Essentials of Obstetrics and Gynecology

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The Obstetrics and Gynecology precinct in every general hospital of India, is a wonderland. Every nook, corner and crevice of that arena holds a sight to behold, and conversations that leave the residents and onlookers alike, astounded.

The welcoming note coming from the unit, as soon as you enter its hallowed walls, is that of the wails and the shrieks emanating from the labour room. And of the labour room song, that every fresher is taught on the first day.

“ Lagao, lagao, zor lagao,

Tatti ke raste zor lagao !

Saans mat roko, zor lagao,

Chalo bibi, himmat jagao !”

Step inside though, and every now and then, you’d find a woman in labour, shouting the most prolific Hindi profanities. BK, BC, MC and every possible permutation and combination of Ch***** in a sentence. You are left flabbergasted that a women could say, nay know, all those below the belt gaalis, that would put the nukkar- ke- lafangez to shame.  It takes a while to realize, that those alarming atrocities are not directed at you, but at the woman’s husband. That narak-me- jale-jallad who put in the seed, and then put her there. And with every push, the outburst erupts to jolt the room out of the calm before the storm. Igniting a chain reaction, with the other hitherto quiet and patient labouring women, breaking into a crying crescendo cacophony.

Unpublished statistics report that every third lady visiting the department, is a Mrs Devi and no matter what her chronological age, her biological age, as reported by the relatives in the hospital records, is always 45.

“ Kitne saal ki hain ?”

“ Paitalis ki hongi .”

“ Hongi ka kya matlab ? Apko apni maa ki umar nahi pata ? Aap kitne saal ke ho ?”

“ Jee tees –paitees.”

“ Fir aapki maa paitalis ki kaise ho gaiyeen ? Unki das saal ki umar par shaadi ho gayi thi kya ?”

“ Chalo pachaas samjho.”

While you try to reason and bargain the age of the atleast-over-60 lady with her son, her daughter-in-law tries to explain their reason for coming to the outpatient department.

“ Chat gir gayi hai.”

“ Huh?”

“ Chat gir gayi hai. Isliye aaie hain.”

“ Arey, to hospital kyun aae ho?  Main mistry thori na hun !”

Giggling under her pallu, the daughter-in-law retorts, “ Aap samjhe nahi. Maaji ki chat gir gayi hai !”

As you stare dumfounded at the relative you are sure has gone bonkers, other women in the OPD break into peals of laughter. And then one patient quietly comes up to you and whispers in a hushed voice, “ Madam, woh keh rahin hain ki unke patient ka shareer bahar nikal aaya hai.”

“Shareer bahar nikal aaya hai ?” you exclaim incredulously, imagining the out-of- body experiences this woman proclaims to be having, secretly trying to remember the extension to the Psychiatry OPD.

“ Bacche daani Madam. Bacche dani, bahar nikal aayi hai,” the peon finally tells you smugly, putting an end to your woes. And that is how you encounter your first prolapse patient, as a first year OBGYN resident.

The Gynecology OPD is full of such ordeals. If you are posted in the Infertility Clinic, you learn, often the hard way, that it is not appropriate to ask the patient how many times she has sex with her husband in a week, at least not in so many words. Asking the infertile couple about sex in open dialogue is tut-tuted upon by the junta.

So it is absolutely inappropriate to pose a question like “ Hafte mein kitne baar sambandh hota hai ?” As the patients and the peons and the security guards teach you, it is wise to be discreet and ask instead, “ Pati se baat hoti hai ? … Har roz ?… Nahi ? … Kyun ?”

Imagine the resident’s plight then, when forced to ask for superficial and deep dyspareunia in the negative history during exams !  And if the patient or her husband face any difficulties during the ‘baatcheet.’

Ask the patient whether her husband has any swellings, malformations or anatomical or physiological deviations in the ‘local parts’ and she breaks into suppressed chuckles, half amused and half horrified at your audacity. In fact, I dare you to try asking for erectile dysfunction in Hindi, with a straight face, like a gynae resident. Looking unflinchingly into the patient’s face, and saying, for example, “ Khade rehne mein koi problem hoti hai ?” And when the male partner’s semen analysis shows oligospermia, the deemed correct way of breaking the bad news, you are ‘taught,’ is “ Apke pati ke pani mein jantu / keetanu kam hain.”  Because there is no better way to describe a sperm in an infertility clinic, than calling it an ‘animal’ or a ‘germ.’

