Happy Mother's Day
10th May,
2020:
[Maa, you have suffered greatly, endured
greatly which cannot be put into words and so I saw the light of the day. Yet,
I am trying to describe that after such a long time and know that it is
reaching out to you wherever you may be this day. Happy Mother’s Day.]
The
Second Sunday of May, fifty years ago, without knowing that this day of the
year would be called ‘Mother’s Day’:
Surprisingly,
I am the sole passenger inside the belly or the fuselage to be more exact, with
neither a crew member nor an air hostess. For that to happen, it would have to
be either my own private jet or a chartered aircraft exclusively for me. Yet,
why is it depriving me of that fascinating sensation which comes from coasting
in the air for the first time? I am unable to peer out into the breath-taking
beauty of the Earth below as darkness surrounds me. A parachute instead of
being harnessed on my torso in the right manner, encapsulates me within its
membrane as in a balloon. Only the back strap of the harness that is stuck to
my seat’s back-rest prevents detachment and falling off. The airplane is flying
smoothly high above the fairy land of powder puff clouds and gliding through
the thin air like a bird. I can feel it. Then suddenly something goes wrong.
Anti-Aircraft gunshots fired from the ground crack into the air. Shrapnel
whizzing past the aircraft explodes, in a manner a meteorite bursts inside-out
before touching the earth. A flying projectile punches a hole on one of its
wings which also is a fuel tank and other rips through an engine located at the
wing’s thicker front edge. The airplane has been shot at by its own territory’s
anti-aircraft gun. A gun that is meant to protect this aircraft from enemy
invaders has misfired on it, taking it for an enemy intruder— a case of
mistaken identity. Fragments of metallic debris are shooting out from the
wrecked Turboprop engine. Fuel is gushing out from the punctured tank. The
airplane while cruising with only one engine and an oil tank on its unaffected
wing is losing altitude fast and in matter of seconds plunges thousands of feet
below to a level of normal air pressure. The pressure inside the cabin, which
was already pressurised for flying at rarefied air at a high altitude, has shot
up to an unbearable level due to clogging of pressure relief and outflow valves
by fine particles of debris. The airplane is now finding it impossible to stay
afloat even till an emergency landing, without jettisoning or throwing out some
amount of excess load— that like ‘the last straw just going to break the
camel’s back’, happens to be me only. With the damaged wing intermittently
fluttering like that of an injured eagle, the whole body of the imbalanced twin
engine airplane then starts shuddering like a washing machine in between brief
spells of stillness. A severe jolt detaches my balloon rupturing the fastener
strap from the back rest. The floating balloon that terrifyingly keeps on
bumping has to be ripped out of the airplane in pieces, or else nosedive into
the ground to end up everything in flames. Neither the airplane survives nor
its sole passenger. The dilemma of ‘either-one-or-none’ baffles ground staff
conferring in the Air Traffic Control. This hellish plight continues for some
more time and then some miracle happens I know nothing about. All of a sudden I
feel a savage push, as if from a huge squeeze on the fuselage resembling a
toothpaste tube. The whole aircraft rocks like a hurricane for an instant. A
door is flung open in front of me and another brutal thrust ejects me out heads
down facing the airplane. As I start falling freely in the air like a skydiver,
the parachute opens. Wind roars around me. It is a bright sunny day with the
sky as clear as crystal glass. From the open sky, I peer out into my new world
down below. It looks wonderful. I peer back to the aircraft for a brief second
to see it speeding away for a safe emergency landing. Miraculously both are
saved. I descend as slowly as a feather dropping freely in air from a soaring
eagle until I softly touchdown to see mom sitting on the sun-lit, lush-green
meadow in her agonising wait for me.
