Nickolepsy

The Assent Of Man

October 12, 2010
4 Comments

This time I had my wallet open, five-dollar bill in my hand before Dana turned to help me.  It didn’t matter.  We danced our usual dance.

“That one’s on the house, honey,” she said, smiling and nodding toward the cup of coffee in front of me.

“No, no,” I said.  “I’m paying,” and put the five on the counter. She pursed her lips, traces of the smile still there, and shook her head.  A lock of thin, blonde hair escaped from her ponytail and slid down past her ear.  It covered part of the tattoo on the side of her neck.  I had forgotten about her tattoo.  Her eyes, blue and a little bit puffy, crinkled in mock anger.  I frowned a little at her for real, as if to say, “Just give me a break this time.”

Usually I dance along, matching her smile for smile and gracious for gracious.  Today I needed a win.  The weather was gray and drippy, I had stayed up too late the night before, and I wanted to get through morning rounds at the hospital quickly.  There was no one in labor — if I were lucky, I’d be able to shave a bit off of the pile of paper on my desk before being paged.  Just let me pay for my coffee, I thought.  I don’t want to talk, I don’t want to play games, I just want to get to work.

~

The day before in clinic had been busy and frustrating.  I had left notes undone, had put off the filling out of forms.  After clinic I had gone home, fussed at my wife, and nagged my boys until the living room and kitchen were tidy.  Then everyone had escaped to their rooms or their friends’ houses, leaving me alone as I drank wine and folded laundry.

Somehow that hour folding laundry felt like the only real one of the day.  I reveled in the quiet.  I poured the glass of wine, sipped it, plunged my hands into the warm, dry, inchoate mass of cloth, and then piled it on the table behind me.  Sip wine, match socks, sip, smooth and fold pants, snap and fold towel, sip again.  I brought order to chaos.  I felt like a god.

Folding laundry makes me feel like a god.

Being a doctor doesn’t.

Even the infrequent life-and-death moments that I face feel quite earthly.  My work mostly involves the give-and-take negotiations of office visits.  When I’m on call at the hospital, I occasionally face a tense situation (like a difficult birth) that requires calm and focus.  Those moments are less common than you might think.  Lapses and wrong decisions can have terrible consequences, of course, so, like my colleagues, I’ve developed rituals that I follow compulsively.  It’s not exactly a godlike existence.

The paperwork is my one work-related shot at godhood.  Shrinking that pile brings order to chaos.  It doesn’t feel warm and soft in my hands like clean laundry does, but that’s not the problem.  The problem is that the pile is a prank played on me by the real gods.  When the 7PM pile is bigger then the 7AM pile had been, I am Sisyphus.  When it’s smaller, I am Tantalus.

Last night I was Sisyphus.  I’d rather be Tantalus.

Today I could be Tantalus.

~

Dana didn’t let me off the hook.  She leaned towards me, over the counter, and said quietly, firmly, “This is on the house.  I wouldn’t have my son if it wasn’t for you.”

That was simply not true.  I’ll tell you what really happened.

I first met Dana a couple of years ago.  I happened to be on call the weekend she went into labor.  Her labor was pretty normal — we had a few worrisome moments when the baby’s heart rate dropped, but he turned out to be fine — and the delivery was straightforward.

There were only two reasons why her delivery sticks in my mind.  One was that she had come in determined to give her baby up for adoption, and had asked not to be shown the baby after he was born.  Then, just before she started the pushing phase, she announced that she was going to keep the baby, and would I please please hand him to her when he was out.

After I handed him to her, she clutched him as if he were her long-lost love, but she didn’t kiss him or nuzzle him.  She looked at him with astonishment, as if she weren’t sure he was real.  She barely seemed to notice when I delivered the placenta, or even when I stitched her laceration.  She held his slippery little body tightly to her chest with her eyes closed, then lifted him and stared at his face, then clutched him back again, over and over.  She breathed deep, shaky breaths, and silent tears trickled down the sides of her cheeks.

The second reason I remember her delivery is that she works down the street from the hospital, in the cafe where I often get my morning coffee.  On the day  I admitted her to the hospital, I had vaguely recognized her as the new person behind the counter at the cafe.  In the process of admitting her, I learned some of her most painful secrets.

She was a mess back then.  She had had problems with Oxycontin and alcohol in the past, although she had been clean and sober since before the pregnancy.   We talked about this on the day I admitted her, and I asked why all of her urine drug screens had been positive for marijuana.  She pooh-poohed this, saying “That’s an herb, not a drug.”

She had had Chlamydia twice (one of those times being at the beginning of the pregnancy).  She refused to name the father of her baby, saying only, “He’s an asshole.  I don’t know where he is.  He’d be the world’s shittiest father.”  She had moved back in with her mother — at the age of 31 — after she had found out she was pregnant.  She said that she and her mother got along well enough, and that she liked working at the cafe.  “I never thought I’d like such a boring life,” she said, and then laughed.

As we finished the process of admitting her that day, I said that she seemed to be finding herself.  She said, “Yeah, right,” then snorted.  “I’d still be a shitty mother.  Maybe someday.”

That night, her baby’s heart rate dipped a couple of times, briefly.  I told her that I was a little worried about the baby’s circulation.  She looked surprised and angry.  The heart rate recovered, and then stayed reassuring.  The next time I came in, she said, “My mom wants to know why you’re not doing a c-section.”  They had spoken on the phone.  I explained that the dip in heart rate was the equivalent of his holding his breath for 30 seconds.  Not a problem in itself, just a little red flag that told us that to keep an eye on the baby.  She was silent for a moment, and then said, “Oh.”  Then, “Ok.”  Then her eyebrows buckled and she frowned.  “You sure?  Just because I’m not keeping the baby doesn’t mean I don’t care.  I’d have the c-section, you know.  I know what’s important.”

I told her that I was as sure as I could be that the baby was fine at that moment, that it was perfectly clear that she cared, that I had assumed she wanted to do the right thing, and that we were going to do everything to make sure we ended up with healthy baby and healthy her.  The rest of her labor and delivery went uneventfully – except, of course, for her announcement that she would not be putting him up for adoption.

~

Ever since then we have struggled over who would pay for my coffee. At first she pushed me not to pay, saying each time, “I’ll cover it.”  I refused to let her pay.  Sometimes before she handed me the cup, she would announce that she was buying my coffee that day, and then ostentatiously put money in the register to cover it.  I would then put extra money in the tip jar, and she would glare at me.

We gradually accomodated each other.  She loved it once when I said that I didn’t feel human until I had my coffee.  She called me “Dr. Human” for a while.  I felt like more of a Dr. Monster, though, letting this person who earned so little money buy me anything.  After a couple of months we each relaxed, and now she often doles out compliments instead of money.  Sometimes she “by accident” gives me a large instead of a medium, and then says, laughing, “You don’t want me to waste the cup, do you?  You’ll be EXTRA human today.”

Usually when I see her I ask about her baby — now toddler.  She always has photos, and always seems excited to show them.  “He’s my love, you know,” she says.  “God really blessed me with this one.”  I murmur appreciation.  It’s a pleasure to see how happy she has become.

~

Today, I was in no mood for pleasure.  I was surprised that she so brazenly refused to let me pay.  Then, when she said that she wouldn’t have her son if it hadn’t been for me, I realized that she thought I had saved his life.

“No, no,” I said.  I took a deep breath and put my hands on the counter.  She started to say something, but I needed to make her understand what had really happened.  “He would have been FINE.  Have you thought this whole time that I saved his life?  I didn’t need to do ANYTHING for him.  I don’t remember what I said to you, but, REALLY, I was just a bystander, keeping an eye on him.  YOU did all the work.”

