• leaflet

    . . .a thin triangular flap of a heart valve. . . a small book usually having a paper cover . . . a medical lit-art e-journal from The Permanente Press
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Crash Cesarean: Poetry in Motion

Vol 6: Iss 2, Prose

There are certain items on the medical school bucket list—dissect a cadaver, identify your first diagnosis, assist in a major operation. One of those experiences that we are truly privileged to become immersed in is the natural phenomenon of childbirth. Somewhere packed into the womb, adjacent to the syncytiotrophoblast, is a plethora of adjectives that gets delivered sometime between the neonate and the placenta. Emotional, fascinating, perplexing, nerve-racking, beautiful, incomparable, impressive. One other adjective is “defining”. Many people in the delivery room become re-defined (mother, father, grandmother). It can also be a defining moment for a medical student. A fair number of obstetricians cite their first delivery as the impetus for their career trajectory. 

Eager to help deliver my first baby, I was certain that baby Doe would be the one. During my second call-shift as a medical student, a mother presented for induction at 37 weeks. Her previous two pregnancies were without complication, but she currently met criteria for preeclampsia. I introduced myself to the patient, her significant other, and the patient’s mother. The atmosphere was jovial and welcoming. Every time I checked the strip, I was reassured that I would be helping to deliver my first baby before the night was over. At the last cervical exam, the patient was determined to be 9 cm with 80% effacement. I prepared my gown and gloves for delivery. Like an aura before a migraine, there was an evanescent calm preceding the impending storm. I could not tell exactly what was wrong, but I could sense it. The midwife asked me to help turn the patient on her side. Her face was strangely sober. We helped the patient through a few more positions in a type of desperation yoga. I did not receive complete confirmation of the direness of the situation until the patient and her family were made aware. “The baby’s heart rate is down. We need you to stay as calm as possible.”

The nurse called the obstetrician as I relayed the message to start preparing the OR. Panic ensued. Panic on the face of the soon-to-be-grandmother. Panic emanating from the patient. Panic beginning to confront me like a train screaming down the tracks. Remarkably, there was no semblance of consternation on the faces of the growing number of health professionals that expediently became involved in our case. There was an order to the chaos. Everyone in scrubs had a designated purpose and they fulfilled it in a perfectly natural manner. As for myself, I did not stand frozen or gripped by the situation, but rather recognized the choreographed nature of a stat-section and realized that there was no place for cogs in the wheel. I was a spectator to a dramatic scene of—realistically—life and death. In the moment, there was no telling how fast (or slow) the entire process went.

According to hospital records, the actual time from decision-to-cut until baby’s first breath was 11 minutes. What did this eleven minutes feel like to the patient? To the father? To the staff carrying out a precarious protocol? The calm demeanor of the surgeon and the surgical staff during the incredibly abbreviated operation was difficult to capture in words. As the baby broke into the realm of reality via the amniotic portal, the tension in my muscles reached a peak. The palpable stress was vanquished when the baby let out its first cry. Relief washed over me, a naïve observer of a sequence of events that was apparently navigable for the others in the room. In an instant, the participants in the most portentous spectacle I had ever witnessed seemed fulfilled, their collective fears ameliorated. 

As I exited the operating room, I glanced over at the new mother. She was sound asleep on the table. I asked the anesthetist a semi-rhetorical question (perhaps I had missed what happened on the opposite side of the blue surgical curtain). 

“What type of anesthesia did she receive?”

“Just an epidural. It could be the mag[nesium] but I honestly think she’s just exhausted from the whole process.” 

Lost in the grand display was the selfless devotion of the mother to her unborn child. An entire unit rallying around her, her last quantum of energy spent immediately after she bore witness to the fruit of her literal labor. In the midst of all of the adjectives associated with birth I was left with a novel definition of a familiar noun: appreciation.