“I will assist you with this delivery, young man.”
As we stood at the scrub sink, the obstetrician had spoken the words that medical students loved to hear. Finally, years of lectures and study would translate into real medicine, actual clinical practice.
As we entered the delivery suite, I sensed that something had gone awry. The nurses were generally silent; the patient seemed isolated and forlorn as she endured sequential contractions. Then the wordless clues began to fit together: there was no fetal heart monitor, and the usual frantic pre-delivery rush was subdued, unhurried.
The charge nurse looked at me with cold efficiency. “This young lady last felt her baby move this morning. When she arrived we discovered that the fetus was dead—an intrauterine demise. Her husband was so shocked he simply left and we’ve been unable to locate him.”
The obstetrician glanced over and handed me a syringe of lidocaine. The baby was crowning and there was no time to delay. I sat upon the delivery stool and injected anesthetic for the episiotomy. From that moment I began a rote set of procedures, not unlike a pilot before takeoff. Cut the episiotomy, slowly guide the head down and out, check for a nuchal cord (an umbilical cord around the baby’s neck), suction the oropharynx. Deliver the infant, cut the cord, handoff to the nurse.
I was desperately hoping for an unexpected cry from the tiny limp body, but none came. As I passed the baby off, the nurses gently cleaned and wrapped him as they would any other newborn. In the meantime, my oft-rehearsed procedure continued. Deliver the placenta, check for retained uterine contents, stop bleeding. Close the surgical laceration. The entire post-delivery process went smoothly, as if I had done this a dozen times. The repair was clean and the bleeding was stopped. This had gone seamlessly and I was pleased with myself.
As I stood to remove my gloves and gown, the nurses slipped the baby into his mother’s arms. She began to stroke his hair. After a long moment, she looked up and said, “He would have been such a beautiful son for us.”
At that moment a torrent of emotion overwhelmed me. My ears were roaring and I felt faint. I stumbled into the doctors’ locker room, and the tears erupted violently. After a moment, the obstetrician stepped into the room. Silently he changed into street clothes as I choked back overwhelming grief. Finally, he turned and put his hand briefly upon my shoulder. “Well son, it is better that you learn now—as a doctor you will not be always victorious.”
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