She glanced around, making sure no one was in line, and that her coworkers couldn’t hear us.  She leaned over the counter, put her hand on mine to keep me there, and said in a quiet, strong voice, “Oh, I remember what you said.  I remember EXACTLY what you said.  You said he held his breath.  That’s when I knew how scared I was for my little boy.  That’s when my heart started to open.  You told me that you would keep him safe, and that’s when it opened all the way.  I kept my heart closed the whole time I was pregnant, because I shouldn’t have got knocked up, and I knew I had problems, and I was scared of what my mom would think of me ‘cause I knew I couldn’t be as good a mom as her.”  Her voice cracked.  “But you saw through me, you saw that God loves me, and you told me that of course I cared about my little boy.”

She paused for a moment, and a tear dropped from one eye.  I started to respond, but she pressed my hand harder against the counter to hush me.  “God blessed me that night.  I know it was really Him that opened my heart, and that He worked through you.  I thank Him every day.  But He’s way up there, and you’re right here.”  She wiped her eyes with her sleeve and looked straight at me.  “ You are right… ” She gently knocked my hand against the counter as she said it.  “…here.”  She knocked my hand against the counter again, then clasped it.   “I’ve worked really hard to be good.  I don’t swear no more.  I don’t smoke weed.  I can be that good person you saw that night.  You look stressed out.  Let me pay for your cup of human this time.  OK?  Because God loves you, too.”

My heart opened.

I let her give me the coffee, watched as she fished a couple of crumpled dollar bills from her pocket and put them in the register.  I put my five away, and stood there.  She looked up.  Returning to her usual perky tone, she said, “I get you something else?”

“Yeah,” I said.

I asked her to give me a photo of Robbie, her little boy.  She sniffed once, wiped her nose on her sleeve, grinned, then pulled off the little photo taped to the side of the register and handed it to me.  He has her thin blond hair, her wide set eyes and her broad face.  I put his photo in my jacket pocket, and picked up my cup of human.

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Song of the Day — David Bowie

May 19, 2010
4 Comments

What a silly time to write.  3 in the morning, while on call.   Following two women each of whose labors are slow, each of whose babies are doing fine.  I could nap for half an hour.  Tomorrow I will regret not sleeping more.

Tonight I am fascinated.  And once again Late Night Exuberant Nick indulges himself at the expense of Morning Slow-Moving Grumpy Nick.

Thus it has always been.  Thus it remains.

There’s a reason that Harold and the Purple Crayon kept me so absorbed — Harold understood that no matter when the portal of fascination opens, you must take your purple crayon and dive through it.  Go exploring.  Indulge.  It’s a crime against yourself to do otherwise.

Today I got to be present for an amazing labor and delivery.  A young woman from Guatemala, standing all of four feet, eight inches, having spent all of five months in this country, pushed out her first baby — an eight pound, five ounce boy.  Pretty standard story, so far, to my eyes.  We get a lot of Guatemalan Harolds here, keeping their heads down and working their purple crayons to draw new lives for themselves.

What was unusual was her two older sisters.  They were utterly acculturated, speaking perfect English with only slight accents.  Though they were in their mid- to late-20s, they had a total of only one child between them.  They were almost as small and thin as my patient, and worked constantly.  One would murmur in her ear during contractions while the other refreshed the damp cloth and wiped her forehead.  One would draw the bath while the other calmly and forcefully reminded the patient that she was going to do this, that she should breathe through this contraction.  The patient took a few baths.  Each time, when I walked in the room afterwards, the fronts of her sisters’ shirts and jeans were soaked.

After a while, I decided that these women must have attended many births.  I knew that their mother (whose body had borne 9 children) was a midwife.  Not only were these two sisters engaged throughout, nurturing her, coaxing her, reminding her that she was strong enough to get through this, they also had a mastery of the small touches.  The face cloth.  The back massage.  The well timed joke.  It was no surprise, when the disc that monitored her baby’s heartbeat slipped off, that one of her sisters absent-mindedly picked it up, swabbed more gel on it, and replaced it.  Perfectly.  Found the heartbeat immediately.

The aftermath of a normal, healthy birth is always a warm, euphoric scene — a similar feeling to that of a dressing room after a successful performance.  It’s always satisfying to catch the new mom’s attention and explain to her exactly what she, personally, here, today, did that was amazing, and why that means she is likely to be a great mom.  I never lie.  I never have to.  Maybe three or four times I have felt like I couldn’t find meaningful praise, and those times have skipped this spiel and just said congratulations.

Today, I got to do this, and then lingered longer than usual to praise her sisters.  That’s when I found out that, though the eldest had been through her own labor, neither of them had ever attended a birth before.  I must have looked surprised, because the younger of the two then launched into the story of how they had talked to everyone they knew, and had taken books out of the library and watched “many many videos.”  Clearly, this was the project of the entire few months since they had found out about their newly-arrived sister’s pregnancy.

I said, “Excuse me, but we read a lot in medical school, too.  You’re not supposed to be this good at it without experience.”

She laughed briefly, to show me that she got the joke.  Then said, “but it was FASCINATING!”

It is.

Fascination

One last thing.  Roll your eyes if you want to.  Yes, I’m talking to YOU, my dear.

I want these people in my country.  I’m talking about people who grab their purple crayons, who bust their butts to make good lives.  This is not at all about lefty-liberal politics.  This is me wanting to surround myself with people who work hard and show initiative.  I love that.

You can unroll your eyes now.


Unsuffer This

January 31, 2010
13 Comments

(click for song):          Trouble

“I’m sorry to wake you, doctor, but we can’t find the heartbeat.  Can you come?”

“What heartbeat?  Ms. Evans delivered at five o’clock.  I don’t have anyone else in labor.”

“She’s here for a scheduled section, doctor.  I know she’s not yours, but can you please come?”

“Yes.  Of course.”  I looked at the clock next to my bed in the call room.  It was 6:35AM.  I had dropped like a doll on top of the blankets an hour earlier without even changing out of my scrubs.  I was exhausted, and had hoped to sleep until my replacement arrived at eight o’clock.

I turned on the light, splashed some water on my face, noticed my red eyes and bed hair in the mirror, let a twitch of self-conscious worry about looking professional seize me, smoothed my hair once, and then shuffled quickly out to the labor and delivery unit.

Rachel, who had teased me earlier by threatening to page me five minutes after I fell asleep, intercepted me at the doorway looking miserable and slightly scared.  “Sorry, Nick.  This is a 39 week nullip here for a scheduled c-section for placenta previa.  Hasn’t felt the baby move for 2 days.  Didn’t realize she should call.   Linda’s been all over her belly with the Doppler.  I checked it while she was calling you.  Nothing.  We thought you could take a look with the ultrasound.  I hope you don’t mind.  She knows something’s up – I didn’t want her to wait.”

I nodded, grabbed the little cart with the ultrasound on it, and wheeled it into the recovery room.  This young woman was here to have her first baby, was scheduled to have a caesarian section one week before the due date.  The placenta, which is like a tangle of roots and soil from which sprouts the umbilical cord and which normally attaches to the side wall of the uterus, covered instead the opening of this woman’s uterus.  If she were to labor normally, her dilating cervix could make her hemorrhage.  Statistically, 39 weeks is the time when babies are least likely to suffer complications, so here she was waiting today for my incoming colleague to give her a c-section.  Formal ultrasounds are done in the radiology department, but we kept a little machine in labor and delivery to confirm things like fluid levels and the positions of babies’ heads.

