Labour of love: lessons learned overnight

"“Final year students are required to do two night shifts per week in their Obstetrics and Gynecology posting.”

Ever since I heard my in-charge say those words, the apprehension started building up until it became a real bothersome issue. I tried to look for an escape route, anything, to be able to skip those night duties. Amazingly, I’d never had to do night duties in my clinical rotations so far but this being my final year as a medical student, all the loose ends would now have to be tied up. In other words, there was no escape.

The reasons I was reluctant to experience the famous Obs&Gyn night shift were many: the delapidated infrastructure of the hospital I work in, lack of basic facilities, burden of work, uncooperative senior doctors and shortage of paramedical staff. Plus, the very idea of a thirty-hour work shift with hardly an hour or two of sleep in between, while being surrounded by the screams of women in labor, was something I couldn’t imagine myself doing. I didn’t even want to become an Obstetrician anyway! All I could foresee was me, frustrated and panicky, struggling to get through the night. I tried not to think of the condition of the doctors’ room, the bed-bug infested mattresses and the stinking washrooms.

With all these fears in mind and protesting about the cruelty of making us work such long hours, I tried to put on a brave face anyway and get through it. It’s just a month, just a month… it’ll be over soon insha’Allah, I kept repeating to myself. After a strenuous day in the outpatient clinics and an hour’s rest in my University’s waiting area, I joined four friends with my bags and baggage to walk over to the hospital. It was 3pm and I started wondering about whether the two water bottles I’d brought along would get me through the night (I didn’t want to wander off looking for water at night), what I would eat (would the sandwiches be sufficient?) and whether there would be water for wudhu.

The teaching hospital where students like myself receive their undergraduate training is the second largest hospital in Pakistan. A public-sector hospital that is over a hundred years old, it suffers from many of the same problems that plague Pakistan: a lack of funds and basic facilities, mismanagement of available resources, deviation from some standard protocols, poor hygiene and sanitation, ill-discipline, etc. The Obstetrics and Gynecology departments, three in number, despite ongoing efforts towards improvement, are not such that you would ever want to see your relatives there. The doctors may be skilled and great at their jobs but the general condition of the hospital would make any conscientious public health official faint!

With a heavy heart but a firmly set jaw, I changed into my green scrubs, slung my stethoscope around my neck, filled up my pockets (blood pressure measuring apparatus, pen, paper, torch, pins, cellphone, etc.) and set off for the Emergency and Labor Rooms. It was just like past experience had indicated – busy, busy, busy. However, the work that interns were supposed to do was being managed by fourth year medical students with residents (senior doctors) occasionally supervising. That knocked some sense into me – if fourth year students were dealing with the work so skilfully (they had started night shifts earlier and were used to it by now), why couldn’t I?

I took the plunge and, subhan’Allah, there was no looking back. It was all very new at first, trying to keep pace with how expectant mothers were being managed in preparation for their deliveries. A lot of women were almost ready to give birth and so we were soon rushing to and fro collecting supplies, installing intravenous canullae and urinary catheters, administering various injections, fetching delivery trays, cotton swabs, shuttling between various senior doctors and coordinating with patients’ families waiting outside. It was Asr time before I knew it and I managed to offer my prayer within its proper time.

As Maghrib came around, the Labor Room showed no signs of “clearing out” any time soon. In fact, as one lady safely delivered her baby and was wheeled out, two more would hurriedly be brought in from the ER. It was right after Maghrib that I found myself assisting a fourth year student who was monitoring a lady in labor. It was my first real time directly assisting at such close proximity so I restricted myself to securing the patient’s lower limbs as she went through the pains and difficulties of delivery. It was a lesson in humility, watching the lady struggle to bring her first child into the world, alive and healthy. What saddened me, though, was the indifferent attitude of some doctors towards the lady – they spoke to her with impatience and in harsh tones, demanding she “cooperate” so that complications (such as ‘obstructed labor’) would be prevented. What has happened to us? Just because most of these patients are illiterate and from very poor backgrounds, we assume they do not have emotions and do not understand the language of love? The only (weak) excuse the doctors had on their side was the burden of work and long hours without adequate rest… but that doesn’t justify treating expecting mothers in such a poor fashion.