“Maa,
look at me, I have come down to you from the sky by an airplane just as you had
once told me,” I cry out. Teary eyed she gazes at me and instantly forgets all
her torments. Her soul smiles through her eyes that scatter an inexplicable
glow that any analogy howsoever nonsensical, fails to capture. That is the joy
of motherhood. My daydream ceases…
Indeed,
that was a daydream and not a dream. The one-hour morning flight from Calcutta
airport to Guwahati was too short for falling into such long dreams. That was
my first air travel. My first year final exams at IIT-Kgp just being over, I
was on my way to spend the summer vacation where dad was posted then— AF
station situated on the Shillong peak, which is also the headquarters of Eastern
Air Command. A hill station during summer! I felt thankful to dad for going
there on posting during my first year. I would be seeing mom a year after she
cried buckets while seeing me off, as though to a School’s Boarding-House and
not to any 'Hall of Residence' of an ‘Institute of National Importance’. It is
all the same to a mother. And I would be seeing dad after he last saw me off in
the Hall saying— “Remember that you were pronounced dead before you were born,
yet you have come up thus far. So, you have nothing to be afraid of.” These
parting words concluded that incredible birth story he began narrating to me on
way to Kharagpur, leaving me wondering what kept him from telling all these to
me until the panic of the imminent ragging started showing on my face. Perhaps
I would have grown a bit bolder, a little more forward, rather than turning
into a shy, timid and withdrawn PCM buff. Nevertheless, that feature alone saw
an average like me through the IIT-JEE just in time, rather than missing the
bus in an attempt to become all square too early. Five years at IIT or even the
initial years at a job for that matter were there to take care of all that.
Possibly that was more practical for a feeble ‘preemie’ like me.
As
the airplane rose higher and higher in the air, (now that I am in Engineering,)
roads appeared like strips of black tapes and rivers like thick aluminium wires
to my eyes, looking from the aeronautical womb. And with that, mom’s reply— “You
came down to me flying down from the skies in an airplane,” whenever I asked
her, “Where did I come from?” kept on ringing in my ears. My absurd daydream
went on stretching out further and further to cover whatever that could have
occurred in reality. Mom’s evasive answer was good enough for a child to
swallow, but not anymore for a sophomore like me, who out of curiosity, has dug
out enough tips on this issue.
Now I know that the exact medical term for the homophone- ‘Ek-Lamp-Asia’ going into my ears in a configuration that a child could make any sense of, is in fact, ‘Eclampsia’- a dangerous condition of pregnancy, like the dangerous condition my wild daydream got the airplane into.
Pre-Eclampsia
is a complication more common during the last trimester or the last three
months of pregnancy, with symptoms such as build-up of high Blood Pressure—
like the high cabin pressure of the airplane, together with high Proteinuria—
like fragments of wreckage debris gushing out along with the fuel. But unlike
common Hyper-Tension, Eclamptic high BP is caused when the antibody of mother's
own immune system attacks its own placenta, mistaking it for a Pathogen or a
foreign body, an enemy intruder such as virus and bacteria. That is medically
an ‘autoimmune disorder’ or metaphorically ‘a case of mistaken identity’— like
the territory’s defence force’s anti-aircraft gun shooting at its own airplane
which intends to protect against enemy infiltrators. The only known way to cure
preeclampsia is by prompt delivery of the baby prematurely, either through
induction of labour or C-section— like immediate jettisoning that last straw
from the airplane. But when delayed, Pre-Eclampsia can rapidly progress into
full blown Eclampsia where the complications aggravate further, added by
seizures and convulsions or vigorous shaking of the body occurring in between
erratic gaps of deep coma— like violent shuddering of the airplane in between
erratic spells of stillness. That potentially becomes a life-threatening
situation both for the mother and the unborn child. Further indecision at this
stage pushes it to the worst-case scenario with ‘placental abruption’, when the
placenta gets detached or jerked out from the inner uterine lining before
delivery— like detachment of the ‘balloon’ by rupturing its fastener strap from
the back rest. Abruption results in severe haemorrhage or bleeding from the
torn tissue, to the extent of both ending up in the ‘funeral pyre’— like nose
diving of the airplane into the ground to end up everything in flames, unless
some miracle happens. Flustered medical staff is conferring in the labour room—
like the baffled ground staff conferring in the Air Traffic Control…
That
was exactly the scenario from where dad had begun narrating his version of that
incredible birth story on our way to where would be my first address of staying
on my own away from home. And here is my own version of it, after digging out
the related ‘medical terms and facts,’ seeming bland in his otherwise absorbing
account of the connected events:
On
a clear mid-September morning in the early fifties at Kanpur cantonment,
powder-puff clouds lazily drifted on the autumn sky with no apparent signs of
an untimely wind storm. A new life form throbbing inside her made mom feel
euphoric like gliding high in the air, with no apparent signs of warning that a
storm was brewing within. Nor anything remarkable was detected during the
prenatal check-ups earlier to indicate what was to come. He had been feeling
delirious with the expectancy of soon becoming three from two in the
camp-household far away from the native town. Then suddenly everything seemed
to turn upside down.
