Then I began to probe further, delving into the psychosocial factors. “What do you think is causing this pain?” I asked.
“Well, it might have something to do with the stress that I’ve been under lately,” he said. I encouraged him to continue.
“It’s my wife, Doctor. She’s causing me a lot of stress.”
“Tell me more about what’s going on between you and your wife. How is she causing you stress?”
“Well, she’s always complaining about money. She says there’s never enough. What can I do? I’m trying my best,” he said.
I nodded and immediately his posture relaxed. He sat back in his chair and smiled for the first time. The relief was evident on his face. “I’m glad someone is finally listening to me,” he said.
I was thrilled and proud of myself. I’d made a breakthrough with this man by taking his complaint seriously and probing deeply enough to uncover the real cause of his complaint. Too often he’d been dismissed with the assurance that there was nothing wrong with his heart.
I still needed to examine him, even though the history pointed to family stressors as the primary factor contributing to his symptoms. He continued to smile as he took his shirt off and lay on the examination table.
I was still a novice at examining patients so I started from scratch, beginning first with a general examination before concentrating my focus on his chest and cardiovascular system. I was slow and methodical.
“Do you have a husband?” he asked suddenly.
I was startled; I hesitated for a few seconds but then dismissed the question as mere small talk.
“No,” I said and I continued my examination.
“You’re a beautiful woman,” he said. He looked straight at me. My hands were flat on his naked chest.
I may have been a novice doctor but I was a seasoned woman. I knew a chat-up when I heard one. I said nothing, and continued the rest of the examination in silence. His mouth was curved in a smug grin throughout, and I felt that the therapeutic partnership I had tried so hard to establish had left me very exposed.
Initially I was upset and confused. I didn’t know if I’d acted correctly, what recourse I had in that kind of situation. Should I have stopped, refused to continue the examination? Or perhaps I should have reported him to the doctor in charge?
By the time I got back to medical school, however, I had rallied my internal resources enough to view the incident as a learning opportunity. I wrote an essay on it in which I discussed the complexities of the evolving doctor-patient relationship and the challenges that women faced in what was previously a male-dominated profession. I wasn’t going to be beaten by this man who couldn’t see beyond my gender. In many ways this single-mindedness served me well. I was a fighter, and I used this trait to push my way through.
Though I was defiant the lesson of that incident stuck in my mind. I realised that as educated and accomplished as I was, in some patients’ eyes I was still just a woman with a petite frame and a friendly smile. Getting too close to them could land me in trouble.
In fourth year I also learned the value of a healthy sense of humour. As I would later appreciate, sometimes laughter was the saving grace that helped to diffuse the pressure of the environment in which I worked.
I was introduced to the field of obstetrics in the second half of the year. I’d been looking forward to the eight-week block as I would now take on the responsibility of delivering babies.
At the start of the rotation we were each given a blue book in which to record the various procedures that we were required to perform or observe. There were fifteen standard deliveries that we had to manage; in addition we had to observe complex procedures such as forceps deliveries, episiotomies and Caesarean sections.
Unfortunately I began my rotation at Mowbray Maternity Hospital, a secondary-level maternity hospital in the southern suburbs of Cape Town. Women who came to Mowbray were referred there from the clinics with complications such as prolonged labour or gestational hypertension. Many of the deliveries required intervention by an experienced doctor, and there was little opportunity for the students to manage their own deliveries. As a result, by the fourth week I was running behind on my procedures, while I knew that my colleagues at the clinics had already filled their delivery quotas. I was extremely competitive in those days and when my turn came to go to the clinics, I went in like a dog after a bone.
I was posted at the midwife obstetric unit in the Cape Flats township of Mitchells Plain. As the name implies MOUs were obstetric units run almost entirely by midwives. They were primary health care facilities, often physically located on the grounds of a local clinic. Here women with uncomplicated pregnancies gave birth naturally with little medical intervention, but with the added advantage of having trained personnel on hand in case of difficulties. There were usually no problems; women would arrive in labour, give birth, nurse their babies and then go home.
I went into that first day at the MOU determined, but I needn’t have worried. Babies were just dropping out, some quite literally. I had a field day in the delivery room. In many ways I wasn’t really doing anything. I was reminded that in days gone by women would go off on their own to give birth, that their bodies knew what to do. What modern medicine was doing was improving the chances of survival for both mother and baby.
The midwives were skilful and efficient, and their guidance was invaluable to my learning. I clocked up many deliveries and at some point I was elated when I realised that I’d have more than enough for my blue book.
I’d been working non-stop when a woman arrived in the late afternoon. She had been in labour for a number of hours, but her labour pains weren’t the only discomfort troubling her. She had taken a laxative some time before, and the active ingredient was starting to work.
For the uninitiated, it is important to understand that the sensation a woman feels when she is in the final “pushing” stages of labour is similar to the sensation of needing to defecate. We would use this fact to our advantage to coach inexperienced mothers through the labour. “Push like you want to poo-poo,” was the mantra, and once they got over the embarrassment of what we were asking them to do, they settled into the process and pushed their babies out.
Sometimes women took laxatives in the early stages of labour to clear their bowels in preparation for pushing. Timing was key, of course, as it was important that the laxative had completed its work before the pushing phase began.
The woman who came into the MOU that afternoon hadn’t managed the timing correctly. She was now in full labour and the laxative was just kicking into action. As she started to push she did what her body naturally demanded in order to push her baby out, in the process also evacuating what seemed like the entire contents of her alimentary canal onto the bed in front of us.
The midwife and I stood at the busy end of the bed in silence, heads down, doing what needed to be done. The woman was oblivious to anything except her own pain; I concentrated my focus on the baby orifice while the midwife worked double time to clear away the semi-solid faeces that were emanating from her rear. Sheet after sheet of incontinence dressing was changed as she continued to push.
I was relieved when her bowels were finally empty and we could concentrate our energy on helping her to give birth to her baby. My relief was short lived, though; when the next contraction came it was accompanied by an almighty explosion of wind from her anus.
“Sorry,” she chimed.
I glanced up at her face and she looked genuinely embarrassed. I burst out laughing; here this woman was, having just emptied her bowel in front of us without so much as an acknowledgement, and now she was apologising for a fart! Tears streamed down my face as we worked, and I was aware that given