Primum non nocere

Primum non nocere means, "First, do no harm" in Latin.

Do you know what is CTG? It is a medium for the fetus (baby in mummy's womb) to communicate with you, doctors! Beside the ability for printing out the fetal heart rates on a graph paper, it also shows maternal's womb contraction and sometimes in some machine, mummy's heart rates also was shown.

I am still a houseman (HO), whatever that I did wrongly, my medical officer (MO) will have to answer in the morbidity and mortality review meeting, or even worst, in the perinatal mortality review meeting.

However, when your MO didn't blame you for your mistakes, that doesn't mean that I am right or I am ok with it. Tears dropped this morning when I was holding the patient's CTG. I need to be more competent and confident. Even though I am sure of something, at least, I have to inform my MOs.

Lesson learnt yesterday. Hopefully the baby is now in NICU, not another place.

手术室里的紧急时刻

当宝宝的头严重的卡在母腹中时，我几乎紧张得难以呼吸，其实对于所有在手术室里的同事们而言，那都是个令我们难以忘怀的午后。

          
           我是那场急性胎儿难产紧急下段剖腹产手术的第一助手。切口已经开了，但是宝宝的头依然严重的卡在母腹中。经过多次的推力尝试，医生始终没有办法找到胎儿的头部。刹那间，我的脑海中浮现了许多的想法：-

如果医生无法找到胎儿的头部怎么办？
如果我们寻求紧急协助，妇产专科医生能否及时赶到?
我今天是否能听到新生儿的哭啼声呢？

          我的心脏因紧张而剧烈的跳动着，因为面对这样的案例我没有太多的经验，我甚至紧张得在那冷冰冰的手术室里流下汗水。通常在剖腹产中，手术室里只会有儿科实习医生，但是今天儿科的 medical officer (MO) 也在手术室里。经过了接近10分钟的持续尝试，医生决定直接为孩子接生(即从拉出腿部接生而并非头部)。感谢主医生找到了胎儿的左脚，随着找出右脚...经过几次的扭转(因为胎儿被脐带缠绕了)，胎儿终于顺利的从母腹拿出。

          我真的好佩服 X 医生的医术，她简直令我目瞪口呆。最重要的是，我很钦佩她在危急之中的镇静。她并没有责骂任何人，只是冷静沉稳并且非常迅速的完成了她的工作。

          胎儿被取出之后并没有哭啼，胎儿被移交至儿科医生。但是，一会儿后我们听见了她的哭啼声，手术室里的所有人都松了一口气。X 医生开心的说:"好了，现在我们可以轻松一些来继续完成接下来的子宫及双侧输卵管结扎手术了。"

手术后，我告诉 X 医生:"我刚刚真的很害怕胎儿没有办法顺利的拿出。"

X 医生:"其实一开始我也非常紧张。" 

我:" 但是你刚才十分冷静啊!" 

X 医生:"如果我不冷静下来，更何况手术室里的其他人呢？" 带着一抹微笑，她便走开了。

那个傍晚，我到 Neonatal Intensive Care Unit (NICU) 看看那历经折腾的新生儿。胎儿的气管已经被插管了。得了meconium aspirated syndrome，在写这篇文章的我，希望现在那宝宝没事了。

The Emergency in Emergency OT

A breath holding moment for me, in fact for all who were in the operating theater (OT) that afternoon, when the baby's head was deeply engaged.

I was the first assistant for the emergency lower segment caesarean section case for acute fetal distress. Incision been made, baby's head was deeply engaged. Multiple attempts for per vaginal push were made but the surgeon still unable to grab and pull put the baby's head. Many things ran across my mind, what if:

-the surgeon failed to grab the baby's head?
-can the specialist make it on time if we call for help?
-can I hear the baby's cry today?

With a very little experience of mine, my heart was thumping with fear. I was sweating in a cool OT room. Most of the time, there was only a pediatric houseman (HO) there but this time around, I saw the pediatric medical officer (MO) was there too. Attempts been made for almost 10 mins and finally, the surgeon made the decision to deliver the baby via breech (means that pulling out the baby's leg first instead of the head). Thank God that the surgeon was able to locate the baby's left leg.... then the right leg. Baby was delivered with multiple twisting, due to the cord rounding the baby's body. I really admire this Dr. X's skills. Incredibly made me speechless. Above all, I saluted her calmness in time of emergency. She didn't scold anyone, she did everything calmly but very fast.

Once the baby was out, she didn't cry, she was handed to the pediatric MO. However, after a while, we heard the crying sound from outside. Everyone sighed in relieve. Then, the surgeon joyfully said, "Now, we can relax a bit and continue with the closing of the uterus and bilateral tubal ligation."

After the operation, I told her, "I was so scared just now if the baby couldn't be delivered."

Dr. X: Initially I was Uhm,,,ah,,err... already.

Me: But you are so calm just now!

Dr.X: If I was not calm, how about the rest of the people in the OT?

(With a smile, she walked away)



That evening, I went to NICU to see the baby. The baby was intubated. The impression was meconium aspirated syndrome. While writing this piece of sharing, I really hope that the baby is now ok.