That
particular morning she woke up much earlier than usual feeling restless. She
complained of seeing spots in front of her eyes and having a bit of a headache
and nausea. He was worried and wanted to stay at home for some more time. But
she declined, taking these things as normal to occur at this advanced stage,
which would go away if she had another round of sleep after he set off for the
aerodrome. But just when about to leave he saw her wobble dizzily, he sprung
forward in a reflex action and held her before she could hit the ground
disastrously. She fell unconscious in his arms. The apparent depth of her
unconsciousness, the irregular breathing, the bounding heartbeat that he could
feel, told that something very grave had happened. An ambulance rushed from the
nearby Medicare Centre. Yet, by the time the rear panel of the military
ambulance was opened in front maternity ward of the AF Station hospital, she
was already in the ‘worst case scenario’. A flurry of activity burst out as the
medical orderlies whisked her away, finding it hard to retain her on the
stretcher while under seizures and haemorrhage. Stunned at the terrible turn of
events, he paced along with them in desperation till the door of the antenatal
ward was forcibly shut before him.
She
was diagnosed with ‘Eclampsia progressed into its terminal stage,’ in the space
of just an hour or so, without even conceding the least attention time to its
preliminary stage that would have responded to treatment. The only known
prognosis was maternal and prenatal mortality for sure in those days.
She
was immediately put on respiratory support and a mouth wedge inserted to arrest
tongue laceration. She was given anti-hypertensive injections to control blood
pressure. Infusions of Magnesium Sulphate was administered intravenously for
calming convulsions like ‘pouring oil on troubled waters’ by Benjamin Franklin
for quelling sea waves in storm. But even then, she had violent convulsive
seizures and when it subsided, a deep coma would follow, to be followed by
another convulsion, which would be terrifying to see, only if his eyes could
meet all that while he hopelessly peeked through the window pane into the
makeshift darkened enclosure prepared especially for her with partitions at one
end of the eight-bed ward.
Though
just enough to run elective or scheduled surgical procedures by only pre-booked
specialists drawn from a small panel of surgeons shuttling between several
hospitals, this AF station hospital was not as adequately armed for an
unforeseen situation of such intensity.
But
fortunately, not everything over there was as dismal or gloomy. On the brighter
side, a real-life couple of Gynaecologist and Obstetrician (ObGyn), Dr Joshi
and Dr (Mrs) Joshi, both from the Army Medical Corps (AMC) were very much
present there.
Dr
Joshi, by virtue of his posting as the Administrative Chief was rooted there,
unlike other floating doctors. And so was Dr (Mrs) Joshi, who too was grounded
there by the reason of her being the regular ObGyn at the OPD.
All
looked puzzled except Mrs Parker, the middle-aged, Anglo Indian matron, caring
yet firm, tender yet unyielding in her dealings, which made her vulnerable to
recurrent transfers. Destiny seemed to have placed her here at this very moment
for a different cause.