I opened the curtain to find a young Latina woman in the bed, johnnie lifted to reveal the large bulb of her abdomen.  Her face was heart-shaped, with a jutting chin.  Her long black hair was mostly gathered inside of a blue lunch-lady surgical cap, with one wisp stuck to her damp cheek.  Her eyes were dry, now, but clearly puffy from crying.  She stared intently into the eyes of the young man who knelt on the floor with his elbows wedged under his chest on the bed next to her pillow.  His two hands cradled one of hers, his stubby fingers interlaced with hers, stroking her hand with one thumb rhythmically, as he would a rosary.

“Hola,” I said, in my best calm, avuncular tone, and plugged the machine into the wall behind them.  They looked at me expectantly.  Pleadingly, or perhaps I imagined this.  “Yo soy Doctor Mayper.  ¿Español es mejor?  ¿Engles?”  I’m Doctor Mayper.  Is Spanish better?  English?

“Español,” said the young man.  Spanish.

So, in clumsy Spanish, I told them what they already clearly knew.  That the nurses were having a hard time finding the baby’s heartbeat, and that I was there to take a look with the ultrasound.  I felt relieved when they both continued to look worried as I set up, because that meant they probably did not hold false optimism.  Sometimes a new nurse like Linda might misjudge something like a fetal heart beat, but Rachel was a skilled and experienced charge nurse whom I trusted.  If she hadn’t been able to find a heartbeat, then there was probably no heartbeat to find.

I sat on the edge of the bed and turned the machine on.  Linda, a young blonde-haired woman with freckles and an upturned nose, whom I had vaguely dismissed during the few months she had worked here, hovered at the side of the monitor, fidgeting.  Rachel, an African-American woman in her late 30s with hair so straight that I wondered if she ironed it, a nurse both competent and so funny that I wished I could arrange my schedule to take call only when she would be the night nurse in charge, hung back frowning, arms crossed, rocking back and forth unconsciously.

As the monitor warmed up, I asked the couple their names.  Luz Martinez.  Jose Salvador.  I squirted the cold blue gel onto the flat tip of the ultrasound probe.  Adjusted the monitor so that we could all see, and pressed the probe against her belly.

Shadows and fuzzy gray lines played on the monitor, splitting and coalescing like a grainy black and white kaleidoscope until I got my bearings.  There the spine, looking like the crossties of a train track.  There the balloon of the skull.  Slide the tip of the probe over, as if massaging her belly.  The face with its dark eye sockets.  Slide the probe up.  That’s the abdomen.  Back toward the skull.  Back down.  Back and forth.  Narrow in on the chest, a sinking sensation in my own at the lack of a butterfly heartbeat.

My eyes, which had darted back and forth between Luz’s belly and the monitor screen as I got my bearings, now stayed fixed on the screen.  The back and forth sweeps of the probe shrank to tiny scooping arcs, as if it were a spoon and I were using it to scoop a beating heart from the bottom of a bowl of soup.

With each adjustment it became more obvious that this baby’s heart had stopped fluttering.  The monitor blurred and swam briefly as I blinked away tears.  There.  That’s two, four chambers.  Try another angle.  Yes.  Another angle.  My world had shrunk to this staticky image on a screen, of a heart that would not beat, in a shadowy body that floated passively as its mothers breathing turned to sobs, bobbing up and down like a corpse floating next to a wharf at high tide.

Not “like” a corpse.  A corpse.

My vision grew watery again.  As I stared at this calm, still heart, my head swam and my heart raced.  I looked at Luz, then Jose, as if seeing them for the first time.  Luz had covered her face with her free hand.  Tears crawled down Jose’s cheeks.  He clutched her hand to his mouth, squeezing it, his hands pressed close as if in prayer, staring at the screen.

I lifted the probe from her skin in defeat.  “Lo siento,” I said.  I’m sorry.  Gel lay smeared on her belly, heaped at the sides like plowed snow.  She peeked over her hand at the monitor, which of course now showed only static.  Her face folded at the sight as if in anger, then she clawed at her forehead with her fingers, pounded her eyes with her hand, and sobbed deep, gasping, gulping sobs.

Still holding the probe uselessly in my hand, tears now pouring out of me, I looked to Jose.  He still clutched her hand, but had moved it with his, pressed his thumbs against his forehead and rocked back and forth tapping against them as if in gentle mimicry of Luz’ pounding.

~

After the c-section I hung around to interpret.  The hospital has professional Spanish language interpreters, but the visitations of medical professionals kept leaving Luz and Jose with unanswered questions.  So I appointed myself general liaison from the arcane country of medicine.  I had no other responsibilities, and could afford to sit the whole morning with them after the c-section.  To be honest, I was there also because I couldn’t figure out how to cope with this horror.  It was a relief to find something useful to do.

I had scrubbed in for the c-section, as first assistant to my colleague Jean Baptiste.  Dr. Jean, as most people called him.  The boom box that usually sprinkles the room with quiet music during operations lay silent.   Words were scarce – just the bare minimum needed to keep the correct instruments flowing into and out of the operating field.  Luz’s body was covered with a sterile blue drape, With a circular window open in the middle to reveal her lower abdomen.   It inflected at her chest, and soared up like curtains to clamps a couple of feet above her body, hiding her face and head from our view.  Jose sat, wearing a yellow hospital gown and his own lunch lady hat, behind the curtain to be with Luz.  She was awake the whole time, of course, spinal block numbing her body from ribs to toes.

The baby was a little bit stiff as he came out.  Dr. Jean nodded to me as he cut the cord, and I lay the baby in the blanket held by the pediatric nurse behind me.  It felt surreal, this ritual performed every day with babies floppy or crying, now steeped in silence.  As the nurse swaddled him, I turned to Luz and Jose.  “Baron,” I said.  Boy.  Instantly I regretted the word, spoken out of habit.  How could this matter to them?  But, oddly, a small smile flickered on each of their faces before the deluge of grief returned.

The pediatric nurse brought their son to Luz, and held him close to her face.  Luz kissed his thick black hair, her eyes tightly closed with tears somehow escaping anyway.  The nurse gestured to Jose.  Did he want to hold the baby?  He opened his arms uncertainly, took the swaddled, lifeless body, then clutched his son to his chest and closed his eyes.  Rocked back and forth a little.  Softly murmured, “mi hijo, mi hijo.”  My son, my son.

The baby’s face was tinged, mottled with purple and red, and a little bit puffy.  As Luz had kissed him I had felt thankful that his skull hadn’t started to soften yet.  Sometimes, when the baby has died a long time before delivery, we need to wrap him or her carefully in a damp blanket, only the face exposed, the gelatinous head buried in folds of cloth.

His puffy face pinched his eyelids closed, as if he were trying to ignore us, as if in imitation of his parents’ expressions.  He had felt warm – a last gift from his mother – but stiffer than a living baby.  I couldn’t decide which was more disturbing – the warmth or the stiffness.  I had quickly checked his neck, his cord, scanned his body, but saw no sign of why he had died.  The placenta was normal, the amniotic fluid clear.  I wished he would look peaceful, but instead his puffy eyelids made him look vaguely annoyed.

~

As Luz was being cleaned and brought to the recovery room, I sat with Jose in a small side room and asked if he had any questions.

He asked, “¿Mi hijo… sufrió?” Did my son suffer?

I froze a split second longer than I would have wanted to.  Of course there is only one correct answer to that question.  “No,” I said.  I could imagine agonizing suffocation, pain incomprehensible to such a young, tiny person.  Such thoughts torture me sometimes.  But I could know nothing for certain, and my responsibility was to the living.

He looked at me.  “¿No cree que sufrió?”  You don’t think he suffered?

I pursed my lips, raised my eyebrows.  Closed my eyes to try to banish my own demon thoughts.  Shook my head gently.  Looked back at him.  “Se fue a dormir.”  He went to sleep.

