Tag: Medical student

Prepare for Joy: Sit Beside Me

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bench…we all suffer.
For we all prize and love;
and in this present existence of ours,
prizing and loving yield suffering.
Love in our world is suffering love.
Some do not suffer much, though,
for they do not love much.
Suffering is for the loving.
This, said Jesus, is the command of the Holy One:
“You shall love your neighbor as yourself.”
In commanding us to love, God invites us to suffer.

Over there, you are of no help.
What I need to hear from you is that you recognize how painful it is.
I need to hear from you that you are with me in my desperation.
To comfort me, you have to come close.
Come sit beside me on my mourning bench.
~Nicholas Wolterstorff from Lament for a Son

I wondered if 7:30 AM was too early to call Margy. As a sleep-deprived fourth year medical student, I selfishly needed to hear her voice.   I wanted to know how she was doing; she was not sleeping well either these days. She was wearing a new halo brace—a metal contraption that wrapped around her head like a scaffolding to secure her degenerating cervical spine from collapsing from tumor growths. When she was fitted into the brace, she named the two large screw-like fasteners anchored into her frontal skull her “Frankenstein bolts”.   I had reassured her that with a proper white veil draped around the metal halo, she would be more suited to be Frankenstein’s bride.

Each patient I had seen the previous 24 hours while working in the Emergency Room benefited from the interviewing skills Margy had taught each medical student in our class. She reminded us that each patient had an important story to tell, and no matter how pressured our time, we needed to ask questions that gave permission for that story to be told. As a former nun now married with two teenage children, Margy had become our de facto counselor, and insisted physicians-in-training remember the soul thriving inside the broken body.

“Just let the patient know with certainty, through your eyes, your body language, your words, that you want to hear what they have to say. You can heal so much hurt simply by sitting beside them and caring enough to listen…”

Now with a recent diagnosis of metastatic breast cancer, Margy herself had become the broken vessel who needed the glue of a good listener.   She continued to teach, often from her bed at home. I felt compelled to visit her that day, maybe help out by cleaning her house, or take her for a drive as a diversion.

Her phone rang only once after I dialed her number. There was a long pause; I could hear a clearing of her throat. A deep dam of tears welled behind a muffled “Hello?”

“Margy?”

“Yes? Emily? ”

“Margy? What is it? What’s wrong?”

Her voice shattered like glass into fragments, strangling on words that struggled to form.

“It’s Gordy, Emily. He’s gone. He’s lost forever…”

“What? What are you saying?”

“A policeman just left. He told us our boy is dead.”

I sat in stunned silence, listening to her sobs, completely unequipped to know how to respond. None of this made sense. I knew her son was on college spring break, heading to Mexico for a missions trip.

“I’m here, Margy, I’m listening.”

“The doorbell rang about an hour ago. Larry got up to answer it. I heard him talking to someone downstairs, so I decided to try to get up and go see what was going on. There was a policeman sitting with Larry on the couch. I knew it had to be about Gordy.”

She paused and took in a shuddering breath.

“Gordy died last night as they were driving to Mexico. They think he was sleepwalking and walked right out of the back of the moving camper and was hit by another car. “

Silence.  Strangling choking silence.

“They’ll bring him home to me, won’t they?   I need to know I can see him again. I need to tell him how much I love him.”

“They’ll bring him home to you, Margy. He’ll come home.  And we will go see him together. ”

 

bench3

What Oops Means to Me

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My husband, who I’ve loved for over three decades, has one (and only one) little annoying habit.  He says “oops!” for almost any reason.  It ends up being a generic exclamation that could mean anything from “I just spilled a little milk” to “There is a fire on the stove”.    If I’m driving and he’s a passenger, an “oops” from him might mean an impending crash or just a plastic bag flying across the road.  It is unnerving, to say the least,  to not know immediately what he is exclaiming about, or its significance.

What he doesn’t realize is that “oops!” can cause a PTSD response in someone with my history.