I wasn’t able to dwell on those thoughts long as our attention was soon diverted to another lady who was also in pain and distress. However, her distress was of a different nature. I saw her turn her face away towards the wall, sadness written all over it. She was at the end of her nine-months but had experienced a fall about five days ago and could not feel her baby move anymore.  Based on tests, the doctors feared the worst: her baby was no longer alive. Helping with her delivery was something I won’t easily forget. After an agonizing wait, her fully formed and healthy-sized baby boy emerged from the womb, clearly showing signs that he had passed away days ago. The doctor moved to place the limp baby on the mother’s abdomen but, out of sheer distress, she brushed him away with a cry of sorrow, unable to bear the sight of the son she’d been nurturing for the past nine months. She grabbed my hand and held it close to her face and I couldn’t move or say any words of comfort.

Just imagining how it would feel being in her place brought tears to my eyes – what was she going through? Oh, what Allah (swt) wills, our limited knowledge can never encompass it! We ambled over to see the baby later and it was difficult to look upon his still body without feeling a stab of pain. But work had to be done and life must go on, so leaving him wrapped up in a cloth, we returned to our duties.

The hours flew past and it would be 8pm one moment and 11pm the next! Running to and fro between the ER and the Labor Room, fetching forms, working around irritable nurses (who didn’t release medical supplies readily!) and politics between doctors, I soon forgot my own issues. It was getting late and hunger pangs were hastily suppressed with a bite here and there between duties. After a quick break for Isha, it was back to the ER for the actual night shift. At this point, I’d been awake for eighteen hours and didn’t know if I’d be able to sleep during the night. Sympathy with myself, does it sound like that? It might, considering how I’d lamented about the night shift earlier but strangely, as the hours went by, I thought less and less of myself as I witnessed the suffering of others. How is that for a lesson in humility? Alhamdulillah.

Sometime around 1am, I was busy in the ER, arranging for patients’ blood request forms and ordering necessary supplies from their relatives waiting outside. It was then that I met Mehnaz. A slight figure, pale and looking like she was past forty, she was sitting demurely in a chair, waiting to be attended to. Upon inquiry, I discovered she had come to the ER because of pain in her lower abdomen after a pregnancy-related surgical procedure she had undergone a day earlier at a private clinic. What shocked me was that she said she was actually twenty-seven years old! Her extremely low hemoglobin levels and the resultant anemia, coupled with a frail constitution (from undernourishment) made her look much older than her actual age. It was suspected that the procedure she had undergone had perforated her womb – she would have to undergo exploratory surgery as soon as possible.

I got a chance to be directly in-charge of carrying out Mehnaz’s initial assessment. As I drew blood into multiple syringes for necessary preoperative tests, I sensed some resentment in her towards me. It was not surprising, considering how frail and weak she already was, as well as the irritable attitude she was used to seeing some ER doctors display. I wasn’t sure how to react myself, as I’m not very used to being open with my emotions, but as I talked to her and learned about her circumstances and family, the reserve that had previously marred my dealings with the patients began to fade away. That was when I began to really feel what it means to be a doctor: you’re not just someone treating wounds but rather, you’re in a position to lessen someone’s pain solely by speaking kind words and reassuring them. And for some patients, that means much more than any medicine!

I kept checking back on Mehnaz to see if she was comfortable and didn’t realize it was already 2am. Could I catch an hour or two’s sleep now? After all, without sleep, staying awake in class the following morning wouldn’t be very easy. I checked back on Mehnaz again.

“You won’t go away, will you? You will be here till morning, right?” she asked me hurriedly, as if sensing I was about to take my break.

Mehnaz’s worried but hopeful tone touched me deeply. I reassured her I’d around until morning, insha’Allah.