Jose clutched his face, bowed his head and sobbed audibly.  I had not seen him allow such expression in front of Luz.  I reached out and patted his shoulder, crying again myself, thinking guiltily of my own three living sons.  He shuddered a little and shook his head.  I withdrew my hand.  Then, twisting in his chair away from me towards the wall, he let escape the same deep, gasping, gulping wail that had erupted from Luz earlier when she saw the blank ultrasound screen.

I sat with them, first in the recovery room where nurses came and went carrying sad faces, then in the postpartum bedroom where the nurse visits were interspersed with concerned specialists wanting to impart information, ask preferences, get signatures on permission forms.  The three of us had never met before that morning, but every time I asked if they wanted privacy they seemed sincere in their reassurances that they were happy I could stay.  When we were alone, I mostly sat in the corner chair, gazing out the window and looking back at them occasionally, wondering if I had betrayed Jose by covering up my nightmare fantasies about how their son had died.

They had to make decisions, the biggest of which was whether they wanted an autopsy.  The neonatologist, the head of the special care nursery, the chief pathologist, even the geneticist (who happened to be in the hospital for a meeting with the pathologist that day) all came to speak in somber but urgent tones about the benefits for future pregnancies, future babies, if Luz and Jose were to be able to understand what had happened this time.  No need to decide now, they were told, but the clock is ticking so please tell us as soon as you make your decision.  We’re so sorry.  We know this is a difficult time.

Then the specialists would leave, nodding at me, thanking me for interpreting, and Luz – usually Luz, except when she would nod at Jose as if to tell him it was his turn to ask something – would ask what felt like the important questions.

“¿Tienen que cortar a abrir su cuerpo?”  Do they have to cut him to open his body?

“Si.” Yes.

“¿Se lo puso de nuevo juntos después?”  Do they put him back together afterwards?

“Si.”

“¿Está seguro de que no se sentirá ningún dolor?”  Are you sure he won’t feel any pain?

“Si, lo prometo.”  Yes, I promise.  “Nunca se sentirá dolor.  Nunca.  Sé que estos médicos y que se amable y respetuoso.  Quiero confiar en ellos con mi bebé.”  He will never feel pain.   Never.  I know these doctors, and they will be gentle and respectful.  I would trust them with my baby.

This was all true.  I felt relieved to be able to say such honest reassuring things.

“Doctor,” Jose said after a long silence.  “Diganos lo que haría.”  Doctor, tell us what you would do.

“Esta decision tiene que venir del corazón.  Yo vivo en este mundo de la medicina, y no se puede imaginar a lo que la vida fuera de la que es.  Sin embargo, una autopsia puede ser la única forma de descubrir algo que podemos hacer para proteger a sus futuros bebés.”  This decision must come from your hearts.  I live in this world of medicine, and can’t imagine anymore what life outside of it is like.  But an autopsy may be the only way to discover something that we could do to protect your future babies.

“Gracias, doctor.  Mi esposa y yo quiero estar sola ahora.”  Thank you, doctor.  My wife and I would like to be alone now.

~

I visited them twice more during her stay, but the next time I visited the hospital they had already gone home.  I called Rachel – the first time she and I had spoken outside of work – and she told me they were planning to move back to Colombia as soon as Luz could safely travel.  They had asked to have the autopsy, and had arranged then for the body to be flown to their home in Colombia for the funeral.

I asked if she knew what they had named him?

Jesús, she said.  Jesús Salvador Martinez.

~

It was the following Sunday when I paid a visit to an ordinary-looking, white split-level ranch house next to the bay.  The house, which belonged to Jose’s uncle and aunt, was immaculately painted, the grass trimmed, small green shoots emerging from a garden plot in the side yard.  A pale blue boat resting on its trailer in the driveway.   A metal Christian fish ornament sticking to the rear of the pickup truck parked on the street.

Jose came out as I parked my car behind the pickup truck.  He waited at the bottom of the driveway as I walked down, then gave me a beatific smile as he took my hand in both of his and held it.  The bizarre thought that he was about to kiss me flashed through my mind, but he just nodded his head as he stared at my face.  My heart sank as I looked into the eyes of this handsome, poised young man who deserve so much to be gripping a baby boy in these hands, lifting him up against the clear sky in this warm spring air and listening to his squeals of joy.  But still Jose smiled.

He brought me past the garden plot to the back patio that overlooked the bay.  There Luz sat, like a queen in a white wicker chair, facing away from the late morning sun, strands of hair floating here and there in the breeze, wearing a pale nightgown and a peaceful smile.

“Muchas gracias por venir, doctor.  Significa mucho para nosotros.”  Thank you so much for coming, doctor.  It means so much to us.

I smiled for the first time, very slightly.  “De nada.  Tuve el honor que me invitara.  ¿Cómo se siente?”  It’s nothing.  I was honored that you would invite me.  How are you feeling?

I paused, horror stricken again at my mental image of her baby strangling inside of her, wondering how I would have felt about seeing the personification of my son’s death walk towards me on that patio.  I shook my head to clear it, smiled again, and said, “No solo su alma, quiero decir.  Espero que su cuerpo se está recuperando, también.”  Not just your soul, I mean.  I hope your body is recovering, too.

She nodded, her face returning to neutral.  Jose anxiously showed me to the chair he hoped I would sit in, so I gave her my painstakingly written condolence card and the white rose I carried for her, and sat.  We spoke of life in Colombia, of our frustration that the autopsy would likely reveal nothing, of my heartfelt respect for them as people.  They had been gracious to everyone, had let themselves feel the pain, yet had not seemed to let it ferment into poison.  They seemed to have no need to find a scapegoat.  I half wished they would have chosen me as a scapegoat, because then I could focus on that rather than the incomprehensible truth that had brought us together.

The visit ended pleasantly, and a little distantly.  Conversation lagged, I told her I hoped she could rest, and said I should go, implying prior engagement.  Jose quickly asked if he could show me something first.  Of course.  I held Luz’s hand in both of mine, wished her strength and peace and a happy life, then let Jose lead me along the rocky edge of the bay to a nearby pier.  Next to the pier a boulder jutted from the ground, newly chiseled rectangle holding a metal plaque.

The plaque read, in English:

Jesús Salvador Martinez

Born April 16, 2006

Died April 14, 2006

These were the dates written on the birth certificate and the death certificate that I had had to sign, one after the other, the previous week.

“Mi tía y el tío quería ser capaz de visitario.  Pensamos que tal vez usted querría eso.  Usted es bienvenido aquí en cualquier momento.  En cualquier momento.”  My aunt and uncle wanted to be able to visit him.  We thought maybe you would want that, too.  You are welcome here anytime.  Anytime.

He reached out with his hand to hold my shoulder the way I had tried to hold his back in the small conference room on that terrible morning.  He kept it there on our walk back to the house.


Birth Story #4: Little Red Hen

January 25, 2010
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Little Red Hen

In August 1996, a couple of weeks before Henry was born, an ultrasound showed that he had a distended bladder that would not empty. I was on call at the VA Hospital for my sub-internship when Sarah paged me with the news, and we spent the rest of her pregnancy stressing about whether he had a blockage that could potentially damage his kidneys.

Ironically, in order to visualize Henry’s bladder, Sarah’s had to be full. She had drunk a pitcher of water before coming to her appointment, then for two solid hours endured the near-constant squeeze of Henry’s body from inside and the ultrasound probe from outside. In this contest of urinary fortitude, Henry was the clear winner. Sarah finally begged to go relieve herself, while Henry kicked and swam, clearly enjoying the ruckus he had caused. A showoff before he had even been born.