I was a very nervous third year medical student when I walked through the doors of the giant hospital high on a hill for the first day of my Surgical Rotation.  I had never been in an operating room other than to have my own tonsils removed at age four, and that experience was not exactly my happiest memory.  I worried I was not “cut out” for the OR, and wondered if I would faint watching patients being opened up, smelling the thin trail of smoke of the cautery burning bleeding vessels, or hearing the high pitched bone cutter saw.

The first lesson on my first day was to learn how to gown and glove up without contaminating anything or anyone.  It took several hours for an extremely patient nurse to get me to the point of perfection.  She taught me what to do if my nose itched (ask a circulating “non-sterile” nurse to scratch it over my mask), or if I thought I felt woozy (back away from the operating table so I don’t fall on the patient!).  I was ready to watch my first surgery by the afternoon.

It was fascinating!  I wasn’t lightheaded.  I could handle the sight of blood, wounds and pus, and the sounds and smells didn’t phase me.  I went home elated, eager for the next six weeks of caring for patients in a wholly new way.

Each day I helped in three or four surgeries, being asked to do different tasks by the surgeon, from holding retractors so he could see what he was doing, to doing the suctioning of blood in the surgical field, cauterizing blood vessels, and putting staples and sutures in the skin at the end.  The chief resident I worked with most frequently was a very high energy guy, talking non-stop during the surgeries, sometimes teaching (“what’s this that I’m holding? what does this connect to? tell me the blood supply to this?”), all the while listening to Elvis Presley tapes blasting over the sound system.  He’d dance in place sometimes, and sing along.  To this day, I can’t think of gall bladders without hearing “You Ain’t Nothin’ But  A Hound Dog” in my head.

So when the surgery got complicated, I could tell because all the surgeon’s antics stopped.  He got very quiet, and he focused on his hands, including getting more demanding of the staff around him.  Shadow swept in, covering his normally sunny personality, and he’d bark orders, and sometimes grab my gloved hands and move them where he needed them.

One day, we were involved in a high risk surgery on a patient with late stage liver disease, who had a recent near fatal bleed from dilated blood vessels in her esophagus, caused by back up of circulation that could not easily pass through her scarred liver.  The blood vessel shunt procedure the surgeon was doing would allow the esophageal varices to deflate with less chance of breaking open again.   The surgeon had been intently working, without singing or dancing that day, so when I heard him softly exclaim “oops!”, I looked up at his face.  His eyes were big and round, his forehead sweating.  I looked down at the large blood vessel he had just nicked accidentally, and then the wound filling rapidly with blood.

“We have big trouble here!” he shouted.  I was moved out of the way, and the surgical team launched into action.  I was sent five floors down to the lab to retrieve as much blood for transfusion as I could hold in my arms, and spent the next hour running blood up those five flights of stairs.

That patient didn’t make it.

Sometimes in my dreams, now thirty five years later, I am running those hospital stairs carrying bags of blood, swirling in a vortex of red.   I never do save the patient.

And “oops” always means big trouble.

A Loss of Innocence

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snow225146

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.

snowonsnowdrops

For more information :

Intrauterine Fetal Demise – birthinjurycenter.org/types-of-birth-injuries/intrauterine-fetal-demise/

Hitchhiking Right Out of the Classroom

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His reputation was well known and all the medical students had heard the stories about Dr. Rosse. As the Anatomy Professor, his class would become the primary focus of student energy in the first year of medical school, with other classes seeming like so much background noise.

Dr. Rosse believed in active student participation in class, in the cadaver lab, on oral tests. He told us from the first day on: ” You will learn to THINK in this class like you’ve never thought before! Your patient’s lives depend on this. You will be prepared for my class each and every day, just as you must be prepared for whatever your patients will need from you.”

He was correct.

There were 110 of us in the lecture hall that first day, looking nervously at each other and at the empty podium down in front. We had been assigned three chapters in the anatomy textbook before Dr. Rosse’s first lecture and were expected to know the names of the bones and major blood vessels.

Dr. Rosse’s assignment for himself was to memorize our names and faces from a photo directory provided to him two days previously.

He began his lecture in the barely darkened room, running quickly through a carousel of slides of graphic photos and drawings of body parts. Within five minutes, he stopped and in his thick European accent, pointed at a student in the second row said: “Mr. Davis, can you tell me the name of this blood vessel on this slide?”

