Student Scene
 Photo by Jeff Cleary |
How a Doctor Builds a Family
Only after several weeks of my obstetrics and gynecology rotation did I come to the long-awaited first day on the labor and delivery floor. With my lukewarm cup of coffee in hand and snow from my bike ride still clinging to my coat, I squeezed into the elevator with several other staff members and a new father, complete with flowers, balloons, diaper bag, and an empty stroller. His presence appeared to lighten the air, and I left amid murmurs of congratulations and a ring of smiles.Accompanied by the sound of my own echoing steps, I pondered how simple pregnancy had always seemed in the past, a sort of natural conclusion to the love and marriage continuum of adult life. One of four children, I recall my mother describing her sense of calm when her last child was born--a sort of assurance that after three uncomplicated vaginal deliveries, a fourth can be done. I remember how she had read a book titled The Joy of Breastfeeding. Somehow, the whole of pregnancy and giving birth had always been pleasantly sheltered with a hazy filter of distance and ignorance.
But here at the hospital, I found some much more sobering--at times, frightening--realities. Pregnancy can be a medical emergency. Of course, medical students are reminded that the teaching hospitals may not always reflect normal patient populations. Yet in these few short weeks, the plunge into such a mix of joy and sadness and mingling with so many lives could not help but leave some mark on my own life.
'Come Quickly'
The first delivery happened suddenly. The intern poked her head into the hall: "Come quickly or you'll miss it!" I dashed into the room, grasping for mask, goggles, gloves, and gown. My job may have seemed simple, but I knew it was critical--support the perineum (and having read about first-, second-, and third-degree lacerations during vaginal births, I took the task seriously).|
Maybe it is my own misgivings and sorrows and struggles that are the very bridge connecting me to the ones I serve. --Alisa Land |
Not surprisingly, books did not really prepare me for the sight of this little one bursting into the world--being helped into the world was more like it. It took some wrenching and pulling, the baby's head bulging and covered with fine hair, face rather puffy, straining to be born. A final grunting contraction from the brave mother (while I was pressing mightily to hold that perineum) and the child slipped into waiting arms, a gush of fluid in her wake. It was 4:19 p.m. Ten pounds, 3 ounces. "Happy birthday," someone said to this little one as her cord was clamped and she was wrapped and handed to the waiting pediatrician.
Human Dramas, Happy Endings
As the day rolled on, I continued the hourly visits and note-taking on the other patients I was following through labor--a woman in her 40s with an IVF first-time child, a woman in her 20s who wanted a vaginal birth after having a cesarean section, and a 17-year-old mother with her 18-year-old boyfriend about to deliver her first child.When the woman in her 40s gave birth, I felt a connection to her--she was a professional who had delayed child-bearing and then struggled against the odds to have her baby--a precious little boy--later in life. From her, I went to the bedside of the teen mother. I stroked her head, comforting and encouraging her in turns as her boyfriend cheered her on toward delivery. "You keep pushing mama, we're gonna have this little baby!"
Amid this happy chatter, the fetal heart tracing of my other patient began to show decelerations. En route to a planned C-section for failure to progress in labor, the case suddenly changed to a stat C-section. My intern told me not to scrub in--no time. I stood back, helped the father into the room that had suddenly grown strained and hushed as the surgeons grappled to open the mother's uterus. Pooling blood flooded up, and I could only see the scissors diving into the abdomen. The father began to faint. I took him outside, speaking my few words of Spanish to try to comfort him as he asked, "Why so fast?" The answer was too difficult to trust myself to explain. Finally, the baby was delivered, rushed to the NICU team, bluish, and immediately put on oxygen. Ultimately, even this mother and child recovered.
The Empty Hours
A day later I visited each of these four patients and their families. In every room I found a beautiful baby, held in a mother's arms with family and friends around. Sunlight cast a warm glow, a rare moment in this bleak January, a fitting symbol of hope.Yet I left their rooms with a fading smile, wondering why I felt so left behind. Perhaps I simply had to grieve a little for myself, for the hours and days and years I have spent in building others' families even though I have no children or husband of my own. But somehow, even with the austere hours and many sacrifices, I find my life is rich with sharing in my patients' joy and suffering, and I remember why I came to this extraordinary profession. Maybe it is my own misgivings and sorrows and struggles that are the very bridge connecting me to the ones I serve and will enable me to be both a physician and healer in the days to come.
--Alisa Land, a third-year medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.