“Is there anything I can help you with? I’m about to close the shop. Is it urgent?” I asked her because I had to rush to a meeting to prepare activities for the new resident doctors who will start studying and working this July.
“I want to consult the doctor about an unplanned pregnancy.” This woman had been standing at the counter in front of my examination room for a while but chose not to come inside to see me, and I didn’t know her reason.
“Um… I’m really sorry, but I have to close the shop quickly because I have a meeting. Besides, I don’t perform abortions anymore. If you want to know where to go, I can recommend a place.” I looked at the clock, and it was half-past seven.
“But doctor, I don’t know how to decide which method to use.” Hearing this, I had to stop. It indicated that she might have already seen a doctor somewhere.
“And what did they say?” I chose to stop and listen.
“Doctor, I’m scared.” This kind of voice often makes me weak in the knees, unable to walk further.
“Alright, tell me. I’ll listen carefully.”
“I went to see the doctor at that clinic.” She mentioned the name of the doctor she had just seen, whom I knew well. “The doctor said there are two methods: using medication or vacuum aspiration.” If it starts with “vacuum aspiration,” then I consider it good.
“And what are you worried about?”
“I’m worried about everything. The doctor said if I choose vacuum aspiration, it can be done immediately without anesthesia, but if I choose medication, the bleeding will last longer.”
“That’s how it is.”
“I want it to be over quickly so I can get back to work, but I’m afraid of the pain,” she said.
“But if I use medication, I’m scared that the bleeding will be heavy and prolonged.”
“That’s how it is.” Hmm… I feel like I’m repeating myself.
“Doctor, can you recommend which method I should choose?” Here we go again.
“I don’t know. I’ve never been pregnant or had an abortion.” Yes, what comes out every day is “poop,” not “abortion.”
“Doctorrrrr…” She dragged out the word. Actually, I was just teasing her because I found her cute.
……………………..
The activity I was going to help organize for the new resident doctors is called “non-technical skill.”
The name itself indicates that it’s not a technical skill. So what is it? Try reading slowly.
Doctors work to treat patients, using medical knowledge to help care for them. An obstetrician like me takes medical history, performs physical and internal examinations, compiles information for diagnosis and treatment. All of this is technical skill, which is academic knowledge and ability. So what is non-technical skill?
It’s another set of abilities we need to use alongside to promote patient care activities for smoothness and safety. Alright, some people might be confused. I’ll try to give an example (so are you asking us to read or listen?). No matter how skilled a doctor is, if they can’t communicate effectively, they can’t fully care for patients. I’m talking about communication skills, which are non-technical skills.
No matter how skilled a surgeon is, if there’s no nurse to assist, no anesthesiologist, no assistant doctor, no nurse to fetch sutures and instruments, no other department doctor to help if problems arise, no one to wheel the patient in for surgery, the surgeon can’t operate. Even if all components are present, but the doctor is rude, throws things when angry, insults everyone who disagrees, even if the surgery is successful and the patient is safe, the colleagues are all traumatized. I can’t say that surgery is perfect, and one day, mistakes might happen.
I’m talking about teamwork skills, which are non-technical skills. A doctor comes to work after being on call all night, being summoned until sunrise, and still has to see patients in the ward, then rush to the OPD. Playing like this, no matter how skilled, they’ll be blurry, and the patients will suffer. They need rest and sleep before working.
I’m talking about time management for rest, which is a non-technical skill. See, behind the work, we can’t just be skilled in academics; we need skills in other areas that are equally important.
There are many other non-technical skills, but I want to talk about “awareness” or “situation awareness.” It’s about recognizing what is there (awareness of its existence), understanding what it is (interpretation), and predicting what will happen (forecasting). Let’s see how I used this skill while talking to her.
“Doctor, I’m scared.” I had to pause my rush. The meeting could do without me, but this patient might face disaster if she goes for an illegal abortion. I was aware and predicting ahead.
“The doctor said it would be a live suction.” Hearing that, I interpreted it as her receiving standard care, which is suction. The term “live” might mean she didn’t fully understand.
“I’m scared that the medication for abortion will cause heavy bleeding.” I was visualizing the medication process for abortion, understanding what happens during the procedure, and predicting the bleeding level for her current pregnancy stage. We talked until she felt that the clinic she was going to the next day was standard and safe, and then we parted ways.
It’s pitiful, women abandoned by men often end up like this. The ones who get hurt are never men. The ones who feel guilty forever are never the men who choose to abandon the women they impregnated and left. Well, I chose to let it go before walking to the car, letting my mind drift with the cool breeze of early rainy season hitting my face. This cool, moist breeze might be followed by a heavy rainstorm, and when the big raindrops pass, they’re replaced by the clean scent of the air, a refreshing feeling, and the wetness when stepping on the streets of a big city.