The student sat up startled, and sat silent, gathering his wits. Dr. Rosse looked pointedly at his wrist watch and started saying, “Drip. Drip. Drip.”  The student started to sweat.

“Drip, drip, drip, your patient is losing blood, Mr. Davis.”

The student, in a moment of enlightenment asked,” the inferior vena cava?” and Dr. Rosse said, “Very good, Mr. Davis!” and made a notation on the tablet on the podium in front of him.

The rest of our hearts immediately were in our throats, something that Dr. Rosse would later tell us was an anatomic impossibility, no matter how much it felt like it. There would be no dozing off, daydreaming or not preparing for this class.

My turn came the following week as he called out my name, his steely eyes fixed on only me. I got off fairly easy with a question from Dr. Rosse about the attachments for the extensor pollicis longus. I had memorized all the arm muscles the night before so was prepared.

“Yes, very good, Miss Polis.  Now tell me, if I were to fall off this podium right now, land on my outstretched arm and rupture my extensor pollicis longus, what would I not be able to do with my arm?”

I had no idea. I looked at him somewhat aghast. I thought I had done the necessary preparation to be ready for his questioning. My memorizing names and locations of muscles and tendons had only taken me so far. I had not really thought about the functionality of what I was learning and how it might be relevant to my future patients.

“Think now Miss Polis! This is not so very hard that you can’t THINK it out!”  Dr. Rosse demanded from the podium.

So I guessed. “Uh, you can’t grip?”

“Exactly wrong! Take a hike back to your study carrel, Miss Polis.  You have not prepared yourself well enough. Go back to your book, and with each muscle you memorize, you must feel it on yourself or your study partner and think about how it works. Your patient will thank you for that someday.”

I was mortified that day, but survived that anatomy class, survived six oral exams over the cadaver with Dr. Rosse, and although I didn’t get an A in his class, I was very relieved to get a B+. As a student, I had never been asked before to actually apply what I was learning to make it relevant to my future work. Dr. Rosse was right. I had learned to not just memorize, but to think.

And when I saw my first extensor pollicis longus rupture seven years later in my practice, I was absolutely confident of the diagnosis because my patient could not lift up his thumb when asked to act like he was hitchhiking.  And my patient did thank me.  Dr. Rosse was right again.

Looking Ahead in the Rear View Mirror

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Amazon, formerly the Public Health Hospital
Amazon, formerly the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital

While sitting very high in the upper reaches of Safeco Field watching the Mariners play the Cleveland Indians, my attention was diverted to the expansive view of surrounding Seattle. In particular, I kept looking at the PacMed Tower above us on Beacon Hill, now home of Amazon.com.  It seems like only yesterday when I spent thousands of hours in training inside the walls of this remarkable old building, but in reality it is over 30 years ago, back in the days when it was the Public Health Hospital, home for medical care in the region for the Merchant Marines, as well as many of the indigenous people of the northwest and Alaska, in addition for the local folks who needed affordable (as in free) health care.  I had opportunity to work several rotations in this building as a medical student in Seattle, and to think of this place as the headquarters for Amazon makes my brain do twists.  There was so much life and death inside those walls for so many years.  Now it is corporate headquarters for a web giant, selling every gadget and gizmo under the sun and some days I feel like one of their best customers because it keeps me out of the toxic environment of the local mall.

I first walked in this building as a very green 24 year old med student beginning a surgical rotation, knowing only which end of the stethoscope to put in my ears and which end rests on the patient.  The first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me.  I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) is rare these days.  My chief resident was an exceptionally talented but eccentric man who worked himself and all under him around the clock.  After becoming very prominent in a city known for its fine surgeons, he developed a drug problem for which he sought treatment and remains an authority on helping impaired physicians, assisting other providers to acknowledge addiction before they harm a patient.  He could only operate listening to the music of Elvis Presley.  I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus.  It is my particular burden to bear…

Those were heady days and nights of experiencing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR as our team operated on a Native American patient bleeding from her dilated esophageal varices, which had developed as a result of her damaged liver from her long alcohol dependency.  We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. Instead I’ve spent the last 20 years of my clinical life working in alcohol and drug treatment, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail.   Even when all the right people, and the right equipment, and the right medicine is seconds away, death still comes, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us.  We can die, in our sleep, whenever it is our time. Years later, I remember that in my evening prayers.