Left
alone entangled with the darkest fears, no message either good or bad came out
from the other side of the swing-door apart from the sound of a scuffle faintly
reaching his ears, whenever nurses holding kidney dishes busily swung it open
or close. What was going on? The uncertainty only served to make the wait seem
even longer. Morning was almost wearing on to noon when the doorknob turned.
“Our
matron is calling you inside,” a nurse hurriedly led him inside the anteroom
that preceded the antenatal ward. He followed prepared to take the worst. His
feverish eyes scanned the room until they fell on the figure of a lady in
hospital uniforms, standing in prayer with folded arms before a wall crucifix
in one corner. He took a few swift steps and stopped as though transfixed on
the ground at hearing her loud whispers, “Save the child, save it from the
butcher”.
What
was happening? Even if it was taken that she was not overdoing her role as a
Matron by praying to God for her patient, what she was muttering struck him as
a terror adding on to the prevailing agony, trauma and suspense. What more was
to come?
The
matron turned towards him. Her demeanour put him at ease.
“Get
this drug from anywhere in the town-- Just anywhere. Don’t worry about the
money. For military prescriptions it can be adjusted later on. Hurry up, or
else...” she handed him a prescription bearing the signature of Dr (Mrs) Joshi,
the lady Obstetrician along with the name of a drug.
“Or
else what?” he blurted out realising that the implications of what she couldn’t
bring herself to tell must be very grave.
“Or
else, you’ve got to sign these papers of consent to permit that mindless
gynaecologist Dr Joshi to become an abortionist and rip the baby out in pieces
to save the mother,” she disclosed the inevitable pointing towards the papers
on the table in such a tone that sent him right away racing for the miracle
drug.
While
nobody needs to be explained what a modern Stethoscope is, a Pinard-Horn is a
trumpet shaped wooden device with a uniform end-to-end hole. The practitioner
places its flat end-disc on the ear, while the horn’s hollow end is moved
around on the pregnant mother's abdomen for directly listening to baby’s
heartbeat in utero.
A
Fetoscope is a Stethoscope with its chest-piece replaced by a smaller version
of Pinard-Horn that picks up the sounds and transmits to the ears through the
tubing in the same manner.
Listening
to the sounds from the heart, lungs or other internal organs, with a
stethoscope is medically known as auscultation, whereas palpation is the
process of using one's hands for feeling an object, such as a tumour inside the
body with the sense of touch which Mrs Parker did instinctively.
All
that drama had been unfolding here during a period when ultrasound was still
under experimentation as a diagnostic tool even in the developed countries.
Hence, the Fetoscope— a combination of the modern Stethoscope and a
‘Pinard-Horn’, that didn’t require ultrasound to listen to the baby’s
heart-beat, was the best auscultation devise in their hands in the given
scenario.
However,
like an ‘eye of a storm’, only those intervening spells of stillness in between
bouts of seizures provided that calm slot to the Fetoscope for picking up the
foetal heart beats. But the Fetoscope drew a blank for the second time in succession.
“There’s
no heart beat,” Mrs Joshi’s voice quivered as though her own heart had skipped
a beat.
Ears
of the midwife as well as the surgical nurse picked up nothing, as they took
turns one after another, while Mrs Parker, the veteran Matron stood and watched
silently.
“Mrs
Parker, would you now try your ears at that,” requested Dr Joshi, eyeing the
Fetoscope on the surgical trolley-cart, lying among other delivery appliances
like— Amniotic Hook, Haemostat, Forceps, Sutures, Speculum, surgical gloves,
sponges and cotton swabs.
“Please don’t show that to me. Even the cardboard spool of toilet-paper roll
can serve the purpose of listening to heart beats, only if one understands the
position of the baby’s head simply by palpation first,” Mrs Parker undermined
them in a huff, sore at her relegation to fourth in the order.
She
applied all her tactile skills in palpation and then held the probe precisely
on the specific location expecting to be greeted by a faint heart-beat. But
nothing got conveyed to her ears through the tubing as to ‘save her face’ after
she had made all those boastful claims. She heard nothing, not even as faint as
the ticking of a wristwatch under a pillow.
