Thursday, May 6, 2010

Third Year Memories

Now that 3rd year is over, I'm starting to prepare my personal statement for residency and filling out questionnaires for the dean's office to make sure my dean's letter is the best it could be. It makes me remember a lot of the memorable patients and situations that I've been presented with in the past year. All of these things have shaped who I've become and what kind of doctor I will be. I feel humbled to have been a part of their lives.

The most vivid memory I have of my entire clinical experience to this point was from my OB rotation on labor and delivery. I did my rotation at the University Hospital, which does a lot of high risk OB care. I think I wrote about my experience with the fetal hydrops baby at the time, and it's an experience I've thought about often throughout the year. As the year went on I felt I needed to write the experience down. It was just published in the arts in medicine journal for my school. I'm copying it here. It's a sad story, but it was a life changing experience for me. I promise to write happier stories in the days to come!

Can We Name Her

The induction of labor had carried on for 48 hours when I sat at board rounds. My intern was nowhere in sight, and someone let me know that the lengthy labor was at an end and Mrs. T was ready to push. I remember running down the hall, feeling strongly this was where I was supposed to be. My first vaginal delivery.

But it wasn’t to be a normal delivery. Mrs. T had come in two days ago to triage at 32 weeks. Her ultrasound showed a baby with severe hydrops, edema so bad that waiting much longer to deliver would only make the delivery more difficult. The baby had little chance of survival regardless of how long the pregnancy was allowed to continue. The parents, who spoke only Vietnamese, spoke with the fellow for hours before the understanding started to show. Their child would not live; mom’s health was at risk if delivery was postponed. They would induce. And so for two days they would walk the halls, without pain relief, to deliver their first child, a daughter.

When I reached their room my intern calmly asked if I really wanted to be there. I agreed that I did. I had been taking care of this family since they came in, and I wouldn’t feel right if I left them now. I gowned and gloved, and for some time only myself and the intern were there. Slowly, as rounds were finished and the baby was imminent, the room filled to capacity. Every OB resident, attending, student, pediatric fellow, attending, resident, student found their way into the room. Fetal hydrops is not common; quite a learning experience.

The delivery was nothing like what I had expected. When she was born there was no crying; not from the baby. She was hurried to the pediatricians. I saw her only briefly, but for weeks to come I saw her again and I again whenever I closed my eyes. My first baby. The saddest thing I’d ever seen.

I couldn’t keep the tears out of my eyes as the pediatricians intubated and compressed; trying desperately to keep fluid out of her lungs. They tried to make a miracle.

Twenty minutes later, though, it was clear that there wouldn’t be a miracle today. She hadn’t made it. She was swaddled and wrapped as any other infant headed for the nursery. She was brought to mom and dad, who waited to hold her just once.

Quietly, everyone wept. The pediatricians quietly left the room, holding each other for support. I stayed with my intern as the placenta delivered and the lacerations were repaired. We stayed as the family cried together, trying to stay quiet and small, to give them their moment together, as alone as they could have it.

Out of their quiet moment, as the instruments were being put away and the drapes taken down, came a question. The English was broken, but the question was clear – “Can we name her?”

“Of course,” my intern said, “I think that you should.”

I felt like a voyeur watching this tender moment. My mask still covered my face and it was as if I was watching from behind a two way mirror. Such a small comfort, but one the family needed so desperately. I couldn’t imagine a time when a physician could have made more of a difference than she did for that family. In such a terrible moment, so much compassion.

In the week to come, so many happy deliveries came through that floor. And every happy delivery confirmed just how great this career could be. But I’ll never forget that day when I learned what it was to be truly needed. From surviving the lowest low I could imagine, I found new meaning in my future work, and I’ll be forever grateful for the lesson.

I never found out her name. But, somehow, knowing she has one makes me feel better. I know this moment changed me forever. At that moment I knew what I would do with my life.


The Maiden Metallurgist said...

Thank you for sharing that, it was sad and beautiful.

shrimppesto said...

that was beautiful. *hug*

Anonymous said...

Your ability to share a story like this will make you a great doctor.-Kathryn