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  ‘Whatever, let me examine once.’ I heard Radhika’s dejected voice. Ten minutes had passed, and I heard Radhika telling Fadhuma hurriedly, ‘I have to get an opinion from another doctor. I’ve to get my colleague, Dr Razak, here.’ And she rushed out. Her face was pale. ‘Guru, I’m not sure how much you know about it. Fadhuma is circumcised, just like Rukhiya. She had come to see me twice for prenatal visits, and on both occasions refused to let me examine her below her waist. I suspected that there could be something like this. This is the first time I’m doing a pelvic exam on her, which is highly unusual. I think we need to take a chance and try ‘Version’ at least once before taking her to the operating room. I don’t have much help upstairs in the labour ward to sedate her. Can you sedate her here in the emergency department? I’ll try to get Razak here and ask him to convince her to be ready for C-section if this doesn’t work. I am almost positive that a normal delivery is impossible for her. At least let her have the satisfaction of a sincere attempt from our side.’

  I had heard about the Female Genital Mutilation of women from this part of the world but despite working in the emergency department, I had never seen one. I felt uncomfortable. I started to wonder if Radhika could pull this off by herself. Razak arrived within five minutes of paging him. Radhika brought him up to speed on the situation. Both of them went into Fadhuma’s room and started discussing the plan. I went inside the procedure room to get ready with all my equipment and medications needed for sedation, in case Radhika and Razak delivered Fadhuma’s baby right there in the emergency department.

  Radhika said, ‘Guru, we are ready. Give her some morphine and anything else you choose to sedate her with. We will give it our best shot. We will try Cephalic Version and try to move the baby to the right position. If this does not work, we will have to perform the C-section.’

  ‘Radhika, don’t you think you are taking too much risk? I can get the chopper here in ten minutes. Any doctor at the University will admit her. Nobody is asking you to try this at Amoka. You are holding yourself to an unreasonably high standard of care. Stop trying to be a hero. She can be in Minneapolis in thirty minutes.’

  Radhika replied, ‘It will be too late by then. We do not have that much time,’ and went into Fadhuma’s room. I followed her. Duniya and Fadhuma were conversing in Sanghaali when I went inside. Radhika asked Fadhuma, ‘Look Fadhuma, they have cut you down below. Why didn’t you tell me before?’ She gestured with her index and middle fingers to simulate a scissor-cutting action. Her desperation to communicate her thoughts to Fadhuma was quite evident. I couldn’t help but snigger even in that situation.

  ‘What does it have to do with what you are doing today?’

  ‘Where do you think the baby comes out of? Your distorted anatomy makes it impossible for you to have a baby the normal way.’

  ‘Not true. What was done to me was Sunnah. I delivered my first three children normally. Only those who have had Pharaon will have difficulty bearing children. My mother did not have a Pharaon done on me.’

  Radhika was speechless. She obviously had no clue what these Sunnah and Pharaon are. She persevered, ‘Fadhuma, I have told you more than once, the head upward position of the baby and your “cutting” below makes it impossible for you to have a normal delivery. I will try my best to turn the baby around. The baby’s heart rate is all over the place. Anytime during the procedure, if I feel that the baby is in danger, I will have to perform a C-section.’ It was not clear how much Fadhuma understood what Radhika said via Duniya’s interpretation, but she nodded her head in agreement to everything that Radhika said, and signed all the papers placed in front of her.

  I felt that Radhika was taking a huge risk. But she was the specialist and supposed to know more than me on child births and I had no say in the decision making. I had to defer to her decision. I went out to check on Fadhuma’s husband. He had not returned yet.

  I asked Razak, ‘What do you think?’

  Razak was changing his gloves, ‘Radhika is way gutsier than me. I would never even think of venturing into something like this if I were in her position. But this is not the time to analyze what’s right and what’s wrong. We don’t have the time to think. Could you push something into Fadhuma to make her sleep?’

  I asked him while drawing Propofol into a syringe, ‘How long do you think you guys need to turn the baby around?’

