Wednesday, March 01, 2006

Stillborn

Stillborn
by Peggy Spencer, M.D.

“Get the med student to do it.”

The harried intern tossed this instruction to a nurse as he ran into another delivery room. She glanced my way, saw that I’d heard, and beckoned me to follow.

It was my clinical OB rotation at County General, a huge place overwhelmed with over 300 deliveries a month, not enough staff, and no time to teach a med student. The residents were always in the OR with Csections or Gyn surgeries, leaving Labor and Delivery to be run by interns. I had learned on the fly; how to “catch babies”, sew episiotomies, start IV’s, check “Mag” levels, and perform the various and sundry other scut jobs assigned to the “scut dogs” like me. All day I hustled between blood draws and monitor checks, urging laboring women to “push!” and sharing their happy tears when a squirming new life emerged. Every night I fell into bed in a trailer in the hospital parking lot, only to rise 4 or 5 hours later and start all over again, crazily, giddily happy.

Trailing the nurse down the busy hallway, I passed a woman in jail blues with cuffs on her feet and a scowl on her face, waiting her turn for evaluation. The frail and wondrous sound of a newborn’s cry wafted out of a delivery room next door. Down the hall, a woman labored loudly, coached thanklessly by a clumsy female friend. Families wandered the halls, staff came and went. The busy, cheerful bustle was familiar to me by now.

The nurse paused outside #7, the door of which was uncharacteristically closed. Turning to me, she gave me a once-over, and then said without emotion, “It’s a stillborn. Ever do one?”

Stillborn. The word sank into me and settled, lodging somewhere behind my sternum.

“No, never,” I managed. My face stayed impassive, an expression I had practiced until it was internalized. Stay calm. Do not react. Show no shock when a 15- year-old tells you it’s her second child. Show no amusement when a patient mispronounces a medical term. Show no horror when a child comes to the ER bloody and broken by her father. Show no hesitation when asked by a superior to do something. Be the steady, the rational, the nonjudgmental, ever-reliable doctor.

“Hmm.” She looked at me a moment longer, then seemed to come to a decision. “It’s just like a regular delivery. Give the baby to me.”

Just like a regular ----? But how — but who — but what do I — but — it was too late. The door was open and we were inside.

The heavy door swished closed on dimness and muffled silence. In the bed, the only sign of life was the movement of breath. A woman’s chest, gently heaving. A mother’s breast. A mother’s breath. Her child, breathless and still inside her. Her family, tableaued around her in awkward support. Dull faces turned slowly toward me, incomprehension mixed with pain in their eyes. The nurse moved softly, preparing the scene. Sorrow clung like a mist to everything and everyone.

Suddenly, I felt like a marauder. These people had never seen me before in their lives. Here they were, gathered in grief at one of life’s most searing moments, and who is there to “help” them through it? An inexperienced student with an unknown face and unfamiliar hands. I had no business there. They deserved better. She deserved better. Death was laughing in this young mother’s face. She needed a dear and familiar healer to ease this pain, a seasoned guide to smooth this rough passage.

But this was County, and I was all they had.

Inhaling deeply, I lifted my head and stepped forward.

9 comments:

Marianne said...

What a way you have with painting a scene! This is awesome!

Joan Saks Berman said...

Very moving. By the way, I posted again to Marianne's site before I read your comment, so I didn't follow your advice that time, but i can try it here.

FunnyFungiBunny said...

This touched me to the core. I am a student in limbo, waiting to see if I will get into medical school...only 13 more days until letters go out. I often wonder how I will be able to put on that face, how I will avoid crying. I talked with a physician from New Orleans, not about the horror that happened during Katrina, but about a little girl of 7 who had known nothing other than cancer, treatment, and every clinical trial known to man. She finally asked her parents, when no more clinical trials were available, to "let her go". How can a 7-year-old ask her parents to let her die? I couldn't stop the tears, and in front of what may be my future mentors, I cried and said, "She's the same age as my daughter...."

Virginia DeBolt said...

You achieved perfection with this piece. Don't lose track of it. It belongs in your book (you know, the one you haven't thought of writing yet).

Tall Cool One said...

nice description and (sigh) closing

bbkrak said...

Oh, the memories you get reading your post. I also rotated for OB in a county hospital, ages ago. Babies kept being born as attracted to the outside world by honey, like bears. How often did I feel dumped on. Didn't they know I was as tired as they? But I was young and we could take it, not loosing any knowledge we had acquired thus far from fatigue. Could not lead this life anymore. And how are we to feel when the still born is the one of your intern. What do you say to somebody you are working with day in and day out? Nine month of pregnancy for nothing. Not expected. Young couple. His only comment was his wife did not want any more babies. The sorrow on his face. By the end of his residency, they had a bouncy baby boy. He left, I had another year to go. A veteran was I now.

Anonymous said...

Great writing Peggy. You have documented the dual loyalties medical students face - the call from the hierachy to remain impassive and "clinical" and the call from your heart to scream in anguish over the pain elicited by the stillborn death of a child.

Tbone

Heather said...

That was incredible.

PaiDojo said...

Peg, That was beautiful and very touching. Brought tears to my eyes. Poor Mother, poor student.

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