Nevertheless,
her ears or anybody else’s for that matter, failing to perceive those decibels
was no reason for the infant’s heartbeats however faint, not to exist, she
reasoned. But the very next moment, intuition far removed from logic eclipsed
her reasoning, when out of nowhere ‘silent screams’ seemed to reach her ears,
as though the baby was still alive but in distress, medically called foetal distress.
An electrifying feeling! Yet she retained her poise while straightening up,
bearing a tender melancholy towards the tiny unborn bundle— so helpless, so
vulnerable, so defenceless. How sad that a heart that had throbbed so
vigorously inside the mother’s womb until this morning, should now be called
upon to prove itself by sending out a beat that could be heard by these
insensitive people, or else get lost forever without seeing the light of the
day…
Yet,
I saw the light of the day instead of being consigned to darkness forever,
because someone had the backbone to defy authority and the courage to speak up
for me. I woke up to life instead of being put to eternal sleep, because
someone placed ‘clinical haunch’ above ‘clinical diagnosis’ when the two were
in conflict.
“Do
you need a hearing aid, Mrs Parker?” mocked Dr Joshi.
“To
hear we always don’t need real sounds to hit our ear drums assisted by a
hearing aid,” replied Mrs Parker, “I’ve heard the baby’s silent screams,” she
said gently in reply to his caustic remark, not losing her cool.
“Was
it your third ear, something like the third eye, Mrs Parker?” Dr Joshi joked.
“Not just third, it is my thirty-third year into midwifery, may be since you
were in school, Dr Joshi. It just came out of nowhere and I’ve heard it. Can’t
explain how. Not trusting my gut feeling will be a blunder,” Mrs Parker stood
on her ground.
“Do
you realise that another two convulsions at the most and the mother will die
too,” Dr Joshi warned in a grave tone.
“What
do you mean mother ‘too'?” Dr (Mrs) Joshi, who was silent until then asked.
“All
four out of four here, who are ‘medically certified for auscultation’, have not
heard any foetal heart-beat. So, the objective conclusion should be that the
baby is ‘stillborn’ and it needs to be ‘evacuated’ immediately to save the
mother. So, better prepare for the surgery,” Dr Joshi who was the ‘Chief
Surgeon’, officially addressed the surgical team that included his wife in the
role of Assistant Surgeon.
“Prepare for surgery or butchery? Your diagnosis is suspect. I decline and so
will the midwife and the other nurses with me,” retaliated Mrs Parker sharply
with a glint of open defiance in her eyes and stood like a barricade beside the
patient cot. She uttered nothing more, only glared at Mrs Joshi, telling with
her eyes to take over the baton from her in the confrontation.
It was not surprising that an ‘extraordinary’ birthing situation should arouse
such ‘out of the ordinary’ reactions, when even normal situations invoke their own
measure of agony. And all this is because of the fact that, even normal
birthing experience has never been without its own share of pain and agony for
humans. But, why has a natural phenomenon like giving birth to an offspring
never been that easy?
This
is due the hypothesis called ‘Obstetrical Dilemma’, arising from nature’s need
for striking a balance between two conflicting evolutionary demands at the same
time— Human intelligence (demanding bigger head size) versus bipedalism
(demanding narrower hip size), for which the female hip-bone compromised on a
narrower size— a trade-off that gave a ‘tight fit’ to the skull at the
narrowest cross-section it has to pass though en-route this world. This is the
simple ‘mechanics’ behind all her pains and agony on the verge of attaining motherhood,
eulogised over the ages.
Hence
unlike other primates, becoming a mother has never been and never will likely be
an easy task for humans. Yet, no woman needs to be taught how to give birth to
a baby. Nature has put her airplane on route to motherhood on ‘autopilot’.
