As a physician-in-training in the late 1970’s, I rotated among a variety of inner city public hospitals, learning clinical skills on patients who were grateful to have someone, anyone, care enough to take care of them. There were plenty of homeless street people who needed to be deloused before the “real” doctors would touch them, and there were the alcoholic diabetics whose gangrenous toes would self-amputate as I removed stinking socks. There were people with gun shot wounds and stabbings who had police officers posted at their doors and rape victims who were beaten and poisoned into submission and silence. Someone needed to touch them with compassion when their need was greatest.
As a 25 year old idealistic and naive student, I truly believed I could make a difference in the 6 weeks I spent in any particular hospital rotation. That proved far too grandiose and unrealistic, yet there were times I did make a difference, sometimes not so positive, in the few minutes I spent with a patient. As part of the training process, mistakes were inevitable. Lungs collapsed when putting in central lines, medications administered caused anaphylactic shock, pain and bleeding caused by spinal taps–each error creates a memory that never will allow such a mistake to occur again. It is the price of training a new doctor and the patient always–always– pays the price.
I was finishing my last on-call night on my obstetrical rotation at a large military hospital that served an army base. The hospital, built during WWII was a series of far flung one story bunker buildings connected by miles of hallways–if one part were bombed, the rest of the hospital could still function. The wing that contained the delivery rooms was factory medicine at its finest: a large ward of 20 beds for laboring and 5 delivery rooms which were often busy all at once, at all hours. Some laboring mothers were married girls in their midteens whose husbands were stationed in the northwest, transplanting their young wives thousands of miles from their families and support systems. Their bittersweet labors haunted me: children delivering babies they had no idea how to begin to parent.
I had delivered 99 babies during my 6 week rotation. My supervising residents and the nurses on shift had kept me busy on that last day trying to get me to the *100th* delivery as a point of pride and bragging rights; I had already followed and delivered 4 women that night and had fallen exhausted into bed in the on call-room at 3 AM with no women currently in labor, hoping for two hours of sleep before getting up for morning rounds. Whether I reached the elusive *100* was immaterial to me at that moment.
I was shaken awake at 4:30 AM by a nurse saying I was needed right away. An 18 year old woman had arrived in labor only 30 minutes before and though it was her first baby, she was already pushing and ready to deliver. My 100th had arrived. The delivery room lights were blinding; I was barely coherent when I greeted this almost-mother and father as she pushed, with the baby’s head crowning. The nurses were bustling about doing all the preparation for the delivery: setting up the heat lamps over the bassinet, getting the specimen pan for the placenta, readying suture materials for the episiotomy.
I noticed there were no actual doctors in the room so asked where the resident on call was.
What? Still in bed? Time to get him up! Delivery was imminent.
I knew the drill. Gown up, gloves on, sit between her propped up legs, stretch the vulva around the crowning head, thinning and stretching it with massaging fingers to try to avoid tears. I injected anesthetic into the perineum and with scissors cut the episiotomy to allow more room, a truly unnecessary but, at the time, standard procedure in all too many deliveries. Amniotic fluid and blood dribbled out then splashed on my shoes and the sweet salty smell permeated everything. I was concentrating so hard on doing every step correctly, I didn’t think to notice whether the baby’s heart beat had been monitored with the doppler, or whether a resident had come into the room yet or not. The head crowned, and as I sucked out the baby’s mouth, I thought its face color looked dusky, so checked quickly for a cord around the neck, thinking it may be tight and compromising. No cord found, so the next push brought the baby out into my lap. Bluish purple, floppy, and not responding. I quickly clamped and cut the cord and rubbed the baby vigorously with a towel.
Nothing, no response, no movement, no breath. Nothing. I rubbed harder.
A nurse swept in and grabbed the baby and ran over to the pediatric heat lamp and bed and started resuscitation.
Chaos ensued. The mother and father began to panic and cry, the pediatric and obstetrical residents came running, hair askew, eyes still sleepy, but suddenly shocked awake with the sight of a blue floppy baby.
I sat stunned, immobilized by what had just happened in the previous five minutes. I tried to review in my foggy mind what had gone wrong and realized at no time had I heard this baby’s heart beat from the time I entered the room. The nurses started answering questions fired at me by the residents, and no one could remember listening to the baby after the first check when they had arrived in active pushing labor some 30 minutes earlier. The heart beat was fine then, and because things happened so quickly, it had not been checked again. It was not an excuse, and it was not acceptable. It was a terrible terrible error. This baby had died sometime in the previous half hour. It was not apparent why until the placenta delivered in a rush of blood and it was obvious it had partially abrupted–prematurely separated from the uterine wall so the circulation to the baby had been compromised. Potentially, with continuous fetal monitoring, this would have been detected and the baby delivered in an emergency C section in time. Or perhaps not. The pediatric resident worked for another 20 minutes on the little lifeless baby.
The parents held each other, sobbing, while I sewed up the episiotomy. I had no idea what to say, mortified and helpless as a witness and perpetrator of such agony. I tried saying I was so sorry, so sad they lost their baby, felt so badly we had not known sooner. There was nothing that could possibly comfort them or relieve their horrible loss or the freshness of their raw grief.
And of course they had no words of comfort for my own anguish.
Later, in another room, my supervising resident made me practice intubating the limp little body so I’d know how to do it on something other than a mannequin. I couldn’t see the vocal cords through my tears but did what I was told, as I always did.