Many anxious medical consults later, we were pretty sure that he was okay – maybe he would need a procedure to open his urethra soon after birth, but either way his kidneys looked fine and he should have a normal life.

Still, earth’s gravity increases for any parent whose child is in danger, and those last weeks were heavy for both of us.

~

We had moved, with our 3-year-old twins Isaac and Sam, into a communal house in Oakland that June with our friends Derek and Ted. Derek and Ted had been together for a couple of years, and were now looking to adopt a child themselves. Derek, in particular, dove into domestic life. That summer he was more involved in supporting Sarah and helping to raise our children than I was. He had taken her to that ultrasound appointment when Henry’s bladder became an issue, and he, Ted and their friend Shuman who stayed with us before returning for his senior year of college ferried the boys around Oakland when Sarah was busy.

Our household presented quite the picture. Sarah is even whiter than I am, with pale skin and bright red hair. Ted is half-Japanese, half-white. At that time Derek had finally convinced him to stop shaving his head, but he still had multiple piercings and wore a leather jacket festooned with metal doodads. Though his face in those days was often set in a scowl, he was actually the most committed of all of us to the constant human give and take involved in communal living. Shuman’s parents are first generation Indian immigrants who were still in full denial about his homosexuality even after he had come out to them the previous year. This summer, then, he had come to California to let himself breathe freely as a gay man. Ted and Derek loved to mock his every effeminate mannerism. Derek was the most visible of all of us. Half Filipino, half African-American, he is a large man who looks vaguely Samoan. With long frizzy hair that he sometimes braids and sometimes gathers behind his head in a ponytailed fro, a huge metal hoop through one eyebrow, often wearing a dashiki, and possessing a smile that makes the recipient feel like they just won a prize, Derek naturally dominates any room he happens to inhabit.

Despite our appearance, though, and our blended household, we felt quite conventional. Sarah and Ted taught at an uptight suburban high school in Silicon Valley, Derek and Ted worked ungodly hours running Quilumbo, the nonprofit educational organization they had cofounded, Shuman was a Princeton undergrad, and I was finishing medical school. Our visits to Costco involved two shopping carts and embarrassingly large packages of toilet paper, as well as one adult assigned to Sam and Isaac at all times as they ran through the hanging plastic slats in front of the freezer section or pleaded to build a fort behind the cereal boxes. The boys were the weirdest members of our household. At that time they were obsessed with gender, and would point at people and say loudly to each other, “Penis!” for man and “Vagina!” for woman. “She’s a vagina,” Isaac would say. “She’s got long hair.”

“Derek has long hair,” Sam would point out. “SHE’s a a vagina,” pointing at someone else. “She has a dress on.”

“No,” said Isaac. “Shuman wears a dress sometimes. And he’s a penis.”

This was all more than I could handle, so I always asked to push the shopping cart, claiming post-call fatigue.

~

One evening in the middle of August when I was on call again at the VA, Sarah began feeling contractions. A burst of domestic energy carried her through cooking dinner for everyone and washing the dishes, but when Sam and Isaac asked her to read them that summer’s favorite illustrated book “Sir Gawain and the Green Knight” she begged off. No one had offered to help her with cooking and cleaning, she said to them in front of Ted, Derek and Shuman, and now Ted would read them their story because mom needed to go have a baby. All three adults jumped up, falling over themselves to say yes, go, Derek you take her, ok I’ll take her, can I do anything else, really are these contractions, I’m so sorry, what else can I do?

Isaac and Sam, however, thought this was a terrible idea. They wanted mom to read the story, not to go have a baby. Mom grimaced at a strong contraction, though, said “ow”, and the boys were told to kiss mommy goodnight and come upstairs with Ted. Who would read it two times if they wanted. This worked for them, and they tumbled up the stairs asking “three times? Can we have it three times?”

So, Derek drove Sarah across the Bay Bridge to Kaiser Hospital in San Francisco, while Ted read and reread and reread the story of Sir Gawain keeping his promise to return after a year to the Green Knight’s castle to let the Green Knight chop his head off, each time asking the boys, “Is it important to keep a promise?” Each time listening as the boys solemnly swore that they would keep promises, too.

Meanwhile, Shuman paged me at the hospital to tell me that Sarah was in labor, which is far more difficult and painful than just having one’s head chopped off. Though I felt guilty at signing out my work to Jose (my supervising resident) and leaving, this birth represented a promise of mine far more serious even than ritual execution, let alone writing admission orders that could be written by somebody else. Luckily, Jose agreed, and shooed me off the ward.

In a crowded elevator on the way out, one of the other residents learned I was leaving because my wife was having a baby. He asked, “is it your first?”

“Third,” I said, distracted.

“Third?” he said, looking shocked. “What are you? A Mormon?”

~

Meanwhile, Derek brought Sarah to the hospital. Her contractions were becoming more painful as they got there, and the walk up the hill from the parking lot in the freezing foggy wind felt Sisyphean. After they got to the E.R. and were told to go to the Labor and Delivery ward, she had yet more climbing. Up three flights of stairs and down an infinite hallway with no offers of wheelchair or even of help. Derek offered to carry her at one point, and they both burst into laughter at the thought of it.

Finally she arrived and was waiting to be triaged as I rushed in, still wearing my VA scrubs, scared that I had missed the delivery. Derek said goodbye and left to go retrieve Ted and Shuman, clearly anxious to avoid missing the birth as well. We had asked a friend, Inga, to stay with the twins because all of our housemates were dying to be in the hospital for the birth.

The nurse showed Sarah into the delivery room at about 11PM. A distracted resident came in, checked her cervix, and pronounced her to be 3 centimeters dilated, that she was far from delivery, and that she should go home for a couple of hours and then return if the contractions continued. Almost as soon as she left the room, though, Sarah started screaming in pain with each contraction. It was horrible to watch, and I still can’t imagine how she endured it. Henry’s head was facing the wrong way, and once it was low enough in her pelvis each contraction squeezed the back of his head against her tailbone. It’s as if the back of her pelvis were caught in a vise, being bent outwards with just short of the force required to break it.

As a physician, I see people in pain all the time, but rarely have seen anything more intense than the next couple of hours were for Sarah. Changing positions, whimpering, screaming – my WASPy, undemonstrative, socially correct wife actually screaming out loud in public – none of these made her contractions tolerable. Unfortunately, when I left the room to ask for help, it was as if there had been a bomb scare. Just the unit clerk was visible, and she had trouble finding a nurse who could help us. To make matters even worse, there were multiple emergencies happening at that moment – 2 caesarian sections, and God knows what else – and no doctors were able to come reevaluate Sarah for over an hour.

So Sarah labored alone, with me wracking my brain for tidbits from my OB/GYN clerkship the year before that might help her. Preparing myself for, God forbid, the need to deliver our baby on my own if need be. The room felt that isolated, and help that unavailable. She tried the rocking chair, leaned against the wall, and finally (I kicked myself when she found this because only then did I remember that this could help) perched on elbows and knees on the bed, bottom sticking up into the air, rocking back and forth during contractions. This last position was the least intolerable, and when my frantic and eventually angry toing and froing from room to nursing station finally drew a nurse to come in, Sarah refused to change out of that position even to sign papers or change into a hospital gown.

She begged for epidural anesthesia, as the nurse said irritably in her Philippine accent. “Doctor will be in soon. Not so loud. We have to wait for the doctor to evaluate you. You are disturbing the other patients.” Finally, as the nurse was placing Sarah’s I.V. between screaming contractions, “Doctor” did come to evaluate her. It was a different resident this time, which was a good thing because I wanted to throttle the first one for abandoning Sarah. She checked Sarah’s cervix, and announced that Sarah was too far along, and would not be able to get an epidural.

