Dr. Shantanu Abhyankar,
Wai, Satara, Maharashtra,
INDIA
This was a week ago. I felt dejected, I was in deep despair, in the throes of depression, rather. Had never felt so low, melancholy, despondent and powerless. I am a man of stable mental makeup, taking luck, good or bad, in my stride. Or so I thought. Equanimity, as they call it. But this episode broke me.
There was a patient, pregnant for the fourth time, almost term, with several complications related to her pregnant state. Her blood pressure was high, the sugars were swinging and platelets barely enough. She had had three previous C-sections. I was eyeing her as I perused the papers. I could sense she was fidgety. Her body language told me I was up against a challenge. Something like, ‘Doc, I will deliver with you, only and only if you guarantee a vaginal delivery!’ That would have been easy. I could politely tell her that it was impossible; getting rid of her and her problems at one stroke.
But that was not to be. The lady said that she deeply ‘believed’ in nature and its powers. The world goes around due to these natural powers any way. Apart from those three C-sections, nothing unnatural had ever happened to her. In fact, through diligence and care, she had just not let it happen in any other manner.
Thus she was ok about the C-section part but wanted me to perform a ‘natural’ C-section. This left me aghast, dazed and spent. I was conversant with various techniques of C-section, but was unaware of ‘natural’ C-section. I frankly told her so. She volunteered to define natural C-section as, ‘a C-section done sans artificial gadgets or drugs!’
‘All instruments I use are artificial, I am not conversant with art of opening the abdomen with a sharp flint stone’; I owned up my shortcoming. She instantly absolved me of the sin. ‘Instruments would do’, she said, ‘but you better be careful about the drugs. They should have no steroids, no hormones and no chemicals!!’ Here was a new twist.
I had now got over the initial prickliness and started enjoying the chat. The conversation now flowed naturally. ‘Ahem’, I began, ‘it’s like this, all hormones are chemicals but all aren’t steroids. But of course some hormones are steroids. However all steroids aren’t hormones but all are indeed chemicals. Some steroids do function as hormones. Finally whether hormone or no hormone, all steroids are chemicals and whether steroids or no steroid, all hormones too, are chemicals!!!’
I had made my kill. But perhaps I wanted to be doubly sure and continued in a philosophical baritone, ‘Let me assure you Madam, the prime reason that a woman is a woman and man a man is hormones; steroid hormones!’ I added with the flourish of James Bond.
My strategy had worked. She sat stunned. She had the expression of a cat staring at the tangled mess of wool, of her own making. Then, for a moment, she contemplated whether to paw her whiskers or to whisker her paws. Finally she gave up and blurted, ‘So be it Doc, just try and keep the C-section natural, that’s all.’
I felt like a hero from an ancient epic. Faced with weird curses, up against all odds; waiting for some quirk of fate or happy coincidence, to finally emerge victorious. I examined her, asked her to return after a week and sat scratching my head with both my hands.
I went over the steps of the C-section as I mused about making it natural. The patient initially receives injection Atropine. This is derived from the plant Atropa belladonna. Of course the one I use is synthetic but it mimics the original, natural agent. I thought my patient wouldn’t have any objections to this. Then the skin is cleaned with iodine. This is natural enough. And later comes a scrub with alcohol. Alcohol isn’t just natural, it’s ‘herbal’ too!
Xylocaine is used for anaesthesia. This is artificial for sure. The natural alternative would be to knock her down with a hammer and rush through the procedure before she regains senses! This, I guessed, would be unwelcome, though natural.
Once the baby is delivered the mother receives injections of Pitocin and/or Methergin. Pitocin (Oxytocin) is a hormone. I wondered if this was acceptable. But this is secreted in the human system. Once she is delivered, this hormone is going to surge forth from her Pituitary. A small additional dose from me shouldn’t matter. Methergin is a fungal derivative, natural and yes, in a way, herbal! The antibiotic would be a Penicillin. This is derived from that famous fungus, hence herbal and hence above objection.
The jigsaw pieces just appeared to be automatically falling in place. Bliss it was.
The uterus and other layers can be sutured with ‘Catgut’, an animal derived suture. The skin can be closed with linen. Usually I use better, newer and safer options but if ‘natural’ was the guiding principle, catgut and linen was the way to go.
I had to strike off some routine drugs for Post-operative pain, for they were artificial. But Aspirin would do. It comes from Willow bark. Pentazocine would help too. This is an opium derivative. Natural, herbal and spiritual as well!!
I would need ample Saline (intravenous fluids) too. But saline is just salt and water. Perfectly natural.
Finally it dawned on me that anaesthesia, surgery, post-op care involved, perfect balancing of input and output, blood loss and transfusion, Oxygen and Carbon dioxide, water and electrolytes; and many more parameters. Thus this was indeed a ‘balanced C-section’.
Add to this the fact that I will be removing the baby, placenta and the membranes in entirety. Leaving anything behind was hazardous. I have to remove all the ‘products of conception’. This would bring relief from pregnancy induced hypertension diabetes and the platelet deficiency. Thus my actions were to remove the ‘root cause’ of these ills.
In short, mine wasn’t just a natural C-section but an herbal one too. Why just herbal? It was ‘balanced’ too. Balanced it was and it was removing the ‘root cause’…and since it was all this why not label it ‘holistic’?
That resolved the conundrum.
Overjoyed, I called up the sign board agency and said, ‘Need a new sign board which reads, ‘Natural C-Sections Available Here!’ Wait a bit, there’s a correction. Let it read, ‘Natural, Herbal, Balanced and Holistic C-Sections Available Here’!!
Dr Shantanu Abhyankar
9822010349
Wai, SATARA
Maharashtra
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