I cried in the bathroom, a sad exhausted selfish weeping. Instead of achieving that “perfect” 100, I learned something far more important: without constant vigilance, and even with it, tragedy intervenes in life unexpectedly without regard to age or status or wishes or desires. I went on as a family physician to deliver a few hundred babies during my career, never forgetting the baby that might have had a chance, if only born at a hospital with adequately trained well rested staff without a med student trying to reach a meaningless goal.
This baby should now be in his 30’s with children of his own, his parents now proud and loving grandparents.
I wonder if I’ll meet him again — this little soul only a few minutes away from a full life — if I’m ever forgiven enough to share a piece of heaven with humanity’s millions of unborn babies who, through intention or negligence, never had opportunity to draw a breath.
Then, just maybe then, forgiveness will feel real and grace will flood the terrible void where, not for the first time nor the last, guilt overwhelmed what innocence I had left.
For more information :
Intrauterine Fetal Demise – birthinjurycenter.org/types-of-birth-injuries/intrauterine-fetal-demise/
9 thoughts on “A Loss of Innocence”
Thank you for such an honest and moving memoir. Regards Thom.
My heart aches, and my eyes weep. Thank you for sharing this monumental lesson and memory.
In early December of 1971, after dating for three years, we were married at the tender age of twenty-three. And we were expecting in June. Mid-January of that same year, while in town on a day off, I found a man slumped against the display window of a large department store, boozy, cold to the touch and barely responsive. A store detective came outside and said, “Just leave him there. The police will take care of him.” Instead, I took him home to our tiny first apartment, undressed him, and put him in a tub of tepid water. Bearded and well-clad in a hunting jacket, wearing wire rimmed glasses, he looked for all the world like a college professor in some sort of trouble. I went through his wallet, discovered his name was Harry and that he was from Syracuse. I called his family and they we glad to hear he was okay, which he was after several cups of hot, black coffee. We were roughly the same size, so I offered him my extra clothes, put his in a bag, and took him back to town to board the bus for Syracuse, where his family had promised to meet him. Though I asked them to call me when he got in, they apparently forgot, and I never heard anything from or about Harry again, until twenty years later, in what amounted to pre-divorce counseling.
What I haven’t told you is that my new wife, just home from a day of teaching, walked into the bathroom while I was soaking Harry and let out a small shriek. I’d lost track of the time and actually never thought to warn her, and probably couldn’t have very well as this was long before cell phones arrived on-scene. That night, or early the next morning, she miscarried. Twenty years and two beautiful children later, she told me–for the first time ever– she thought I had done it on purpose, to make her miscarry. I hadn’t, of course, but I wasn’t a very worthy husband in any case.
I’m only sharing this to assure you that “Man proposes, God disposes” really is true, as harsh as it may sometimes sound. And if I were to comment on your story from long ago, I would say two things: better out than in and better late than never. Given the circumstances, I can find no fault. But the fact that you have held yourself responsible all these years may well have shaped an ethos that has helped many, enhanced, and actually saved numerous lives. Though remorse often seems destructive after a point, I think it can be instructive, too. And I’m certain others will benefit from your sharing today. In my own case, though I never remarried, I’d surely make a better husband if the opportunity should present itself. Now we know the real reason it snows in the “thoughts on” section of this fine blog.
Emily, this has been a sad posting for your readers to read today and I suspect one that has been just as difficult for you to dredge up from your memory once again.
Some memories — especially those that involve our human mistakes or errors in judgment that have caused us so much anguish and gnawing guilt over the years need to be re-evaluated at some point. My faith tells me that this is where the Holy Spirit takes over and assures us by His Grace and Mercy that we were indeed forgiven long ago for what we have continued to punish ourselves. The severity of the pain then becomes miraculously assuaged. The memory does not disappear. The pain and the guilt do – replaced by peace and the gift of spiritual wisdom.
By not being able to forgive oneself and by continuing to harbor guilt for our human errors does not seem to be consistent with what Scripture tells about our loving, forgiving God.
After getting to know you a little through your inspiring (and often earthy, common sense) writing, Emily, it is clear to me that your life is dedicated totally to healing — of body, mind, and spirit. You have long ago ‘atoned’ for any culpability in the heart rending incident that you have described herein.
It is time, way past time, for you to forgive yourself and to create new memories of the times that you have been the ‘wounded healer’ to so many for so long.
Peace be with you, dear DOCTOR Emily,
There are no words, but for yours. Thank you for the sharing the sacred and mundane truism.
thank you all for your comments and healing words. It means so much that you reach out.
I agree with Rob here–it is the memories of our failures, whether real or perceived, that keep us on the path to grace. Perhaps it’s different for doctors and firefighters upon whom people’s lives depend–we NEED to remember. There is no forgetting or forgiving the loss of a life. Like The Ancient Mariner, we will remember and retell and by doing so, we heal ourselves and others.
Thank you for your honesty. If every doctor held herself or himself to such a high, self-analytical standard, griefs and horrors of many kinds would have vanished long ago. I am impressed by your phrase “without constant vigilance, and even with it, tragedy intervenes.” In child-rearing and in many other occupations, perfect vigilance is humanly impossible. Similarly, perfect attention to a problem and relentless analysis cannot be perfectly sustained. We drag ourselves back to the foot of the Cross daily, seeking the peace that will allow us to not only live with the problem but to rise above it to hunt down its solution. The mutual learning between physician and patient that has deteriorated in the litigious atmosphere promoted by insurance companies (and others) is restored, just a little, by your moving story.