Sarah’s face transformed. “WHAT did you say?” she asked, glaring at the resident. Sarah, who is so afraid of behaving poorly that she once apologized to a man who rear ended her at a stop sign, looked like she would cheerfully throw this resident through the window for even thinking of denying her epidural. The resident shrugged.

“You’re 9-1/2 centimeters dilated. You’re going to have your baby before you could get an epidural.”

So Sarah bowed her head, and screamed her way through the last few contractions before she could start pushing. Pushing made her feel better, and the resident asked her to turn over and lie on her back to deliver the baby. Henry’s head must have spun to face the right direction by this time, because Sarah was able to focus on her pushing, red-faced and concentrating, rather than writhe around screaming in pain. Sarah and I had hoped to have my hands on Henry’s head as he came out, and had prepared a little spiel to justify it, then abandoned that thought when Sarah was in her agonies. Now this hope revived, and I suggested it to the resident, who calmly nodded and asked me to put on sterile gloves.

I had only delivered a couple of babies during my OB/GYN clerkship, which was why I had felt terrified at the thought of delivering Henry on my own, but this worked perfectly. I put my hands on his head as it finally emerged, anxiously focusing on the textbook pictures I had studied about where to press and when to do it, while the resident covered my hands with hers and shielded Henry and Sarah and me from my inexperience. Briefly Sarah’s eyes caught mine between pushes. Through my anxiety, I saw her pride and love, and then focused back on Henry’s emerging head with a twinge of confidence.

Sarah pushed Henry’s head out into our hands. The resident delivered his body. Henry cried, but not before I did.

I brought him up to Sarah as the resident cut the cord. I put him on Sarah’s chest, and the three of us lay together for a moment. Warm. Gentle. A family. I kissed Sarah and told her how amazing she had been. She kissed Henry and said “Hello!”

His hair was red. His skin was pale. No one would need to check I.D. bracelets to be sure that this baby and mother belonged together.

Soon, the pediatric resident grew anxious, and asked to bring Henry to the warmer to evaluate him. I followed them. She did her initial exam, then turned to do paperwork. I remembered his bladder then. Felt that bolt of fear return. Reached down to the warmer to feel his lower belly for the mass that belies a distended bladder. Pressed there.

An arc of urine shot from his penis as I pressed, all over my hair and forehead. I yelped and ducked, too late. I looked at Sarah, who started to shake with laughter. “I think he’s ok,” I said, and laughed too.

~

A little while later, while I was in the bathroom washing Henry’s pee out of my hair and then emptying my own bladder, the unit clerk came in to ask if three men could come in to visit. I had completely forgotten that Ted, Derek and Shuman would be waiting outside. Sarah and I both said, “Yes! Of course!” We found out later that Derek had talked the nurses into letting them in far enough to watch the contraction monitor. They had proudly noted to each other that Sarah had the biggest contractions of any of the laboring women there that night, but had grown agitated when the tracings suddenly stopped. They were worried that something had gone wrong, and had not expected that Sarah would have delivered Henry quite yet.

The clerk paused, with an uncertain look on her face. “You aren’t…” she began. We waited. “Do you belong…? Are you in of some…? Are you members of some sort of group?” she finally asked.

Sarah and I looked at each other. “No,” Sarah said. “Why do you ask?”

The clerk looked a little embarrassed. “Oh, well sometimes we get people… Um. It’s just that you all live together, and we like to be sensitive here. That’s all.” She smiled quickly.

The three men entered the room, Ted with his skull freshly shaved and wearing both a rat skull earring and a huge grin, Derek in beads and braids, wearing an embroidered African tunic, and Shuman looking quite conventional above his plaid kilt.

Sarah looked at the clerk and said, “No. We just promised them that they could be here. It’s important to keep promises.”


Birth Story #3: Beanie Baby Baby

January 25, 2010
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Veronica was a couple of months past her 14th birthday when she delivered her second baby.  She showed up at the Birthplace about an hour before my shift started, with painful contractions and a cervix 3 centimeters open.  She quietly went off somewhere in her head with each contraction, which the night nurses had noticed, and so she was already set up in a delivery room by the time I saw her.

By chance, I had delivered her first baby about 10 months earlier.  When I got to the hospital that morning, I couldn’t believe that she was back.  Her name was still bright red in my memory, as the first person I had delivered who was younger than my kids.  Her daughter’s existence made me feel like a virtual grandfather.  I remembered being among a parade of concerned adults after that last birth who had marched through her room, talking about birth control and options and safety.  Talking about how to say no, and why to say no.  Making sure every tiny detail of a plan for her follow up care was in place.

She had apparently followed up as we wanted.  Made her appointments with the OB/GYNs, brought her daughter to pediatric appointments, said all the right words.  Took a trip home to Mexico when the baby was a month old to present her to her extended family.  And met a very nice guy there.  Definitely a new nice guy, because her daughter’s father was in jail for statutory rape.  A nice guy who must have been remarkable, because he was more persuasive than a hospital full of concerned medical and social service workers had been.  5 months later decided to get a pregnancy test after feeling something move behind her belly button.

She refused to name the father.

When I walked into her room, her mother was with her, smiling and holding the beautiful, clean, immaculately dressed, chubby 10 month old girl whom I had delivered the year before.  This baby was clearly loved and attended to.  Smiling, squealing, alert and curious.  Veronica’s mother looked maybe 30.  Her face was unlined by age, and also unlined with worry.  Here was her 14 year old daughter in labor again, and she behaved as if her daughter were 34 and that this was as normal as a sunrise.  The three of them shared a face, as if representing one person at different ages.  Smooth skin the color of a schoolkid’s paper lunch bag.  Round round cheeks ballooning beneath high cheekbones.  Full, dark lips.  Veronica and her mom both pulled their hair back in ponytails; her daughter’s hair was too short for this, so was gathered on top of her head with a ribbon.

Veronica smiled at me too, before another wave hit and she closed her eyes.  She breathed slowly.

“Good job,” I said in Spanish.  “Nice slooow breathing.  Very good.”  She said nothing, but her breathing slowed a bit.  She was an excellent laborer.  I shouldn’t say such things — every woman who goes through labor does something that I still can’t imagine doing myself, and I have no right of judgment — but she had that calm and focus that makes the whole process flow smoothly.  She had shown the same focus the year before.  Her body, too, was the body of a woman.  It was easy to put aside my social horror and focus on this laboring woman who looked and behaved like a normal laboring woman rather than a terrifyingly young girl.  She had a broad torso, a broad pelvis, fully developed breasts and pubic hair.  Only a trace of baby fat, and downy hair at her jaw line betrayed her age.

When the contraction ended, I put my papers down and sat next to her bed.  “Are you OK?”  I asked, again in Spanish.  She nodded.  She hadn’t been a talker the year before, either.  “I need to ask you all those questions again, OK?”  She nodded again.  Her pink cell phone, covered with stickers and what looked like rhinestones, rang.  She looked at the display, and silently handed it to her mom to answer.  I looked to her mom and asked her if she would please wait in the waiting room for a few minutes, that I need to ask private questions of every single patient who comes in, but especially her daughter.  She covered the mouthpiece of the phone, nodded, and smiled, then carried her granddaughter out of the room, explaining something quietly to the phone as she left..

I turned back to Veronica, who looked peaceful.  “Do you need anything?”

“No, I fine.”

“Espanol?  Engles?”

“Espanol, por favor.”

We spoke about this labor — had her water broken? Was the baby moving normally? Any bleeding?  We reviewed her prenatal course, which was completely normal.  We talked about her preferences for pain management — did she think she might want medication?  I told her she had done such a wonderful job last time without it, but made sure she knew her options.  She said no medication, thanks.  I finally swallowed hard and asked why she was pregnant again.

