Thursday, June 16, 2011

doll eyes


it affected me. not just it, but the fact that it didn't seem to affect my colleague.

i was a lowly fourth year medical student, delivering babies for all i was worth. looking back, i realize i enjoyed it. the whole 'joy of a baby coming into the world' really gave me joy that a baby was coming into the world. call me sentimental but i saw each birth as beautiful. somehow i could look past the meconeum and the amniotic fluid and the episiotomies and see what was actually going on. it was a happy time for the mother (mostly). it was the beginning of hopes and dreams. it was a new start for the baby (obviously) and for the mother and in a sense each new birth may have signified a potential new start for me.

she was excited about her new baby, but there was a cloud over her entire admission. the reason she had come in to hospital was because she hadn't felt the baby kicking for the last 24 hours and she was worried. quite soon we were worried too. not only could we detect no movement but we couldn't hear the fetal heart beat with our fetoscopes. my registrar was one of those amazing people who really felt for each and every patient despite the massive torrent of humanity that moved through the labour ward on a daily basis. this patient was no exception.

actually we all new what had happened, but the registrar wanted to make sure. i suppose she just didn't want to tell the mother her baby was dead before she had confirmed it on sonar. actually i think she wanted to use the sonar to show the mother there was no heartbeat to avoid problems of denial once the news was broken. whatever the reason i followed the whole drama as it unfolded, as did my fellow fourth year green medical students.

i remember sitting there in that small labour room where mothers are usually introduced to their new babies while the registrar ran the sonar probe over the mother's swollen abdomen. i remember her bringing the probe to a standstill over the heart. we could clearly see the heart, but there was no movement. the heart was not beating. as we actually already knew, the baby was dead. all that remained was to tell the mother. with genuine sympathy and very sensitively the registrar broke the tragic news to the mother. i saw her face drop as the realization of the loss set in. i could see her fighting back the tears. i was too.

finally it was over and we all slowly filed out to leave the mother to absorb the blow. of course we still had to decide how to deal with the problem of getting the baby out so we didn't have the privilege of dwelling on the human drama that had just unfolded before us. still i took a moment to allow myself to feel it. this involved no small amount of swallowing back the tears.

the registrar turned to us.

"and that is that. which of you is going to deliver this baby?" my colleague was the first to speak.

"excuse me, but when the baby is delivered, can we practice endotracheal intubations on the body?"

i felt nauseous and slightly dizzy. it hadn't occurred to me before then but suddenly i realized the entire humanity of what had just happened had gone completely over the head of my colleague. all he was interested in was the possible so called learning opportunity that he could get out of the 'situation'. quite frankly he had felt nothing for the baby and he had felt nothing for the mother. i couldn't help wondering what sort of a doctor he would one day turn out to be. i never wanted to be like that.

in the end i was the one that had to deliver the baby. there were a lot of tears.

25 comments:

rlbates said...

So very sad.

Lynda Halliger-Otvos said...

How tragic for the mom and for you. I am sorry for the loss.

The other doc... Glad he is not my care provider.

Paracelsus said...

Oh, man.
This is sad beyond words. I'm not about to congratulate you vs your coleague, because this is too primal for that kind of thinking.
The picture you painted with the mother getting the bad news almost got me misty eyed. Who am I kidding, "almost"?
It brings back a lot of painful memories from the wards, and theatres, and delivery suites, about the enormous suffering humans have to endure. Sure, your training conditions you to swith into "pro mode", which is desirable and gets the job done, but still. Skill without humanity means nothing in this field. As I said, anyone can shift into gear and get whatever job's at hand done, but it takes a "special" type of person to do it without any trace of what might qualify them as an actual human being. And that is no less than degrading, for all parties involved.

Sharp Incisions said...

I'm very glad for the sake of the mother that you were the one to deliver her baby. I've been on a case like this too, and it's just impossible to capture how tragic it is in words. I can't fathom your colleague's reaction in such a situation - it's just unbelievable.

Kalei's Best Friend said...

Death of a baby/child is about the worse loss...

rnraquel said...

This is so sad. I have been on both sides of this situation, and it is rough on everyone involved.

SeaSpray said...