  ‘Guru, if everything goes well, it should be fifteen minutes. I have never done this procedure before. This task is even more difficult when the baby is fully grown. In fact, there are lots of medical articles advising against attempting Cephalic Version at full term. My gut says that the chances of Radhika’s success with this procedure are very slim.’

  ‘Then why is she attempting it?’

  ‘Who knows Guru? I’m only a second assistant here. I have no idea why Radhika does certain things sometimes. May be she is trying to prove her point. This is her way of telling Fadhuma that she tried everything before taking her to C-section. Anyway, Fadhuma is her patient. Let’s keep everyone happy. I have already told you what I think. There is no way out here. She will end up getting a C-section.’

  I started injecting the Propofol into her vein and asked, ‘Razak, what are these Sunnah and pharoan?’

  ‘I’ll explain in detail later. Where did this Radhika go?’ He went out looking for Radhika.

  I spoke to Fadhuma through Duniya, ‘Now, slowly close your eyes. Think of something pleasant. The medicine I’m about to give you will make you sleep. You can even sing one of your favourite songs.’ Radhika was standing behind me, ‘Yo, Guru, dude. What are you doing? Trying to hypnotize her? She is already asleep. Move aside.’ She looked at Razak. ‘Are you ready?’

  He replied, ‘Yes ma’am.’

  And they started the procedure of reversing the baby’s presentation by dexterous manipulation. Using the grainy black and white image on the ultrasound scanner as the guide they started working their hands on Fadhuma’s belly to bring the baby’s head down.

  It is an irony that humans who live with their heads held high and up all their lives, come out of their mother’s womb with their heads down! And Fadhuma’s child did not want to let go even here. It was as if the baby sat there stubbornly cross-legged. Radhika and Razak continued their masterly art of belly massage for fifteen minutes. At the end, Radhika was profusely sweating. For someone like me, who had never witnessed this procedure before, the whole affair was a strange, almost surreal experience.

  No matter how hard they tried, the baby did not move an inch. Radhika looked at me, in an accusatory way, ‘Guru, you have to give her something more to relax. What can I do if the uterus is this tight?’

  I threw my arms up, ‘I’ve given her the maximum dose. If you need more medications, then you should call the anesthesiologist. I don’t have the license to administer anesthetics.’ The baby monitor made a loud ringing noise and turned silent. I was a little scared and looked at Radhika, ‘Don’t you be scared, Mr Doctor. Why fear monitor beeps when you can see the baby’s heart beating so well on the ultrasound?’ she commented rather patronizingly and pointed to the ultrasound monitor. Fadhuma started moving her arms and legs slowly. I suspected that Propofol was wearing off and she may wake up any minute. I told Radhika, ‘Look, whatever it is that you are trying to do, please do it fast. I mean it. If not, please call the anesthesiologist. This procedure is taking longer than expected.’

  Razak yelled suddenly pointing at the ultrasound machine, ‘Radhika, the baby is crashing. Look at the heart rate. The umbilical cord is coiled around its neck. I don’t think Version is possible. You’ve got to stop the procedure now. Let’s go to the operating room and take the baby out like RIGHT NOW! I don’t think the baby will make it.’ Duniya stood there dumbfounded. I had absolutely nothing to say.

  Radhika wasn’t ready to give up. She started yelling at everyone there, ‘Razak, I understand. But keep this in mind, if I do the C-section she will curse me for the rest of my life. Let
’s try once more. If I fail, then we have no choice but to take her to surgery. She has signed the consent for surgery. I wonder where her husband is. My god! Look at the baby. How can a thing be so chubby and beautiful but stubborn at the same time? Guru, what kind of doctor are you? Relax her a little more. I can reposition the baby in a minute.’

  I said, ‘No, it’s not an option, Radhika. I’ve given her the maximum dose and why are you being so difficult and want to do the impossible? Razak says that the baby’s cord is coiled around its neck’.

  ‘Look, I don’t have time to argue with you. The baby is in distress now as Fadhuma is waking up and is feeling the pain. If mom is not happy, baby is not happy. Give her another five ml of Propofol. I just need five more minutes to do this job. I promise, if things don’t work out, I will take her to the operating room on this very stretcher.’ She said firmly. She sounded very confident. I had no doubts in my mind on her competence either. But then this was an unusual situation and I could sense the mild quiver in her voice.

