Behind Each Door in the Birthplace

It was the first week of my first rotation in medical school: Obstetrics and Gynecology. I wandered distractedly into the charting area of the labor and delivery unit, having just come from an exciting procedure in the OR.  I noticed a nurse quietly waiting for a provider. Pacing back and forth, she asked if I was one of the residents. I replied no, that I was a medical student. As I responded, I noticed with unease her red, tearing eyes. She said, “We have a patient that really needs to be seen, where is everyone?”

The amazing procedure I had just finished  was a scheduled C-section, made all the more thrilling for me as I was first assist—for the first time—after the other OB’s and residents were pulled away to an emergent C-section in the OR next door.  I was riding high after the new experience, so it took effort to quell my excitement as I explained to the distressed nurse where the physicians were.

Then I asked the question I feared I wouldn’t be able to answer as a medical student: “What’s wrong?”

“I couldn’t find a heartbeat. She’s 40 weeks. She came in for decreased fetal movement.”

My heart dropped to my gut. “Oh no.”

I rushed out to find the doctor I had just assisted in the C-section, Dr. Brown. She had already stayed late to help her colleagues who were tied up in the OR with the emergent C-section, so we waited a few minutes for the physician who was on next for the night shift. Knowing what might lie ahead for this patient, who now carried a deceased, full-term baby, Dr. Brown thought the physician who would deliver the horrible news should also be the one to assist the parents in the inevitable, gut-wrenching process.

When the night-shift physician arrived, after what felt like eternity, Dr. Brown explained the situation. I asked if I could come with her to see the young patient and her husband. It was going to be their first child, a child that was planned, anticipated, and welcomed by this bright young couple. I had not seen bad news delivered before, and I knew exposure is important early on. I want to get it right when it’s my turn down the road, and this seemed like  the worst news a doctor could give to a patient.

We hurried on our way to the patient’s room. Her nurse had turned from distressed to angry, knowing that the patient had been sitting with her husband all this time as they waited for a physician. The nurse had not told them what she had not found. But for two future parents who attended so many prenatal appointments together, they had to know what it meant when there was no whooshing on the fetal Doppler, no movement of the little form on the ultrasound.

What came next was as sad and terrible as one might predict. I didn’t stay the night for the induction of labor, but when I returned the next morning the same doctor was in the patient’s room: mom was now pushing. It wasn’t my place to enter the process at this stage, so I stayed out. I went through the day thinking about all the joy on our unit, except that one room.

Later that night I looked down the long hall to see the parents tearfully making their way to the nursery. The other patients on the unit had no idea what was going on just a few rooms down, but this young couple knew exactly what they had been robbed of, as they moved like ghosts to say goodbye to their baby amidst the happy bustle of the unit preparing (mostly) for new life.

This is a story I carry with me now as I move forward in becoming a doctor. I will always remember the looks on the parents’ faces as they were told there was no heartbeat, the air of tragedy that lingered in the unit all week, the awful feeling that life moved on with terrible normalcy despite their tragedy. Knowing that devastation will have its place in the corners of my future practice does not deter me, though. Having the opportunity to see a well-practiced, kind OB guide this couple with grace through the process showed me what an amazing difference a provider can make. There are parts of life that are unbearable but inevitable; we as physicians are bestowed the opportunity to practice the art of medicine to make these parts a little less traumatic for our patients.