She looked away, shrugged.  Blank face.  Grimaced, and another contraction was on her.

When the contraction was over, I told her that her baby was doing fine, she was doing fine, but that it worried me terribly to see her having another child.  Asked her about the father, and she just shook her head and said she didn’t want to talk about him, even to give his age.  She said she didn’t want him to get in trouble.  I asked the standard questions about whether she had been forced to have sex, whether anyone at home was molesting her or hurting her, did she understand why we all are so worried for her.  With nods and single syllables she gave reassuring answers that left me no clearer as to how someone in a relatively intact family, with no sign of drugs, neglect, abuse, could get pregnant at 13, one month after delivering the baby she conceived at 12.

In her calmness and focus, she managed my questions like she managed her contractions.  Waves to get through.  No big deal.

~

Her labor progressed completely normally.  3 centimeters became 5 became 9.  Her water broke while she was on the toilet, was clear.  Her baby’s heart tracing stayed completely reassuring.  Her mother returned after Veronica and I had finished talking.  She stayed with her the whole time, wiping her face with a damp cloth, murmuring soothing words to her.  Her daughter stayed almost until the delivery, which is forbidden by hospital rules, but no one could come get her until late in the afternoon.  But her daughter, like Veronica, like Veronica’s mother, stayed calm and unfussy, placidly looking at me or the television or her mother from her perch on her grandmother’s lap.  The three of them watched Barney, watched a Spanish language soap opera on Univision, watched an episode of Maury Povich that was dubbed into Spanish.

Veronica never asked for pain medicine.  She clutched a small stuffed doll – a Beanie Baby koala bear – that I hadn’t noticed at first.  When the pain was especially bad she would close her eyes, blow through pursed lips, and tap the doll lightly against the bed rail.  Her world involuted a little more with each contraction, until she her eyes stayed closed even between them, only slight grunts and whimpers occasionally slipping from her throat as the waves grew intense.  Now, as had been true the previous year, when her grunts changed to small red-faced pushes a quick check of her cervix revealed that it was completely open.  Her body was in control of the whole process, leaving this room full of concerned adults about as useful to Veronica as a room full of Beanie Babies would have been.  I told her she could start pushing whenever it felt right, and turned to put on gown and gloves.  When I turned back, she was clutching the backs of her thighs, legs wide open and raised, perineum bulging from her baby’s head, mother pressing a cloth against Veronica’s forehead, evoking a thousand generations of mothers helping daughters.  I murmured soothing words, encouraging words, but more for myself than for her, more to make myself feel that I had some role to play here than that I was truly worried about her.

She pushed again, and an egg-sized area of her baby’s scalp was visible.  Dark hair greased down with mucous and blood, which then disappeared back inside her.  Her groin bulged even between the contractions, the outline of her baby’s skull clearly visible.  Another contraction, and her skin stretched, more wrinkled, mucousy scalp appeared and slid mostly back in.  Another contraction and more scalp, another and it was almost out, another and finally I had a role to play, pinching the skin between her vagina and her anus to help keep it from tearing, pressing gently down and towards the back on the baby’s head to protect the tissues at the top of her vagina, guiding this baby out as she pushed and she pushed.

Finally, a forehead, eyes, a nose, a mouth.  A chin pops out.  Stop pushing.  Bulb suction the fluids and mucous out of the baby’s nose and mouth while his chest is still squeezed shut, before he can breathe, then “Empujes!  Empujes!,” she pushes really hard and the shoulder slips under her pubic bone, the baby is slipping, sliding out of her body, I pull him up at last to reveal the enormous dangling scrotum of a boy, and place him on her belly.  “Felicidades!” I say, “Baron!” as she smiles calmly, as she reaches to him, holds him under his armpits, kisses his slimy forehead.  He lets out a big cry.

“Oh, mi carina, mi amor,” she coos to him, patting his back, completely at home with this.

The aftermath is as smooth and clean as her labor and delivery.  She has no lacerations, normal amount of bleeding.  The placenta detaches easily and completely.  She tolerates the hand inside, the hand outside, the bimanual uterine massage that helps it shrink down more easily.

Her nurse begins to clean her as I tidy my instruments.  I take off my gown with a rustle, my gloves with a snap, and leave them with the bloody gauze pads in the bucket of amniotic fluid and blood and feces under her bed.  When I come back in from writing my note and her postpartum orders, she is already breastfeeding, her mother standing over her smiling.  How can this body, which of all the bodies in the world is most suited to having babies, belong to someone so young?  So unprotected?

And how can this young, vulnerable, abused girl, who I cannot believe is able to give informed consent to sex despite her benign pregnancies and labors, be so calm?  How can her daughter look so well cared for?  How can her mother stand to be seen with this living, breathing indictment of her parenting?  This is the girl who got pregnant at 12 by a 21 year old guy she met on the bus to summer camp.  The girl who said she was 15, while that first father said he was 17.  Who got pregnant again before her first postpartum menstrual period.  Who had social workers practically camped out on her doorstep after her first baby was born.  Yet taking to motherhood like a fish to water.


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Birth Story #2: The Highlander

January 24, 2010
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Sometimes a woman whose labor is going fine can’t take it anymore and asks, even begs, for a caesarian section.  We have all had a few patients who shut down and refused to engage.  Legs clamped shut, world blocked out, pretending she is somewhere else.  Enters a fugue state.  Says over and over, “I can’t do it. Why won’t you give me a c-section?”  Filibusters the process to make us understand that she is not coming back.  Luckily, most of the time if we stay emotionally present, calm and patient, she will make it through and even do well.

Maybe my favorite delivery, ever, was at Highland Hospital in Oakland. A delivery ward that only women both poor AND unaware of better choices would give birth. I trained there for a month in my second year of residency, and it gave me a taste of what terrible can be.

Anyway, one day this very nice 38-year-old woman arrives in booming labor. Long, greasy blond hair, a bit heavy.  Anxious face with a kind smile.  Bad teeth.  Cigarette breath.  Looked like a large, long-lost sister of Courtney Love, and was accompanied by her tiny, ancient boyfriend who was the spitting image of William S. Burroughs.  She had previously had 5 other babies, none of whom were in her custody.  She had been a long-time heroin addict.  Now she was clean, with 18 months of methadone maintenance under her belt.  She was miraculously HIV negative, and this was going to be the baby she could keep.

Heroin addicts (like percocet/oxycontin/other opioid addicts) have the world’s lowest pain threshold (probably part of what got them into it in the first place).  She had blocked out memories of her other labors, and seemed shocked and terrified by the pain of this one.  We gave her medicine, but the baby was coming soon and we couldn’t give her much. Her pelvis was roomy, so clearly this baby was going to come out easily.

Her cervix quickly finished dilating, and we started coaching her to push.  I was still anxious and inexperienced, and let her nurses arrange her, lying on her back, smelly bare feet up high in stirrups, foot of the bed taken off, her bottom perched on the edge to give me room to maneuver as the baby came out.  I busied myself getting gowned and gloved and masked, arranging the gauze pads and the instruments, the sterile drapes.  I only peripherally noticed that the tone of her screams was becoming progressively more urgent.

I sat on the little rolling stool between her legs, like a baseball catcher, running through my mental checklist.  I could see that the baby’s head was starting to crown.  She screamed, “I can’t do this! I can’t do this!”

I realize that she has been saying this for a couple of minutes, and that she really needs reassurance.  I tell her awkwardly that she’s ok, the baby’s head is almost out, but she says, “You don’t understand! I can’t do this! I need a c-section! Cut this baby out of me. I can’t do it. I. CAN’T. DO. THIS.”