Right from conception to birthing and post-delivery, the sequence of commands
that her specific organs spontaneously follow are hardwired into her endocrine
system. A hormone is a ‘biochemical messenger’ that is produced by an organ
somewhere in the body, travels through the bloodstream to reach its specified
‘receptor’ on a distantly located target organ, and then tells it what to do.
There are some other hormones too, which unlike travelling messengers are
locally manufactured at site ‘as and when needed’.
For
example, the process of birthing is spontaneously triggered at full term, when
the baby’s head pushes against the cervix, causing it to stretch. This
stretching causes nerve impulses to be sent to the brain. These nerve impulses
cause the brain to stimulate the posterior pituitary gland to release Oxytocin
hormone into the blood stream. Oxytocin released travels through the
bloodstream and attaches itself to the ‘specific receptor membranes’ of the uterus
and tells them to initiate contractions.
Accordingly,
the walls of the uterus contract or shrink, thereby making the head to stretch
the cervix further to release more Oxytocin. The cycle goes on and on, boosting
the push further and further in a positive feedback loop. This is what happens
after ‘going into labour’.
This
is comparable to the turbocharger of my ‘daydream aircraft’, I began this story
with. Hot exhaust flow from the engine, instead of being thrown out directly,
is ‘fed back’ to the turbocharger to spin a turbine-wheel, which in turn spins
a compressor-wheel. This compressor in turn compresses and delivers more amount
of fresh ‘combustion air’ for the same volume, and with it more fuel, that
delivers more power in a ‘positive feedback loop’.
If
a toy or party balloon is any analogy for the uterus, then a ball entrapped
inside the balloon is the baby’s head and the tubular neck, jutting out of the
balloon and ending in a stiff rim, is the cervix. If the goal in this party
game is expulsion of the ball from the balloon by squeezing it down, then the
aim in natural-birthing is similarly expelling the baby from the uterus,
through the cervix into the birth-canal. But this is only a fraction of the
total interplay between the parturition hormones.
To
begin with, a hormone called ‘Human-chorionic-gonadotrophin’ (hCG) enables her
to recognise the presence of the embryo and begin its automated progress
towards birthing. In response, a big player in this interplay of hormones— progesterone,
initially produced in the ovaries and later in the placenta, comes into play.
This hormone initially maintains blood flow to the womb, manufactures nutrients
to sustain the early embryo and produces the decidua, a unique organ by which
the embryo attaches itself to the inner wall of the placenta. As the foetus
grows, decidua gets stronger to enable clinging, until auto-detachment at term
delivery or preterm-detachment in case of an unstable pregnancy— like that
severe jolt rapturing the fastener and detaching the ‘balloon’ in the airplane
analogy of my story. Also there is enough evidence to suggest that, following
conception, another hormone termed ‘Corticotrophin-releasing hormone’ (CRH) in
the placenta, purposely supresses the mother’s immune system, to the extent that
it does not mistake the foetus for a ‘foreign body’ and attack it, like the
analogy of antiaircraft gun attacking territory’s own aircraft. The foetus
nestled inside the depth of the womb is otherwise safe in a ‘stable pregnancy’.
Now,
just imagine in that balloon analogy— that the ping-pong ball progressively
grows up to the size of a billiard ball and then to the size and weight of a
‘junior short-put’ ball, to which the head-size and weight of a baby in-utero
nearly equals at full term. The tubular neck jutting out from the balloon must
be sufficiently stiff or un-stretchable, to hold load of the ball. Also, as the
ball enlarges, the physical stress and strain it exerts on the balloon’s wall
is on the rise, which it must be able to withstand. The same is demanded of a
uterus for a ‘successful pregnancy’. Progesterone accomplishes these two tasks
by thickening the inner lining of the uterus and structurally maintaining the
‘load-bearing capacity’ of the cervix till the end of gestation. But at full term,
these same set of conditions which had maintained pregnancy until then, must be
‘reversed’ in order to accomplish the process of ‘natural birthing’.
