Fainting in the OR on Rwandan Liberation Day

Jessica Bryce is a medical student in the Class of 2018 at Western University

 

On July 4th, 2016, I fainted in the OR.

It was the beginning of my clinical placement at Centre Hospitalier Universitaire de Kigali in Kigali, Rwanda. I had crawled into bed at 8pm the night before feeling like crap. It seemed I had finally caught the same bug as the other Canadian medical students.

But a multi-hour forearm tendon/nerve repair was planned for the next day, and I didn’t want to miss it. So, in the morning, I donned the thick cotton scrubs, scrubbed in, and entered the impossibly hot OR.

Side note: as an inexperienced medical student, I had essentially nothing to contribute—barring my exceptional retractor-holding-and-gauze-dabbing skills (to the non-medical reader: you could train a monkey to hold retractors).

The attending surgeon was speaking English, “the academic language”, rather than their native Kinyarwanda for my benefit alone. Did I mention that surgical supplies were limited? If I was going to be using up gloves, a mask, and a gown, I’d better make damn sure I learned something valuable.

But, go figure, thirty minutes in my stomach started churning and I could feel my body temperature rising. My thick scrubs became drenched with sweat. The internal dialogue began: I totally have malaria (I was taking malaria prophylaxis and so far the mosquitos had kept their distance — I hadn’t received a single bite.) Am I sweating through my gown? Can they see the sweat? (The gowns were plastic; you don’t sweat through plastic.) Then, it became melodramatic: Maybe I just can’t stand forearm surgery. Is it possible to get through my entire career without ever being in a forearm OR again? No … that’s dumb … the malaria must be getting to you.

Back home, they say that everyone faints in the OR at least once. That it is no big deal; the nurses expect it, just ask to sit down, and don’t (figuratively) sweat it. But even at home, I thought they just said this for the benefit of the non-surgeons in the room—for those that couldn’t wait to get through their surgery clerkship rotations and never enter the OR again. The ones who didn’t eat breakfast or use the washroom before scrubbing in. It turns out I was wrong.

I like to think that back in a more familiar environment at my home school I would have handled the situation better. I would have found a way to make fun of myself or crack a joke about yet another medical student who passed out in the OR. But this wasn’t home. This was Rwanda, where English was the second language. Where I didn’t know the medical culture norms. Where the doctors worked in hot ORs with no air conditioning despite the equatorial heat; where every orthopedic case was an emergent one, and no one was compensated nearly enough. Yet there they were: cheerfully listening to rap while working to repair the patient’s deep forearm lacerations with no scrub nurse on a national holiday in a steaming hot OR. Have I mentioned that it was hot yet? Who was I to pass out in the OR?

July 4th, 2016, was Liberation Day in Rwanda, marking 22 years since the end of the genocide. Liberation Day is a day of remembrance of a dark past and celebration of the huge humanitarian strides that have been made over the last two decades. Today, an outsider would see very little of the conflict that once existed between the Rwandan people. There is an acceptance of one another; people of different religions and races live side by side, and there is greater gender equality than in most other African countries and the rest of the world. The people are very friendly and the capital city is safe and clean, making Rwanda an excellent place to live.

On my very slow and embarrassed walk back from the hospital, I was caught up in a whirlwind of thought: What are the doctors going to think of me when I go into the hospital tomorrow? Will they even let me back in the OR? What if they never accept visiting Canadian medical students again because of me?

Of course, in true Rwandan and orthopedic style, one of the residents made a joke about cold Canadian ORs the next day and then it was back to, “Help me cast this patient, we won’t be able to get them to the OR for a few more days.” In this one simple exchange, the resident exemplified the Rwandan mentality. He honoured my dignity and got back to business. Did I learn how to do an intricate forearm repair in Rwanda and secure my destiny as a hand surgeon? No. But if I can one day demonstrate even half the respect and resiliency of the average Rwandan resident, I will be proud.

I guess those in-short-supply gloves, mask, and gown were put to good use after all.