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Monday, June 20, 2011

Reflections on the Cesarean Section

"Cesarean Section: a surgical operation for delivering a child by cutting through the wall of the mother's abdomen."

I first wielded the scalpel in a Cesarean Section (C/S) as a resident while rotating at the Harbor-UCLA Hospital in 1990. Since then, my opportunities to operate in Bundibugyo were limited by competing demands. But Jennifer and I are refreshing and refining rusty skills with the help of encouraging colleagues here at Kijabe and the hope of using those skills for the good of the patients at Kijabe and beyond. My experience as a surgeon doing the C/S over the past month has resulted in a few conclusions about this particular procedure.

Chiefly, I have determined that the C/S is an absolutely unique surgery. No other surgery issues life in the same way. A new life is released, set free. While most surgery falls into categories of either resection, reconstruction or repair, the C/S is ultimately a rescue. The baby inside is either trapped by an inadequate escape route or suffocating for the lack of sustaining blood flow. Like the Chilean miners who were trapped in the dark recesses of the earth and waited patiently for an external extraction, so are many trapped inside of their mothers. This extraction, this salvage, also parallels the release that Christians find in the gospel as symbolized in baptism. When a believer is baptized, the complete immersion in water represents burial (Romans 6) and then the believer rises from the water into new life, a rebirth, a resurrection. In the same way, a fetus is immersed in fluid and rises to life, gasping for breath as he emerges from the womb. The water and the blood flow abundantly (no sprinkling here) as the baby surfaces. So, much so that under our surgical gowns, we wear a floor length rubber apron and rubber boots!

Like many Myhre vacations, the C/S is both exhilarating and terrifying at the same time. A technician can learn the basic steps of performing an uncomplicated C/S in a short time. However, to progress from technician to surgeon, is to progress from rote mechanical execution to a responsive management of treacherous complications such as severe hemorrhage, adherent placenta, or fetal malpresentation.

I love everything about the C/S. The sharp dissection through the many layers of the abdomen, the incision into the uterus and the immediate fountain of amniotic fluid, the extraction of the gasping blue infant, the restoration of the bleeding uterine wound, and ultimately the mending of the abdominal layers and skin. There's a lot of art and science, planning and preparation, thinking and doing, manipulation and judgment that go into the successful completion of the operation. But beyond the combination of dexterity and discerning which I must bring to the table, I am principally thankful for the opportunity to participate in small way in God's ultimate creative process, that of crafting a life.


Karen said...

Beautiful metaphors.
I would have never put them together, but the C/S and Myhre vacations one was striking-loads of joy on the edge of danger. Glad you are enjoying it!

KevinandJD said...

Love that you are getting so much good experience. I am very thankful for the twins C/S and for the quick thinking of the experienced doctor who performed it. After cutting through both major veins by mistake (they were only an inch or so apart... technically speaking "abnormal uterine structure") he had to act quickly to prevent a full bleed out on my part. We'll always be thankful for him, and for the many of you like him who rescue our children and also work to preserve our lives as well.