When Breath Becomes Air(14)
The sun was up, my shift over. I was sent home, the image of the twins being extracted from the uterus interrupting my sleep. Like a premature lung, I felt unready for the responsibility of sustaining life.
When I returned to work that night, I was assigned to a new mother. No one anticipated problems with this pregnancy. Things were as routine as possible; today was even her actual due date. Along with the nurse, I followed the mother’s steady progress, contractions racking her body with increasing regularity. The nurse reported the dilation of the cervix, from three centimeters to five to ten.
“Okay, it’s time to push now,” the nurse said.
Turning to me, she said, “Don’t worry—we’ll page you when the delivery is close.”
I found Melissa in the doctors’ lounge. After some time, the OB team was called into the room: delivery was near. Outside the door, Melissa handed me a gown, gloves, and a pair of long boot covers.
“It gets messy,” she said.
We entered the room. I stood awkwardly off to the side until Melissa pushed me to the front, between the patient’s legs, just in front of the attending.
“Push!” the nurse encouraged. “Now again: just like that, only without the screaming.”
The screaming didn’t stop, and was soon accompanied by a gush of blood and other fluids. The neatness of medical diagrams did nothing to represent Nature, red not only in tooth and claw but in birth as well. (An Anne Geddes photo this was not.) It was becoming clear that learning to be a doctor in practice was going to be a very different education from being a medical student in the classroom. Reading books and answering multiple-choice questions bore little resemblance to taking action, with its concomitant responsibility. Knowing you need to be judicious when pulling on the head to facilitate delivery of the shoulder is not the same as doing it. What if I pulled too hard? (Irreversible nerve injury, my brain shouted.) The head appeared with each push and then retracted with each break, three steps forward, two steps back. I waited. The human brain has rendered the organism’s most basic task, reproduction, a treacherous affair. That same brain made things like labor and delivery units, cardiotocometers, epidurals, and emergency C-sections both possible and necessary.
I stood still, unsure when to act or what to do. The attending’s voice guided my hands to the emerging head, and on the next push, I gently guided the baby’s shoulders as she came out. She was large, plump, and wet, easily three times the size of the birdlike creatures from the previous night. Melissa clamped the cord, and I cut it. The child’s eyes opened and she began to cry. I held the baby a moment longer, feeling her weight and substance, then passed her to the nurse, who brought her to the mother.
I walked out to the waiting room to inform the extended family of the happy news. The dozen or so family members gathered there leapt up to celebrate, a riot of handshakes and hugs. I was a prophet returning from the mountaintop with news of a joyous new covenant! All the messiness of the birth disappeared; here I had just been holding the newest member of this family, this man’s niece, this girl’s cousin.
Returning to the ward, ebullient, I ran into Melissa.
“Hey, do you know how last night’s twins are doing?” I asked.
She darkened. Baby A died yesterday afternoon; Baby B managed to live not quite twenty-four hours, then passed away around the time I was delivering the new baby. In that moment, I could only think of Samuel Beckett, the metaphors that, in those twins, reached their terminal limit: “One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.” I had stood next to “the grave digger” with his “forceps.” What had these lives amounted to?
“You think that’s bad?” she continued. “Most mothers with stillborns still have to go through labor and deliver. Can you imagine? At least these guys had a chance.”
A match flickers but does not light. The mother’s wailing in room 543, the searing red rims of the father’s lower eyelids, tears silently streaking his face: this flip side of joy, the unbearable, unjust, unexpected presence of death…What possible sense could be made, what words were there for comfort?
“Was it the right choice, to do an emergency C-section?” I asked.
“No question,” she said. “It was the only shot they had.”
“What happens if you don’t?”
“Probably, they die. Abnormal fetal heart tracings show when the fetal blood is turning acidemic; the cord is compromised somehow, or something else seriously bad is happening.”
“But how do you know when the tracing looks bad enough? Which is worse, being born too early or waiting too long to deliver?”
“Judgment call.”
What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? How could I ever learn to make, and live with, such judgment calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too. After all, when I had walked into the hospital just one day before, birth and death had been merely abstract concepts. Now I had seen them both up close. Maybe Beckett’s Pozzo is right. Maybe life is merely an “instant,” too brief to consider. But my focus would have to be on my imminent role, intimately involved with the when and how of death—the grave digger with the forceps.