Prostaglandin, the next player in this game, (a hormone created at
‘work-site’), accomplishes this task by transforming the uterus walls from
‘firm to flexible’ to enable contractions and the squeezes. Prostaglandin also
affects structural modification the cervix causing— thinning out of its walls
(effacing) and ‘shortening’ it elastically, thereby widening the opening
(dilation), till the ‘outward force’ exerted by the baby’s head overcomes the
resistance faced, allowing passage of the baby from the womb to the outside
world through a ‘favourable cervix’. This is looking at Biology from an
Engineer’s point of view.
These
hormones are only to name a few. But what is true for all of them is— just as a
natural hormone produced endogenously, accomplishes certain tasks, so also do
their synthetic versions or analogues, produced exogenously.
At
that point of time when this story was unfolding, the synthetic version or
analogue of Oxytocin, that mimics the natural one, had just found its way into
the country under the trade name Pitocin. Its role as a therapeutic agent to
induce or augment labour for ‘term delivery’ and initiation lactation after
childbirth were known and also as a fall out from this, its non-therapeutic
role or abuse for ‘milk-ejection from dairy-animals’ came to be known. However,
though natural Oxytocin’s role as the hormone of love, bonding, empathy and
‘feel-good’ was known, it was not certain whether its analogue’s role or abuse
as an addictive ‘mood elixir’ had come to be known.
In
that airplane analogy, if a simple push on its ‘push-button starting switch’
for triggering the engine’s self-ignition is comparable with a push by the
baby’s head on the cervix for triggering spontaneous contractions, then use of
synthetic version of Oxytocin or Pitocin for artificially inducing contractions
is comparable with ‘jump-starting’ the airplane using an external battery
called ‘Rescue Booster Pack’. Under the conditions prevailing in the delivery
room, synthetic Oxytocin could at least serve like that jump-start, in absence
of self-excitation from the natural version at preterm.
Now,
coming back to the delivery room…
C-section,
the easiest option, like jettisoning some amount of load from the airplane, was
ruled out for reasons of the likely blood loss in the procedure itself to gain
access to the baby, after it had already suffered placental abruption with
significant haemorrhage. Adding further to the constraint was the on-call
anaesthetist's total inexperience in ‘administering anaesthesia to a comatose
patient for C-Section’, which was still a subject of dissertation in medical
journals.
Under
those uncertainties, the way the low tone consultation between the flustered
OBGYN duo, Dr. and Dr. (Mrs.) Joshi erupted into a heated argument, with scowling
faces, pointing fingers and adrenaline rushes, it gave no inkling of their oxytocin
rushes while sheltered in each other’s arms like love birds the night before.
Voices raised and pitches soared, while each one of them tried to assert one’s
point of view in a perfect model of ‘role-playing’:
“How
do you go from saving lives to taking lives, Dr Joshi?” she was quite vocal on
taking over the baton from Mrs. Parker, who along with the midwife got engaged
with the patient, unseen behind the curtain around the cot.
“Mrs
Joshi, the baby is stillborn, which means death inside the womb from 20 to 28
weeks of pregnancy at which it is now and even if taken remotely that it still
has some life left in it, I am licensed to perform the evacuation if it becomes
absolutely necessary in the interest of saving the mother,” he showed his
powers.
“Doctor
Joshi, ‘showing no signs of life’ and ‘being dead’ do not mean the same thing.
Evacuation, the option going on in your head will only end up killing both at
such an advanced stage of gestation. So, expulsion by induction will be a safer
procedure medically,” she contradicted.
“But,
however dangerous, the risk of immediate evacuation outweighs the risk of your
lengthy procedure whose duration neither mother nor baby survives,” he warned.
“But, however dangerous, the risk of inducing, even if the duration shoots up
to more than 72 hours, outweighs the risk of such late term evacuation,” she
asserted.
“And
what kind of a normal delivery are you pestering me for, until its abnormal
foetal ‘presentation and position’ is moderated to ‘heads down and facing the mother’s
spine’ Mrs Joshi?” he revealed.