“Please, it won’t hurt, right? I’m so scared that it will hurt!” Her voice shook as she voiced her fears about the impending surgery and suddenly, she was clinging to me in fear. Oh, how these patients were suffering from physical and emotional pain! All they needed was someone to sit with them for two minutes and reassure them, and their hearts opened. This time, I didn’t feel awkward talking to her and trying to allay her fears. The reserve was gone. If this was what I was staying for overnight in the hospital, it wasn’t “torture” at all… suddenly, it was a chance to work in the way of Allah (swt) through helping His slaves. It was like Hajj or Tahajjud, where you stay awake at night for a purpose! It’s no longer about missing sleep but making millions… the kind of “wealth” that really matters.

After a quick cup of tea from a tea-vendor who was passing by the corridor outside (no kidding, it’s a public-sector Pakistani hospital!), I changed places with a friend who’d had her nap. Barely able to catch an hour’s sleep in the doctors’ room (which was punctuated with the sounds of doctors entering and leaving every few minutes), I was awakened by another friend who needed to rest, too.

“Who’s in the ER?” I whispered.

“No students right now,” she replied and went off to sleep.

In true TV medical-drama fashion, I rubbed my eyes, caught hold of my stethoscope and shuffled out the door to the ER again. It was 4am and I was just pondering over the idea of Tahajjud when I met Farzana. She was in evident pain and her sister, also a doctor, related to me how they’d come to the ER at that hour. The family had been going from one hospital to another, each refusing to take them in because Farzana’s case was “complicated”… in other words, it was very risky and there was a real risk she could pass away on the operating table. Looking at Farzana, no one could have guessed just how much she had been suffering for the past twelve hours, as she tried and failed to give birth and then was refused treatment by one hospital after another. Finally, her family came to us and she was being prepared for an emergency operation. More work needed to be done around the ER so, feeling like a heartless soul, I had to detach myself from Farzana’s family and run the other errands the seniors were handing over to me.

During the night, I also noticed the concerns and suffering of the patients’ families. I’d write them request forms and ask them to get this test-tube or that syringe from the pharmacy and they’d readily comply. How wonderful are Muslim families who come together to help their loved ones in their hour of need! It would be late at night but they’d rush to the blood bank and get the required blood for the surgery to go ahead. Some hung around the Labor Room entrance, eager for news about the birth of a new child, granddaughter or niece. Therefore, it won’t be very surprising for me to tell you that I looked forward to be able to tell the waiting relatives, “You’ve got a darling new girl!” or “It’s a boy! What will you name him?” In their joy and appreciation for the hard work the doctors were putting in, despite the problems in staffing and management, a doting grandmother would bring in sweets for the staff or insist for them to accept some money to buy sweets later.

So at the end of the night, as dawn broke and I headed off to a secluded area for Fajr, with my scrubs bearing the marks of splashed blood and medications, my feet bearing blisters from all the running around… how did I really feel? The honest answer is: I felt alive… as if I’d just returned from a night at Muzdalifah during the Hajj! I could have been sleeping at home in my comfortable bedroom with it’s neat-and-clean attached bathroom, offering myFajr in a plush Musallah… but no, going through all those experiences that night opened my eyes to an existence that was based on putting someone else before your own needs. In a sense, it was a physical enactment of suppressing the desires of the nafs for the sake of pleasing Allah (swt).

The lessons I learned that night are too many to count. What I saw with my own eyes, heard with my ears and felt in my heart are all valuable experiences I will carry with me insha’Allah. Sure, I may not feel like I can keep this up on a regular basis, or as a future career option (for the sake of my family, whose rights upon me are my basic priority in life, after Allah [swt]’s Rights) but to learn this now, at a time where I doubted my abilities to empathize with patients, is something that I cherish and am grateful for.

Oh, another thing this experience taught me, and what you might have picked up too: never judge something beforehand. Perhaps something is good for you when you are considering it to be the worst thing that ever hit you! I walked into the Obs&Gyn ER with a grim face and walked out with a light heart and a smile. Does it not remind you of an ayah in the Qur’an?

“… and it may be that you dislike a thing while it is good for you, and it may be that you love a thing while it is evil for you, and Allah knows, while you do not know.”

This post was originally published on muslimmatters.org.