Remember the day I drove away? Three years later I drove right back; into the deep end of Obsgyn Medical Residency. Call it madness. Doing the same thing and expecting different results. What changed you ask?
Location. Perspective. And well diversity. Residency was a well thought out buffet. Several options to sample from, and a plethora of disciplines to help you decide where you fit best- oncology, fertility, laparoscopy, adolescent sexual health, urogynecology- name it. Don’t get me wrong, it was still as consuming and as tiring as getting your teething infant to sleep at night. It required grit.
There were good days and bad days. And definitely interesting days. All in varied ratios. The bad days were like crawling belly down through a minefield, hoping not to get blown up by a bad outcome, a nasty colleague, a failed exam or a thesis deadline. The good days however, were a labour of love. They made the bad days pale in comparison; the long days and even longer nights worth it.
Once, I was posted to the acute gyn clinic. Actually, clinic is a misnomer. It was a room the size of a virus with no windows and a door with no lock. There was a huge desk and chair at one corner, an examining couch and a medicine cabinet. It felt like there was no room for an apple to fall.
A typical day would involve camping in that room- day or night- for twelve hours waiting to attend to patients. Sometimes it would get so busy with endless queues and the conversations between the doctor and the nurse would read like:
‘Has the burst abdomen gone to theatre?’
‘No the ectopic pregnancy went in first.’
‘Where is the twin pregnancy.’
‘Oh, there she is, talking to the stab wound guy.’
But I digress. Back to the acute gyn room. It was a light day, meaning I could troll people on facebook while waiting for patients. It was however considered a bad omen to say your shift was light before it was over. Heck you couldn’t even think it lest the gods rewarded you with a beehive of sick patients.
Soon enough, a card was placed on my desk.I got up and called the patient in. AZ was a modest, slender twenty four year old, who dressed her issues well. One can never guess what is going to come out of a woman’s mouth by a simple glance. Women know how to dress their secrets. She walked in head bent, avoiding eye contact. She was accompanied by a female friend who in no time, dove into telling me AZ’s problems as she kept her gaze on the floor. I casually but firmly asked her over zealous mouthpiece to excuse us.
‘Ok AZ, it’s just you and me. What has brought you to hospital today?’
‘I haven’t started my period yet.’ She said hesitantly without looking up.’I didn’t think it was a problem until I shared with an older colleague who told me to get checked.’ Her voice was like her demeanor- soft.
That was a fairly common complaint; so I went through a series of questions to try to understand the root cause. During our conversation, I learnt that she was orphaned quite young and was an only girl with two younger brothers. They were taken up by an uncle and she had no ties to her female relatives. That explained a lot.
I asked to examine her and she agreed, still avoiding eye contact. She was extremely shy. There was nothing out of the norm during her examination, so I sent her for a couple of tests. They were costly. She worked as a tea girl. She fit into the characteristic patient demographic that visited this institution. No insurance, no money.
“Of all these, which is the most important test I can do?”
This question always posed an ethical dilemma. Of course all of them were important in order to tie everything together and make a comprehensive diagnosis. Being asked to pick one was like playing Russian roulette. Because she had a job, she didn’t really qualify for the waiving system. Life sucks. Too poor to get insurance but too rich to get waived.
I chose the ultrasound. The blood tests could come later.
This day was tailored for AZ. There was a reason it wasn’t a typical market day. She was back from the ultrasound real quick. I looked at the results- perplexed. No amount of diagrams or local dialect could help her understand that she in fact, had no uterus or fallopian tubes and her vaginal canal was as short as a toddler. She had a rare congenital malformation dubbed Mayer-Rokitansky- Kuster- Hauser syndrome. A mouthful right?? What happened to simple ailments like, I don’t know, the flu??
‘Am I abnormal?’ she asked.
‘No. You have an abnormality. There is a difference.’ I added as I continued to slowly explain to her what her condition was.
Her gaze lowered further, her shoulders slumped forward. She managed to add at that point, that she had been having difficult sexual relations with her partner. It was a painful, tormenting ordeal for her and he complained incessantly.
‘He says he feels like there is a brick wall in there. Is there a connection?’
I nodded. The pieces were falling in place.
‘Sasa, nitafanya nini?” She asked switching to Kiswahili.’ Is there a cure? Will I ever get my period?’
I had to say it. I didn’t want to say it. I was deathly silent, searching for the words but all I managed was a measly, ‘ No.’
‘AZ,’ I said, trying to get her to look up, ‘we will refer you to a senior colleague who will elaborate further on what comes next.’ She didn’t seem to have heard. I gave her time to comprehend what was happening and after further consultation, referred her for counseling and a support group that dealt with this particular condition. She attended a few sessions for a while and then disappeared. We kept in touch, but like all other doctor- patient relationships, it fizzled out. That was three years ago.
I bumped into her recently. She was clad in a long African dress, her hair in neat braids yet still with a downward gaze. She narrated to me while smiling sadly how her partner left her after she told him about her condition. About how after a while she met her current husband and they had been together for three years. How he accepted her as she was. How three years into the marriage, the stares from her family and friends had intensified; willing her stomach to grow, yet she knew it would not. How she had opted for no further intervention and accepted herself as she was. How the foundation had been of great support to her.
They are now on a journey; the process of becoming parents. Through adoption or surrogacy. They are still not sure. Whichever path they choose, I wish her all the best.
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Mayer-Rokitansky- Kuster- Hauser syndrome (MRKH) is a congenital disorder that occurs in females. It affects the reproductive system causing the vagina and uterus to be underdeveloped or absent. Affected women usually do not have menstrual periods due to the absent uterus. The abnormality is due to absence of a duct that forms the uterus, fallopian tubes and upper vagina. Those affected are unable to carry a pregnancy unless through assisted reproduction and without intervention have difficult sexual relations.
* The patient gave consent for her story to be shared.