The Doctor’s View: Of Shadows That Haunt My Steps

By Denise Kavuma, Uganda:

Every now and then new diseases are discovered and while some are named thus just so the pharmaceutical companies can get every last penny out of gullible individuals, others are simply just a way for the world to define something they don't understand. I verily discovered one such condition recently and I'm well on my way to diagnosing myself with it. It might seem silly, like an overly panicked but not too bright person searching on Web M.D. for symptoms to some complicated disease. I assure you however, that this is very real and while you might not care much for it, I just might actually be suffering from Compassion Fatigue.

Truthfully, I read it in an article on Cracked.com first and then looked it up to find that I qualify for it with a stunning 95% of the symptoms manifesting in me. The name amuses me to an extent; the very thought that I've used up way too much of my empathy and so have none left sounds like a bad excuse for letting an old lady stand in the bus instead of giving her my seat. I feel it in my daily life though, as I see patient after patient die and hear the wails of their devastated families echo in the halls of my ward. I face it whenever somebody tries to explain that they have no money left for a certain medical procedure and I have gotten used to it.

Compassion fatigue has become an almost welcome house guest for it shields me from the deep sorrow of my clients and constantly deflects the defeated and piercing stares coming from terminally ill patients. It enables me to do my job well and efficiently, protecting me from the nightmares that would otherwise plague my sleep, its only asking price being bits and pieces of my soul and the occasional source of joy. This is not meant to be a dark but humorous piece like the rest you might find on this page, no, I promise no respite from the shadows today.

The sort of event that builds up this condition is not the kind that ends sadly but with peace of mind knowing that I did what I could, oh no! It's the kind that starts out like this:

Five full months had passed since I started the job and while I'd faced plenty of challenges and discovered that not everyone I worked with wished me well, I was still going strong, having found my proverbial sea legs and hoping to come out of the whole experience better, damn it! I was working two jobs, one during the day and another at night as I realized that there was a lot more that needed to be done before I settled comfortably into my career and each of those steps required large sums of money; money that I did not have. The jobs had begun to overlap at that point and I was getting less and less sleep with each week, the anxiety that I might not be cut-out for this life after all, settling deep within me and causing a chain-reaction that inevitably ended in depression. Yes I was depressed, so thoroughly put down that I spent a great many of my lonely nights trying to not cry myself to sleep (because the resultant headaches in the morning were not worth the small luxury) and the bottles of alcohol in my house increased in number at a moderately disturbing pace. What can I say, these things follow the pattern of a slow fade.

I got up every morning however, with a little hope that the day would be slightly better than the last only to crumble into an unintelligible mess, numerous times, at the end of it all. My writing took a hit and I became even more reclusive than I already was, ready to either begin taking antidepressants or challenge God and what looked like his failures to me and end it all with a swift but effective plan. So, you can imagine how happy I was this one day when work ended a little earlier than usual for me and I actually got time to sit down and have something to eat for the first time at around 1:00 p.m. I was optimistic that the day would not end in nihilistic thoughts and I felt a little of my true personality fight through the darkness.

That's when it was all ruined by a single phone call. Of course, I did not know at the time that the call would be the beginning of the nightmares that plagued me the next several days and I eagerly picked it up only to be summoned to the Maternity ward.

It's always Maternity.

Apparently, a lady was having a miscarriage but the dead fetus was somehow not coming out and a leg had broken off in the process of trying to get it out. It sounded like a very odd case but miscarriages are usually easy enough to deal with and I picked myself up from my “breakfast” to go and help out. I found a very distressed lady and tired nurse (one whom I'd had to admonish earlier that week for her unprofessionalism) who was not very eager to help me out with my examination. As it would turn out, the lady had actually been given some drugs to try and increase her uterine contractions so she could push the fetus out but they had failed to work.

Rolling up my sleeves, I gloved up and went to work examining, trying to soothe the lady with my very soft but monotonous voice; telling her that everything would be ok. I reached in to examine the cervix and the presenting part of the fetus to see what the problem was only to find that a leg was dangling out. A very malformed and weirdly swollen leg that looked more like a piece of spoilt chicken meat than anything human. And so began a 20 minute struggle (which felt like eternity) to try and get that dead baby out of the lady. I tried all the maneuvers I knew and only achieved some level of success with the rest of the body coming out but the head getting stuck. At this point, the nurse had disappeared and there I was huffing and puffing, trying to calm this devastated lady while I attempted to pull a contorted fetus out of her with every contraction.

Any gynecologist would tell you that the solution to this problem would be to leave the lady and the contractions would eventually push the baby out but that's what the nurses had done initially and there was no progression. As we got more desperate with the passing time, I tugged at the body again and heard a sickeningly cracking sound and out the torso came, tearing off and leaving the head inside. The whole process with the dead, misshapen, and very weak body of the fetus had caused the neck bones to break and a slight tug caused the surrounding tissue to tear leaving me with a headless fetus and the head still stuck in the lady's uterus.

At that point, not even compassion fatigue saved me and the horror of the situation slammed into me with such force and finality, my eyes started to tear a little bit. The mother was screaming with every contraction, just wanting it all to stop and not caring what had happened to her baby. I was sweaty, alone, and tired, having been bent with my head staring into a perineum for 20 or so minutes, hoping that the sudden roaring in my ears was not the beginning of some sort of psychosis. I briefly wondered if children tearing apart in one's hands was the sort of thing that could make someone go insane, but I didn't have time to wrap my mind around that.

Desperate to end it all, I reached into the woman's uterus, steadily pushing my hand around the head and telling her to push as I pulled with each contraction. Three tries later, a weird suctioning noise sounded and the head budged suddenly, but because she was pushing and I was pulling, it came out with great speed and large amounts of liquor (birthing fluid/water) mixed with blood splashed out immediately after with the same speed and force, effectively drenching me and my white coat. I staggered a few steps back, feeling my stomach starting to churn and nausea began to manifest, but I was not yet done.

I reached in again to get the placenta out and that sucker was large and deformed, broken pieces of what looked like minced meat flowing around in it. We examined the body of the fetus later, finding it to be anencephalic and I then understood why the process had been so difficult. But with understanding did not come peace and as I went home to take a shower and soak my coat, images of me pulling out pieces of dead and mangled fetus flesh kept flashing through my mind, my defenses unable to keep them out. A couple of my colleagues heard the story and as they looked into my shocked face, they giggled to themselves, making jokes about how resilient I was.

I was not.

Needless to say, the nightmares for the next so many days were spectacular and I was trapped in them, unable to escape until I woke up each morning, drenched in sweat, still seeing those swollen and distorted legs and that eyeless head that I had pulled out. I could feel the crunching of the bones in my hands and was virtually scared to be left alone to my thoughts. So I shared my experience, making it as light as I could for the group I was telling and trying to find a way to process their sympathies to my plight.

I could not.

Eventually, I managed to build up the walls of my defenses and slammed the doors of apathy on the whole experience, compassion fatigue saving my sanity once more. So I write this, recalling that horrible day but feeling none of the despair and revulsion I sank into during and after that experience. And what do I have to thank for that?

A syndrome that's inaptly named but keeps the shadows at bay.