Delivering a Uterus with a Sigh

I had not really planned to do anything heroic. I usually don’t. Definitely not just after an attack of vivax malaria, with my muscle glycogen stores down to near zero. That patient was obese, weighing in my opinion about 82 kilograms, but the ward scales said 73 kilograms. My associate professor (AP) had diagnosed her to have a leiomyomatous uterus of size of 16 weeks of gestation. She was posted for an abdominal hysterectomy. But she had a lot of central fat, and was at high risk of an abdominal wound breakdown postoperatively, given the overcrowding and contaminated atmosphere owing to building repair work. So the AP suggested we perform a vaginal hysterectomy on her. I never attempt vaginal hysterectomy if the uterine size is bigger than 12 weeks of gestation, and perform an abdominal hysterectomy. But the prospect of opening that huge abdomen, struggling with retraction throughout surgery, closing the huge abdomen at the end of surgery, and possibly dressing and resuturing the broken down wound was discouraging to all. SP finally I did perform a vaginal hysterectomy on her. It took me one hour thirty five minutes. I had to bisect the uterus to enucleate the leiomyoma, which refused to get enucleated anyway because its upper part was beyond reach, and it was degenerated too. The AP jokingly suggested use of a cephalotribe (a destructive obstetric instrument of the yesteryears), and I jokingly told her I was contemplating the use of obstetric forceps myself, but there was no space for their application. I was drenched with sweat by the time I delivered the uterus out, and felt I had run the Mumbai Marathon rather than performed a vaginal hysterectomy. I remember the anesthetist watching my face intently from the head end of the table, holding her breath as I made the final traction, and breathing out with a sigh when the uterus came out and the residents made happy noises. You may wonder how I made out all this while struggling to get the specimen out. Well, after spending 29 years in the profession, I can make out people’s expressions and hear their sighs even when they wear masks.