Emergent Caesarean Section for obstructed labor and the lady had a CS with transverse incision for the same indication 3 years ago. I know there will be some adhesion and it might be hard to give a good first impression as the case is not the perfect one for first impressions; let alone the bad timing that we have to call the OT staff back to the hospital from their lunch table. To be honest, I was a little bit nervous as this would be my first operation in this new mission and the first time to work shoulder by shoulder with a whole new team. The OT supervisor, Big Tony, was my scrub nurse, who is an experienced OT nurse and quite serious, seems to be mad at anybody for their imperfect work. This type of person usually has a very good knowledge of his field and almost perfect skills. He will be very critical and picky with the others, but will be extremely friendly and helpful if you can win his trust and respect. Their world is simply white and black; their attitude to the others is either like or dislike. On the first day of my arrival, I followed my predecessor into OT to observe her CS. Big Tony asked me why I did not scrub in. I was a little annoyed by the question and answered him by no need for me to scrub in since my predecessor could handle the procedure. He finally gave up the idea that I should get familiar with the instruments after he knew I had been working in three MSF missions. He pretended that I did not exist during whole procedure although I was trying to be a little helpful with his work as a circular nurse. I had the impression that he did not like me at all and was concerned how we would work together in OT. At the beginning of my first procedure here, I asked Big Tony for a pair of artery clamps. Although my pronunciation might not be so accurate, I was sure he understood what I wanted since he handed me the exact instrument. He was kind of saying to himself “Can she speak English?” but loud enough to let everybody in the operation room hear that. For me, English is not my mother tongue but my working language; I speak English well enough that I can be understood. I did not respond to that tricky comment. Then he requested me to put the scalpel in the metal tray but not between the patient’s legs; I said ok since this would be safer for my patient and was a reasonable request. The most difficult part of the procedure was the changes of the anatomy structure because of adhesion. Both of us realized the tight adhesion between the bladder and uterus. We completed the procedure without injury the bladder and both mother and baby turned out to be good. The second CS processed so smoothly with almost no bleeding and lasted very short time, just like floating clouds and flowing water. When I said thank you to everyone working in the OT as usual, I received congratulations from the OT team. Much to my surprise, when we met at the compound in the evening, Big Tony said sorry for the rude manner in OT today and admitted he crossed the line. I think in the future, we would have good time working together. Something that could not beat you down will make you stronger; can not remember who said this but I know that I will succeed in my role of this new mission and I have a team that will support me.

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