. I was the patient.
Two weeks prior to this, I was the perfect picture of health; busy attending to patients, oblivious to the changes in my body. I therefore did not realise that my period was late — and when it finally appeared — it was unusually light. I bumped into my colleague in the hospital corridors and she took one look at me and told me; “you look pale.” I chuckled. Who could assess pallor by just glancing at someone’s face? I didn’t give it a second thought.
A week after that, I developed an unusual sense of apathy to everything. I did not feel like waking up or going to work. I spent my entire time at work eating digestive biscuits in between attending to patients. I felt an urgent need to chew on something — anything. In retrospect, I think it was because of this incessant metallic taste in my mouth.
On one such day, the kind where I didn’t feel like working, I sneaked out before the end of my shift. ( Yes we are human; we do that sometimes). I worked in a busy satellite clinic in the central business district so I figured I would pass by the ATM then head on home. As I walked downstairs from the clinic, I had this general feeling of unease; like something was not right with the universe. I shook it off. Dismissed it as the guilt for leaving work earlier than I should have.
I got to the ATM booth. Good. It was empty. As I punched in my pin, I felt my hand tremble. What was that last digit again, I thought. I looked at the screen and I thought I saw a rainbow. Was this a hallucination? I shook my head, as if to rearrange the small branches of nerves inside but it only got worse. I stepped outside the booth conflicted. Going back to the clinic to get checked was not an option. Not after I had dodged bullets and landmines and escaped unnoticed. But something was obviously wrong with me. Suddenly my head was pounding, my heart was beating in my ear and I had this urge to throw up.
That intense nausea, is what had me sitting on a pavement, in the middle of downtown Nairobi, counting my cycle days. It dawned on me, I had been bleeding for an unusually long time — ten days to be exact. There were many possibilities to explain this but the one that knocked the wind from my sails was a probable pregnancy. I immediately thought of — my mother.
My mum — God rest her soul — was the kind you told things like: “I have gotten saved, I got an A in Chemistry, I preached a sermon.” Anything but, “I am pregnant.” I pictured her kaleidoscope of belts. They varied according to the kind of pain she would inflict. Yes, she was as strong as a bull and wouldn’t hesitate to beat the devil out of me if I gave her such news. ‘I can’t be.’ I concluded. Even so, the doubt was heavy enough to get me up from my pavement, across the road to an imaging center.
It wasn’t far from where I worked but the short walk had me in painful stitches. I had this dull ache in my right lower back. I went through the preliminaries of registration and found a good friend posted in the ultrasound room. We were busy chatting about work and the weather as she moved her probe around my abdomen. After a while I noticed she wasn’t talking much. She kept her gaze smack on the screen. She kept asking, “ Where did you say the pain was again?” And I pointed obediently still oblivious. After what seemed like a year, she turned to me and said, “ Do you have someone you can call?”
Those words. When we medics say them, we mean, whatever is coming, is bad — very bad. We throw those words at patients oh so casually not knowing that it’s a preamble for horror. Now being on the receiving end, I was terrified and in disdain. My face became unbearably hot as my anxiety levels shot through the roof. “Just hit me with it Doc. What is it?”
“Well, first of all don’t panic.”
Is this what the handbook of breaking bad news said? I must have missed it. She was killing me with suspense. I had the mind to turn the screen and look this “bad news” in the eye and say, whaat! But trust me, my level of expertise at that time was barely enough to interpret an ultrasound. I would be lucky to even spot my name on that screen. She could tell I was exasperated, so she placed her hand on mine and said, “ You know we radiologists ideally should not discuss diagnoses with the patient. But since you are my friend and colleague, I guess I could tell you; you have an ectopic pregnancy.”
I swallowed hard — and thought of my mother again. Now I definitely had to call someone. My then fiancé, now husband. (Yes ladies, if your fiancé knocks you up with an ectopic, it’s a free pass to the altar.) I didn’t go through the nuances of breaking bad news with him. There was no time for the ‘cat is on the roof’ story. I simply told him, “Yo, I have an ectopic. I think you might want to come to the clinic.” Oh man, the clinic. I left, an escapee doctor, now I was going back with an ectopic!
My colleague — the radiologist — didn’t want me to leave on foot. She said the ectopic was huge and slow leaking. “Why wasn’t I having distinct symptoms?” I thought. She felt that if I walked back it would rupture and I would gain express entry to the next room. You know; the one where people don’t come back from. So I sat there and waited for the husband.
The husband is never in a hurry. Ever. I think his panic receptors were fried the day he drove from nairobi to naivasha — a distance of a hundred kilometres — in thirty minutes. Yes. In his former life, he owned a subaru. He now has two daughters. He sold it. Anyway I digress. So he sauntered into the reception of the imaging center and looked every bit as calm as Donald Trump on election Day. In his calm voice he said, “So an ectopic ey?” No, the flu. I thought.
He took me back to the clinic to go through the process of admission and book an OR. It is during that process that the realisation hit me that I was harbouring an explosive in my right fallopian tube. The staff at the clinic were very efficient. They recognised the urgency of the matter and in no time, everything was set and we were on our way to the main hospital. While in the car, the husband asked, “So who do we call?” There was that question again.
“Let’s call my sister. She will handle the burden of telling mom, should anything happen.”
“Nothing is going to happen.”
I believed him. Why else was he so calm?
We arrived pretty soon; went through the usual admission preliminaries and went to the ward to settle in. The surgeon was already there, waiting to examine me before the operation. After he was done, the porter came by ready to wheel me to the OR.
We made our way through the quiet corridors and white washed walls, and soon enough we were at the theatre doors. Suddenly, I started to feel different. I know there are people who say, “I felt something when I conceived and I just knew.” I usually roll my eyes at such proclamations but at that moment, I just knew. I knew that the scale had tipped over. I felt a sharp pain in my lower right abdomen and I turned over , groaned and threw up. The surgeon turned to me. “ You are sweating.”
Was I? because I was cold. That rainbow appeared again in my field of vision; but it didn’t have the usual 8 colours, it had one. Black. I think I was going to pass out. I was pretty sure the ectopic had ruptured.” I can’t die.” I panicked.
“Let’s get started, we don’t want her to go into shock,” I heard the surgeon say.
Bright lights, cold air, beeping machines and the familiar smell of sterility.
I looked up to see a huge face mask coming towards me.”Please count from ten.” Out.
*******************************************************************
An ectopic pregnancy occurs when a developing embryo implants at a site other than the uterus. Symptoms of ectopic pregnancy, when they occur, appear early in pregnancy, sometimes before the woman realizes she is pregnant.
These include: Abdominal pain, a missed menstrual period, vaginal bleeding, which may be minimal and symptoms of pregnancy (such as breast tenderness, or nausea)
Some women have no symptoms until the fallopian tube ruptures. With rupture of the tube, the woman may experience severe pain, vaginal bleeding, lightheadedness or dizziness, followed by a drop in blood pressure, fainting, and shock.
Causes of an ectopic pregnancy include:
- Abnormalities of the fallopian tubes
- Previous ectopic pregnancy
- Pelvic infections
- In vitro fertilization (IVF)
- Intrauterine contraceptive devices — Women who use an intrauterine contraceptive device (IUD) are less likely to have an ectopic pregnancy because the IUD is effective at preventing all types of pregnancy. However, if a pregnancy occurs in a woman using an IUD, there is a high risk that it will be an ectopic pregnancy.