I put one hand on her baby’s head, the other just below her vagina to protect the skin, tell her she’s doing great, that the head is coming down quickly, that she’s so brave and I know it hurts, and wow this is going fast, only a couple more pushes and you’ll see your beautiful…

SLAM!  My ears ring because she has slapped my head between the soles of her two feet and is squeezing hard.  Stunned, I freeze.  She grips my ears with her toes, keeps squeezing my head.  With the strength of her legs she lifts me out of my crouch, and pulls me up until my face is about eight inches from hers.

Her face was red and furious, and I was glad her feet were muffling my ears because she yelled as loudly as she could, “CUT THIS BABY OUT OF ME NOW. YOU CUT THIS BABY OUT OF ME RIGHT NOW OR I’LL KILL YOU. CUT IT OUT. NOW!!!”

She let go my head, and I realized that the force of her action had pushed the baby out into my hands.  I fumbled, recovered, hooked my finger under his leg and caught him!  So slippery, but also so delivered, with his umbilical cord dangling out of his mother, who started to cry with confusion and relief. I put him on her belly, because my hands and arms felt shaky and weak. My ears rang and I had a sharp headache. “See?” I mumbled unconvincingly, and sat down.

Her boyfriend painstakingly lifted himself from the chair by the window where he had been sitting this whole time.  With tiny steps he made his way over to her side and peered down through his bifocals at their newborn daughter.  His expression was calm, but distant.  He looked her in the eye, bobbed his head in my direction to indicate that he was talking about me, and said in a quavery, slightly slurred, old man voice, “I think you owe this boy an apology, dear.”

She looked at me with the anxious expression she had worn when she came in, now with a tinge of fear.  As I began composing my face to reassure her, I heard one of the nurses behind me start to giggle.  I lost control, and burst out laughing.  The look of anxiety and confusion and then relief on her face, the smell of her unwashed feet that had so recently attached themselves to my ears, the sound of the giggling behind me – these wiped away all traces of young doctor anxiety.  I whooped.  I laughed uncontrollably until tears came, then noticed that she was laughing just as hard.  The baby’s body bounced up and down on her mother’s convulsing belly, like a boat on rough seas.  We reached in unison to steady her, then laughed again.


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So you think YOUR boyfriend is bad?

January 24, 2010
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Sometimes it is not the birth, or even the birth-giver, whom I remember.  Last week we had a stunningly intrusive boyfriend who accompanied his partner to the Birthplace so that we could make sure she was not going into labor two months early.  Here are some questions you might have about this night, which I will answer for you:

Q: “Did he in fact pull his pants down in front of you, his girlfriend and the nurse, with the door to the triage room wide open?”

A:  Why, yes, he did!  You see, while I was asking his girlfriend what she recently had had to eat and drink, he naturally thought I needed to know that he had bumped into the pot he was making soup in this evening (of which she had none, even though he tried to tell her to have some, etc., etc.), thus spilling some on his backside and burning it.  Since I am doctor, though he knows they did not come to hospital for this, would I please look carefully at his ass and tell him how badly burned it is?

Q: “Did he die recently?”

A:  This is an unfortunate misunderstanding, although I think I know what you are referring to.  What he explained was that he had overdosed on caffeine last week, gone to the Emergency Department in an ambulance, “flatlined” there, and been brought back to life.  Given that this makes no medical sense whatsoever, that he has in fact spent the past week accompanying his girlfriend to various appointments to “help”, and that, after flatlining, people tend to stay in the hospital for at least a few days to make sure their lines stay non-flat, my guess is that he meant to say “you have not paid any attention to me for the past 10 seconds and I need to regain control of this conversation.”

Q: “Was there one single comment or question you directed towards the member of this couple whose body has a baby growing in it that was not answered first by the member of this couple with soup burns on his butt?”

A: No.  Not even “do you feel like you need to poop now?”  Not even that question.  Even “do you need to poop now?”, when asked of the person whose intestines contain the aforementioned hypothetical fecal matter, elicited the helpful response from old Soup Burn that, “She took a crap at home around 8.”   (turning to her) “You don’t need to take another crap now, do you?”   (turning to me)  “No.  She’s fine.”

Which indeed she was.  They returned home, having learned that soup can burn, that caffeine can stop a beating heart, that some people do have ESP (Extra Sensory Poopception), and…  Wait.  They came to learn something else, too.  Something about whether or not their baby might be born super-prematurely?  Damn.  Can’t remember.  Must not have been important.


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Birth Story #1: Pherris Buehler

January 24, 2010
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The baby’s father was a quiet, skinny guy who faded into the furniture for most of Sophorn’s labor.  He sported a soft patch of baby hairs on his upper lip streaked with perhaps a dozen black adult hairs, like chaperones at a school dance.

He responded when spoken to, but otherwise sat in the visitor’s chair next to the head of the bed doing nothing for long stretches of time.  He answered questions so quietly and laconically that it was ten hours into the labor before I realized that he spoke English with no trace of an accent.

He was perfectly pleasant, though.   He would pop out to the kitchen to fetch ginger ale or ice, and as Sophorn’s labor climbed to its peak he took on the task of refreshing the cool damp washcloth for her forehead.  I kept calling him “dad”, because I felt guilty that I couldn’t remember his name.

I had met both of them when they came into the Labor and Delivery unit that morning.  As a family doctor who works at a community health center, I work with a lot of young pregnant women, and Sophorn seemed well within the range of normal to me.  17 years old, carrying her first baby, now 2 days past her due date.  The only marginally noteworthy point was that the father of the baby (who seemed about her age) was with her rather than her mom or another adult.

She had had intermittent contractions for the past few days, then awoke at 5AM that morning in a puddle of water.  She seemed embarassed to admit this in front of her boyfriend (they each still lived with their parents), and seemed reassured when I told her that she had not, in fact, peed in her bed but that her water had broken and that this was nothing she could control.

The first time I checked her cervix I stole a glance at him afterwards, and found his impassive downward gaze unchanged.  This reassured me – I have a perhaps flimsy theory that guys who feel the most threatened by vaginal exams of their partners are all secret abusers.  He stayed so quiet that after a couple of hours I stopped thinking about him.

When the time came for her to push, his transformation was amazing.  As her pain peaked she began moaning between contractions.  He kept up with his facecloth duties, but also began calmly murmuring to her, sometimes leaning over to whisper in her ear.  She palpably relaxed as he did this, and seemed able to focus much better on pushing.  They developed a rhythm in which she would signal with an almost imperceptible nod that a contraction was beginning, he would hook his arm under one knee to bring her leg up while contorting his body to be able to whisper in her ear while she pushed.

Sophorn gave birth to a healthy 6 pound boy at around 2 AM.  Dad, whose name I still couldn’t remember, smiled broadly one time, then returned to impassivity.

I was at the nursing station writing my note about 20 minutes later, when her nurse called me back in.  “Dad says he needs a note from you,” she said.

I walked in to find him handing the bundled baby gently to Sophorn.  She held their baby with a dreamy, almost narcotic smile on her face, but he had returned to his shy, downward gazing, difficult to understand self.  I had to ask him to repeat his question to me after he asked it.

“I have school tomorrow,” he said.  “I don’t want to get in trouble.  Can you write me a note?”

Sophorn looked up from her baby.  “Can I have one, too?”

I had to ask his name.

To Whom It May Concern:

Sophorn Lam and Pham Chhoun were in the hospital on 2/7/06 and 2/8/06 for the birth of their baby.  Please excuse them both from school.

Sincerely,

Nicholas Mayper, M.D.


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