Amidst the countless hours of duties, the OBGYN resident is trodden with such euphemisms which she or he is expected to know by heart, just as she or he should remember the FIGO staging of gynecological cancers.  The commonest gynecological complaint – safed pani – should be probed into with detective details. What is the ‘maatra’ of pani  – chhoti chamacch, badi chamacch, katori bhar, lota bhar or balti bhar ? Is it really safed or is it a mix of laal, hara, peela ? Is it khujli-ful or khujli-less ? Is it khushboodaar or badboodaar ? What type of undies does the woman wear – biodegradable or non-biodegradable ? Is her pati parmeshwar also suffering from safed pani ? And if you may be so bold as to ask about promiscuity, the gynae morse code for the same is “ Bahar jaate ho kya ? Pati bahar jaate hain ?”

The wonders and the stupefactions never cease in the Gynecology unit. Every OPD or ward encounter, chance or otherwise, is a learning lesson, leaving the resident enriched with unforgettable, enduring memories, giving her or him valuable schooling in the public affairs of Indian way of life. No wonder then, that these heroes emerge, not only as experts in their fields, but also as connoisseurs in the matters of female tribulations, truly making them the ‘Lady Doctors!’

Executerus

Uterus1

 

Batao bibi, kya takleef hai ?

Mere bacche daani mein bohat dard hai.

(Come again ?!)

Bacche daani mein ? Tumhe kaise pata tumhe wahan dard hai ?

(Aankhein hain ya X-Ray vision?)

The woman points to her lower tummy and proclaims confidently…Yahan dard rehta hai… bacche daani hi hai naa yeh ?

(Umm… no !  Your bacche daani is in your pelvis for starters.)

Bibi, yahan bacche daani nahi hoti..

Phir kya hota hai ?

Aantein hoti hain.

Aantein ? Nahi mujhe motion mein koi problem nahi hai.

Theek hai.. tumhare dard ke liye davaiyan likh rahin hun.

Nahin nahin. Davai-wavai nahi chaiyye. Mujhe bacche daani nikalwani hai..

Kyun ?

Kyunki mujhe bacche daani mein dard hai..

(Here we go again.)

Bibi, uske liye bacche daani nahi nikalte hain. Tumhe antibiotics de deti hun.

Phir davai ! Arey doctor, main bohat pareshaan hun. Leucorrhoea ki bhi itni problem hai.

(Of course. The most pracaharit ‘stri rog’.)

Accha ? Leucorrhoea ka matlab kya hota hai ?

Matlab ? Safed paani, aur kya ?

Bibi. Ye koi kaaran nahi hai operation karwaane ka.

Tum ajeeb doctor ho.. Arey main keh rahi hun naa, kar do.

Tumhari utsukta sarahneeya hai. Par tumhari razamandi ke saath doctor ki razamandi bhi zaroori hai.

Accha suno, mere chaar bacche hain. Aur bacche nahi karne hain. Aage main koi tension nahi chahti, isliye bacche daani niklwaana chahti hun.

To bacche band karne ka operation karwaa lo. Isme bachhe daani kyun nikalwani hai ?

Offo. Aur kya kaaran dun ?… Arey haan, mujhe date bhi time par nahi aati hain. Kabhi aage, Kabhi peeche.

Phir to kuch tests karwaane padenge.

Tests se kya hoga ? Bacche daani hi nikal do na.. pareshaani khatam.

(Bacche daani, ya cheez puraani ? Jo ab ban gayi ‘pareshaani’, aur kisi tarah hai nikalwaani.)

Log kehte hain umar ke saath bacche daani septic ho jaati hai..  Aur cancer bhi ho jaata hai.

Kaun log hain yeh ?

Mere pati, bade buzurg, mohalle waale.. sab hi kehte hain.

Mujhe nahi pata tha aapke chahne waale saare doctors hain.

Doctors ? Hain ? Kya matlab?

Kuch nahi.

Cancer ho gaya to mere bacchon ka kya hoga ?

(Master stroke. The ‘emotional’ cause.)

Tumhe kaise pata tumhe hi hoga ? Aur aise to shareer ke kisi bhi bhaag mein cancer ho sakta hai. Phir to operation karke, sabhi angon ko nikaal dena chaiye.

Hmm… main bhi soch rahi thi, ki bacche daani ke saath, appendix aur pith ki thaili bhi nikalwa lun.

(Stupefied silence)

Bibi mujhe maaf karo. Davai logi to likh deti hun.

Kamaal ki doctor ho! Bahar itna bada ‘lady doctor’ ka board laga kar baithi ho, aur bacche daani nahi nikal sakti. Chalo jee, hum kahin aur chalte hain. Time barbaad kar diya.

 

( Bacche Daani,

Aur safed paani,

Na ho jaye aage koi haani,

Isliye har mahila ko hai zabaani,

Yeh anokhi kahaani,

Ek uterine gaatha Hindustaani,

Jo sunai har ‘bibi’ aur har ‘rani’,

‘Lady doctor’ ko bhi yaad dilade naani.

Yeh hai garbh ki thaili, mere jaani ! )