In motivational approach to self development, it is said one has to dream to be able to achieve something. In management approach, the stress is on original thinking for taking one far ahead of others.
It is the dream of being far ahead of others that probably drives to people to original thinking in many fields including obstetrics. I wrote about original thinking of some obstetricians who used double the recommended dose of intracervical PGE2 to ripen the cervix for induction of labor when there is an urgency for induction of labor. The thinking is definitely original, but bordering on dangerous. Today I heard of another original thought. We were seeing patients in the postoperative ward. There was a patient who had had postpartum hemorrhage at the time of a cesarean section.
"They gave her everything" said the Associate Professor who had taken that call.
"Oxytocin, methy ergometrine, intramuscular PGF2alpha, rectal misoprostol?" I asked.
"Yes" she said. "The bleeding was finally controlled."
"Did she required any blood transfusion?" I asked.
"No."
I suddenly had an idea. "I hope they did not put misoprostol in the uterine cavity" I heard myself say. Sometimes I feel something instinctively and say it without thinking about it. It turns out to be right. It is something like what Malcolm Gladwell wrote in 'Blink'.
"No!" they were scandalized.
"Sir, they put misoprostol into the uterine cavity at the time of a cesarean section in my native place" said one Assistant Professor. "Probably to achieve local action."
So I was right. Somebody had thought along those lines and done it.
"But how would it act, being put in the blood pooling in the uterine cavity, spilling out through the uterine incision, draining out of the cervix into the vagina, and being removed by suction by the second assistant?" asked the Associate Professor.
"It would not act" I said. "But that does not prevent original thinkers from thinking and doing it. Someone like that started giving intramyometrial PGEF2 alpha for atonic postpartum hemorrhage. It was foolish. It was intramuscular injection of a sort. The injection site to heart distance was longer there as compared to intra-deltoid injection, so that the action would be slower in onset. And if the uterus contracted in response to it, its blood vessels would be constricted by the oblique fibers of the uterus, so that further absorption would be stopped. The drug would not spread locally in the myometrium as the original thinker had thought. But a lot of people loved the idea and there was a rush of scientific papers on that. Now watch the journals. Soon there may be scientific papers on intrauterine administration of misoprostol."
All people on our round seemed amused. That encouraged me to come out with even more weird ideas. "Why do they not put misoprostol in the conjunctival sac? They put it in the mouth, vagina, rectum, and now even the uterine cavity." The smiles of many of them were even broader.
"Is the misoprostol sterilized? Or it may cause puerperal sepsis." I said.
"It is not" said the Assistant Professor who had reported this event.
Now I am sure my people will not do such dangerous things.