  I had to be stubborn, ‘No, Radhika, no matter what, I’m not willing to give another millilitre. This medicine will slow down the baby’s heart rate and I’m not prepared to take that risk.’

  ‘If you don’t want to do it, I’ll do it myself,’ she grabbed the syringe from my hand and pushed the remaining Propofol. Fadhuma stopped moving.

  I was furious. ‘Radhika, you take care of the baby. I will take care of the mother. If anything happens to Fadhuma, it’s my head on the line.’

  Razak said, ‘Grow up, doctors. Don’t act like babies. Guru, another five ml. won’t kill her. Consider the situation. Radhika, can you please stick to your job? You guys, don’t forget that there are others in this room, not just you two.’ He glanced obliquely at Duniya. He was clearly implying that our childish behaviour was inappropriate in Duniya’s presence. I was quietly observing Fadhuma’s breathing on the monitor. Radhika and Razak were both looking at the baby on the ultrasound. Radhika was hard at work, sparing no effort to turn the baby around. The baby did not seem to cooperate. As a last effort, she grabbed the baby’s head looking at the ultrasound monitor and tried to turn it around gently but firmly.

  ‘Radhika, What are you trying to do? No, you can’t do that. The umbilical cord is stuck there…’ before Razak could complete, blood started oozing between Fadhuma’s thighs. The monitor went berserk displaying all sorts of numbers.

  Radhika yelled, ‘Oh my god! I might have cut the cord prematurely. We need to go to the operating room right away! Razak, call the crew. Tell them we are on our way. Not sure what the baby’s condition will be when we are done here. We might need to do CPR. Guru, could you also join us, please?’ She grabbed the stretcher and started pushing it and running towards the operating room. Razak and I followed her.

  The C-section was over in thirty minutes. The umbilical cord was not torn, contrary to Radhika’s fears. Since the umbilical cord was coiled around its neck, the baby’s heart rate had slowed down to the red zone. Somewhat like suffocating by squeezing one’s neck. Everything was back to normal in five minutes once she uncoiled the cord.

  The incidents had unfolded rather dramatically. All of us were apprehensive about Fadhuma having a normal delivery. But none of us thought we would need to rush her to the OR and do an emergency C-section like this.

  All I did was stand there. Fadhuma and the baby were doing well. The baby cried loudly right away. I stayed in the operating room for just about twenty minutes and came out to the emergency department to check on my other patients. Radhika came out after wrapping up her work, ‘Guru, I would like to speak with you for a moment.’

  I came out and went to the break room and brought her a cup of coffee.

  ‘Sorry, I was a little rough on you. I was a bit stressed out.’

  I did not respond. I looked at her and saw beads of sweat, as if strung together, on her forehead. She looked tired and I told her, ‘Radhika, you should know better by now. Things will never be under your control at all times. Why were you so stubborn?’

  Radhika gazed at the sky, ‘Guru, I wanted Fadhuma to have at least one chance at a normal delivery. Just one chance. That did not happen. They are scared Guru, they really are. And, you know Rukhiya’s case very well. Do you remember that I had mentioned that there were two young men who had accompanied her to the hospital? These two had threatened me that if I do a C-section, someone will die.’

  I nodded.

  ‘I thought they were trying to scare me and so I had the security escort them outside before Rukhiya’s surgery.’

  I looked at her, lost and not comprehending much of what she said.

  ‘Now when I think about it, they were possibly more scared than me and the threat to my life was just posturing.’

  ‘What do you mean by that?’

  ‘These Sanghaali women vehemently oppose C-section. It’s a virtual death sentence to some of them. This is perhaps what those young men were implying when they said that performing the C-section is nothing but taking Rukhiya’s life.’

  ‘What does that mean?’

  ‘Guru, I’m still trying to understand their situation. We are doctors. All we care about is the mother and, of course, her baby. We never think of what happens to them after they go home. These Sanghaali women, I think their issues are totally different. I guess, their problems start when they go home. They must face their families and their community. I can only document the reasons why I need to do a C-section and do the surgery and feel good about saving both the mother and the baby. This is all good, legally and ethically from my side. The Sanghaali women, however, have to deal with completely different problems. We have no clue what those are.’