“And
what kind of an evacuation are you vouching for while the patient is in coma,
and cannot be given full anaesthesia as to not wake up during surgery, Dr
Joshi?” she disclosed.
A
silence fell. Flustered under moral dilemmas, first things didn’t strike them
first. It happens. Their eyes met calmly, seeking compliance. But turning from
being defiant to compliant over the next course of their exchanges it came out
that: The synthetic version ‘Pitocin’ was only used to artificially induce
labour in elective cases, when labour did not start spontaneously at full term
or upon overshooting it. For planned cases, just the requisite dose was
requisitioned from Command Hospital, where it was not there now.
Furthermore,
premature induction requires much larger doses of the same induction agent or Uterotonic,
for reasons of relative of paucity of Oxytocin receptors on the pre-term
uterine walls as well as for the larger duration.
Moreover,
after artificially inducing labour with Pitocin, the next set of cascading
events like softening, ripening, dilating followed spontaneously at full term
only, with Prostaglandin hormones getting released naturally. But this
spontaneous effect does not follow artificial onset of contractions with
Pitocin prematurely or before full term.
To top it all, synthetic analogues of Prostaglandin, that could initiate this
effect artificially, were yet to be synthesised in laboratories. So, in absence
of a purely non-invasive pharmacologic regimen, they had no alternative other
than resorting to age old mechanical methods. Skill on such invasive methods
among those present there, comfortable with routine procedures only, was also
very much in doubt.
Feeling
lost, they unwittingly looked in the face of Mrs Parker, who came out from
behind the curtains just then.
“While
listening to all that was passing between the two of you, the midwife and I
have fixed all your doubts. Now just like a shot in the air when the preconditions
are ready, try to get that inducing agent in the requisite doze for IV infusion,
just from anywhere and within three hours at the most, or else, let Dr Joshi
take the floor,” Mrs Parker recommended. That was at least better than killing
or letting die from incisiveness. While Dr Joshi walked out to make the papers
ready, Mrs Joshi wrote and handed a prescription to Mrs Parker.
“I
know there is only one person in this world who will move the mountains for the
magic potion,” her voice quivered as she walked towards the crucifix...
“My
nerves racing, I madly pedalled from one corner of the town to other,” Dad
hastened his narration as the destination neared, “I dashed into pharmacies and
clinics, knocked on doors of maternity centres or even abortion clinics to
which I was guided and whose existence I wouldn’t have otherwise known. But
nowhere was it there. I even met with suspicious stares. Yet I carried on the
hunt and time was running out. Suddenly, I suffered a blackout and fell down
unconscious on the street. When I regained consciousness, I opened my eyes to
an unknown person sprinkling water on my face. I faintly heard him telling the
bystanders around me to move wider to let in more air and that he knew how to
resuscitate, being a medical representative himself. I sprang up to full
awareness. No further resuscitation was necessary. I showed him the
prescription. He rummaged through the contents of his MR bag till he came out
with a flasket containing vials of the panacea. He handed it to me saying he
felt awed that a thing he had been carrying for a dubious deal, divinely got
diverted towards a good deed. There are true stories about pilots bailing out
from shot down aircraft, para dropping on enemy land and opening eyes to a
rescuer who was miraculously present there. Any expiation?” Dad’s voice got
choked.
His
story stood at a juncture like that fairy-tale race between the ‘poison and the
potion’ to save the princess— A do or die race which he had to win! He raced
against time beating the abortionist and dashed into the anteroom where the
matron still stood before the crucifix…
The
airplane touches the ground. The exit door opens. As I get out and climb down
the stairs, I can see my mom standing behind railings in the visitor’s gallery
at the edge of the runway, in her eager wait for her ‘budding engineer’ son.
That was real, not a daydream!
“Maa…”
my heart cries out, “I have come down to you from the sky flying on an aeroplane
just as you had told me”.
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