There was also the young surgical resident who was hospitalized with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training.   No vaccination was available in those days, but was developed soon afterward.  And it was in this hospital we began to see unusual cases of young gay men with severe wasting, rare skin cancers and difficult to treat pneumonias, initially called GRID (gay related immune deficiency), part of the early front wave of AIDS as it swept across the US in the late 70s and early 80s.

One night in particular sticks out for me.  It was Christmas Eve 1977, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so were being diverted to other hospitals, so our patient load was light.  I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view in the photo above, only everything was blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night was practically abandoned, and the lights of the city were brighter from the snowfall.   It was an enchanting vision of a city forced to slow itself and be still, anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew.  My chief resident thought I’d make a good surgeon–my heart told me that I’d make a better family doctor.  The city held so many attractions and excitement with the potential of a big salary and notoriety, but my heart longed to return to a farm and a someday family.  It was a wistful bittersweet night and I slept little,  staying perched on that little bed overlooking the sleeping snowy city and wondering where my life would take me.  If I’d looked just a little to my left, and some 32 years ahead, I would have seen myself, sitting with a man I had recently met but didn’t know I’d someday marry, and our nearly grown and flown family in the top rung of a new baseball stadium.  And now the older wife/mother/farmer/family doctor I have become,  gazes back up at the much younger undefined medical student looking out that upper window of a classic old hospital building, reflecting upon who she was becoming on that night long ago.

I still am reminded every day at how little I know,  but I do know this: for however long we’re on this earth, we do have distinct purpose and meaning.  Perhaps my purpose was to be snowbound on that Christmas day, unable to go home from my shift because my car was stuck in the parking lot, spending the day singing Christmas carols for all the patients who had no other options but to stay put in their hospital beds that day.  Perhaps mine was to be the future blessing of an incredible husband and delightful children on a little farm 100 miles to the north.  Or perhaps mine is to continue to share a little of life’s lessons learned while I gaze in the rear view mirror~ the reflections of a life in progress.

The Gratitude of the Guilty

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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 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 great.

A 25 year old idealistic and naive student, I really 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 during 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. There were a high number of deliveries of teenagers at this hospital. Some were married girls of 14, 15 and 16 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 into bed in the on call room, exhausted at 3 AM with no women 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 the 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 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 and suture materials for the episiotomy ready, and when I noticed there were no doctors in the room, I asked where the resident on call was. 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 standard procedure in all too many deliveries. Amniotic fluid and blood dribbled out and 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 skin 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, not responding. I quickly clamped and cut the cord and rubbed the baby vigorously with a towel. Nothing, no response. 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 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. 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 labor 30 minutes earlier. The heart beat was fine then, and because things happened 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 30 minutes. It was not apparent why until the placenta delivered and it was obvious it had partially abrupted–prematurely separated from the uterine wall and 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.

Later, in another room, he made me practice intubating the 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. In the delivery room, the parents held each other, sobbing, while I sewed up the episiotomy in silence. I had no idea what to say and was mortified and helpless as a witness to such agony. I said I was so sorry, so sad they lost their baby, felt so badly there had been no way to know sooner. There was nothing I could say that could possibly comfort them or relieve their horrible loss. And they had no words of comfort for me as I struggled with my guilt.

Later I cried in the bathroom, selfish. Instead of achieving that “perfect” 100, I learned that death intervenes in life unexpectedly without regard to age or status or wishes or desires. I went on as a family physician to deliver hundreds of babies during my career but could never forget the baby that might have had a chance, if only born at a hospital with adequately trained well rested staff, without a student trying to reach a personal meaningless goal. This baby should 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 someday, this little soul that almost was, if I’m ever forgiven enough to share a piece of heaven with innocent babies who never got to draw a breath. Then, maybe then, forgiveness will feel real and grace accepted with the gratitude of the guilty.