  I didn’t know what to say. Just then Razak came out, ‘Radhika, Fadhuma is awake. She is screaming and yelling without a break. According to Duniya, she is saying that she did not know you were doing a Cesarean section, and that you got her consent without explaining to her properly. Her husband is also here, and both are making a big scene. I scooted out telling them that I will talk to you. Please do not drag me into this. You are on your own,’ and left immediately.

  ‘Guru, welcome to my world. This has been my shitty story all along. It was Abdhi then, and now this. This saga never ends—I must fight to deliver babies! I’ll go inside and talk to them.’ She got up to go inside.

  ‘Shall I also come along?’

  ‘Are you going to save me?’ She laughed. ‘Sure, come along. I may need your help.’

  Radhika and I went into Fadhuma’s room. Fadhuma’s husband Hassan was also in the room. He was quite a hunk. He had grown a beard right up to his chest. The beard was dyed with mehndi. He wore a pair of jeans and something that looked like a kurta.

  Radhika came to the point right away, ‘Hello, I’m Dr Radhika. This is Dr Guru. I’m the doctor who operated on Fadhuma. If you have questions on what was done, I can answer them. Do you know English, or do we need Duniya here?’ I shook hands with Hassan.

  Hassan, who had apparently come from Sanghaala nearly two years ago replied rather angrily, ‘I know enough English to talk to you. Look doctors, we’re not sure how much you know about us. Let’s be clear about one thing. Nobody does any surgeries on our women. We are ready to face any consequences that it might lead to. You have acted against our beliefs and cut my wife’s belly open to get the baby out.’ Duniya was certainly helping.

  ‘Hassan, I did try my best to deliver the baby normally. The baby’s head was up and had we been able to turn the baby around, we might still have had a normal delivery. Unfortunately, the baby did not move. I did everything I could but I was not successful. I had to operate as the baby wasn’t doing so well. Please don’t call it as cutting the belly open. This is a medical procedure.’

  Fadhuma was crying all along and talking gibberish which I suspected that even Duniya could not understand.

  ‘You can give any number of reasons, but this is our baby. Fadhuma is my wife. And you have had her sign on paper
s she did not understand. This is wrong. I’m not going to spare you.’

  I asked him, ‘Hassan, what can you do? Are you taking us to the court?’

  Hassan said, ‘Who are you?’

  ‘I’m this hospital’s chief of staff.’

  ‘What does that mean?’

  I was not sure how to respond. ‘That means a kind of boss for all the doctors.’

  ‘Then, are you the boss of this doctor also?’

  I looked at Radhika and said, ‘Yes.’

  ‘Then why have you kept such doctors on the job? Fire her today. We know about Rukhiya’s case. We will not let go of that easily.’

  ‘Sorry, we cannot discuss Rukhiya’s case here. That is against our privacy policy. Let’s talk about Fadhuma.’

  ‘Then write down my complaint. It was wrong to have operated on my wife. You had no authority to force her to do anything that she didn’t want.’

  ‘Look, write down on a piece of paper all your complaints and I’ll pass that on to the concerned authorities. We have no intention of being unjust to anyone. Let us sit down and discuss calmly,’ I said.

  Radhika looked at me and said, ‘Thanks.’

  ‘Of course, I will,’ Hassan retorted. ‘We will first consult our doctor, Dr Mohammad Mohammad. And then write my complaint.’

  Radhika addressed Hassan, ‘Look, Hassan, I can understand your concern. It would be helpful if I speak to Fadhuma alone.’

  Hassan responded, in an authoritative voice, ‘What is there to talk with her? She doesn’t want to speak with you, guys.’

  Radhika said, ‘Look, this is important. I have to speak to her alone. If you do not agree, I’ll have to get the hospital security, and have you escorted outside.’

  Duniya took Hassan aside to a corner on the far side of the room and whispered something to him. Hassan started yelling in Sanghaali and walked out.