I remember a patient from a long time ago. I recall that I had just learned the vacuum aspiration method and started using it in the hospital. We researched and found the best way to care for patients, confident that vacuum aspiration at the gynecology clinic was safe. We could do it without general anesthesia or spinal block in the operating room.
“Doctor, I’m scared.” Haha, back then, I was young. The patient was a nurse, probably a few years older than me, so she had to refer to herself as “sister.”
“Yes, sister, but I’ll prepare your cervix to be soft first with cytotec, so when the suction tube is inserted, it will hurt less.” The main obstacle of vacuum aspiration is the pain during the insertion of the plastic tube through the cervix. So if we can make it soft and easy to insert, it will significantly reduce the pain. But I could predict that the side effects of the medication might cause uterine cramps, nausea, fever, and some might experience diarrhea, so I explained to her to prevent fear if those symptoms occurred.
“Have you taken the medication, sister?” I asked her before having her undress and get on the bed (um… actually, just change into a sarong).
“Yes.”
“Do you have abdominal pain, fever, or chills, sister?”
“Yes, but I can endure it. I just took Ponstan as well.” That’s a pain reliever used with paracetamol.
“I’m inserting the instrument into the vagina, sister.” I told her while inserting the speculum to open the vagina.
“Applying cold medication in the vagina, sister.” It’s an antiseptic.
“Sister, I’m inserting the suction tube now. It might feel a bit uncomfortable. Let me know if it’s too much.” Then I slowly inserted the plastic suction tube. It felt loose and inserted easily, so the patient wasn’t very uncomfortable. You’ll see that I tried to inform the patient at all times about what we were doing. The teacher taught that informing like this helps reduce fear and anxiety, and the pain will lessen. This is a non-technical skill.
“Are you okay, sister?”
“Yes, doctor.”
“I’m going to start suctioning now.” As soon as I connected to the suction device, I unlocked it, and the instrument began suctioning the uterine cavity, and the contents started flowing out. Everything seemed simple, but as the tissue came out, she started to moan.
“How is it, sister?”
“It hurts a lot. Suddenly, it hurts intensely,” she said, starting to grip her arm.
“Just a little more, sister. The pain indicates it should be almost done, but there’s still a lot of tissue coming out.” I was getting curious.
“Doctor, it hurts a lot.”
“Okay, I’ll stop for a moment.” Then I pulled the instrument out.
“Oh, it hurts so much, doctor. Why does it hurt like this?” She was clenching her buttocks. Surprisingly, usually when I pull the suction tube out, the patient’s pain decreases almost immediately. This was unexpected. I was predicting what might be happening inside. Could her uterus be perforated? No, if it were perforated, I would feel it through my hands, and this was a blunt plastic tube, so the chance of perforation was low. Or was there more tissue in the uterine cavity than seen on the ultrasound? This was unlikely because if there was a lot of tissue, suctioning usually doesn’t cause much pain. What the heck? I started sweating. The patient seemed restless, sweating, and agitated.
“Prepare saline, prepare to draw blood, call the nurse outside to help.” I ordered the assistant next to me.
“Doctor, no need, no need to call. I need to poop. I can’t hold it anymore.”
“Oh crap,” I muttered to myself. It wasn’t funny because we still had tissue left, and it wasn’t fully suctioned. If she went to poop now, she’d probably faint in the toilet (this is another awareness, seeing another risk waiting).
“What should I do?” I couldn’t find a way out.
“Doctor, I’ll handle it,” the voice of salvation from Nurse Yao, the smart assistant nurse, spoke up. Then Nurse Yao grabbed a laundry basket, emptied it, and covered it with a plastic bag. It was a makeshift toilet.
“Doctor, please step out. I’ll take care of it,” Nurse Yao said.
“Can you handle it, sister?” I felt grateful, and at the same time, I couldn’t help but worry about both of them. We had never encountered or rehearsed a case where a patient couldn’t handle the side effects of cytotec and ended up with diarrhea like this. It went well. She finished pooping, completely emptying her bowels, and even better, the uterine tissue was expelled more during her emotional release. After cleaning up until it felt clean, I performed an ultrasound and found the uterine cavity looked fine. I assessed that the additional tissue expelled in that massive pile of poop wasn’t much, so I could send all the tissue suctioned earlier for examination. It was great not having to sift through the poop pile for tissue to examine. Otherwise, the pathologist would have been confused. Oh, that image is still vivid.
Thanapan Choobun, the poop spreader
June 28, 2019
Are you confused about how they pooped? That makeshift toilet basket was about a foot high. Nurse Yao had the patient kneel and spread her legs, hugging the chair and leaning slightly forward, like hugging the chair, and then pooping. If she fainted, she could collapse on the chair, and we could easily lay her on the floor. So smart. That’s it.
Source: Story by Asst. Prof. Dr. Thanapan Choobun https://web.facebook.com/thanapan.choobun/posts/2296937617020087?_rdc=1&_rdr