Truly so very sad. I agree ...it was so much better that YOU were the physician delivering her baby.

It must be an awesome feeling to deliver healthy babies. A one with the universe kind of feeling ..helping to bring a new life into the world. Conversely the exact opposite with what you had to absorb and work through.

Your compassion must've shown through to her... even if not then ..when she later remembered things.

Jayne said...

Such an incredibly sad situation, for everyone concerned & involved. I'm also glad it was you that delivered the baby & not some doctor who was more interested in what a stillbirth could do for HIM.

Danger Boy said...

I don't know that I could have avoided giving him the backhand of justice.
And I just shared some of those tears.

LOST SOUL said...
This comment has been removed by the author.
LOST SOUL said...

Haven't you gone "numb"(like your colleague) as the years have gone by ?

anne said...

terrible.

Bongi said...

lost soul, it is true that sometimes one has to put your head down and just get the job done and to become comfortably numb is a constant danger, i remind myself always of the human aspect of what i am doing.

it is easy to whip out an appendix and to sort out sepsis or to cut out some or other organ that is offending in some or other way, but in the end i do what i do to return a patient back to their humanity, so they can stop and smell the roses on the way.

survival is just the beginning. living is what it's all about and that is what i like to remember for the patient when feelings of numbness threaten to overwhelm me.

Zamalek said...

Bongi...I truly feel you on this post. Last year(my 3rd year at Pret)we had to deliver babies at Tembisa, where a mother with an Intra-Uterine Death was also shoved into the corner after she was told that her baby had no heartbeat. The sisters completely ignored her after they told her to just push "it" out.
In the end, I was the one who sobbed as I delivered the dead baby...will never forget that day!!!

kara kadife said...

During my intern year, one of our attendings took to inserting endotracheal stents and we started accepting all sorts of patients from surrounding provinces. So this lady was one of them, she had an ugly anaplastic thyroid carcinoma which was slowly strangling her. Family and attending wanted everything to be done.Her subglottic trachea was 5 mm. I called anesthesia, they did a transnasal awake intubation for she was in respiratory distress and no one had the balls to give her medication. My attending ended up getting really pissed off about me not trying first. I told him that I never did such an intubation before and I would have killed the patient if I tried the usual route with my inexperience. Then he said 'now, did you save the patient my stupid daughter? She is going to die. Or do you really want your first difficult intubation on an actually salvageable patient?'

You know what, as a human being and as a doctor, that attending of mine is lovely, wise, compasionate. I can let him take care of anyone. So I am not sure about your friend turning out to be a bad/asshole doctor looking at this case.

Bongi said...

kara, you make a good point. this is definitely not cut and dried. some time ago i wrote a post called practice that raises the same points you are raising and i think they are valid points. we do need to take the opportunities to learn when they are presented. however what got to me wasn't necessarily him wanting to practice the intubations (although that could only ethically be done with the consent of the mother and that is a whole new dynamic) but more that he hadn't followed the humanity of it all. it had not touched him and if you are in this line and the humanity is not touching you, maybe you shouldn't be in this line.

Solitary Diner said...

Bongi - Beautiful post, but I think you need to be cautious about assuming that you know what your colleagues are feeling. Your colleague may have had an emotional response to the situation that he simply didn't feel comfortable expressing or that he didn't want to think about during a busy work day. I personally often don't react immediately to the tragic situations that I see at work, but I reflect back on them at the end of the day when I can cry in the privacy of my own home.

Elaine Schattner, MD said...

Thank you for this post, Bongi. You describe a common, heart-wrenching kind of situation many of us can relate to.

Wreckless Euroafrican said...

I am not qualified to make a professional comment - but a humane one I can. Thank you for your sensitivity to the patient. You are truly a Doctor because you care.
Salagatle!

daneastside said...

wow, sorry :(

united kingdom pharmacy said...

You know what, as a human being and as a doctor, that is just lovely.

pharmacy in uk said...

i bethink sitting there in that baby labour allowance area mothers are usually alien to their fresh babies while the agent ran the alarm delving over the mother's bloated abdomen.

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sullolaw said...
This comment has been removed by a blog administrator.
Bongi said...

sullolaw, i refuse to allow a lawyer to advertise on my blog.