It was my birthday, about a week before Christmas, and I was on call overnight in the hospital.
It was 1:30 AM on our labor and delivery floor. The buzz of healthcare providers speaking about patients and the announcements from the hospital’s loudspeakers were muted for the night. During night call, there is mostly quietude. Healthcare teams are sparse and the sporadic beeps of alarms and pagers indicate a jarring potential for urgent situations.
On my obstetrics and gynecology rotation, medical students were expected to perform a history and physical exam on new admissions. So when I heard a patient coming to the triage area, I stuffed the labor and delivery book I had been reading into my short white coat pocket, sandwiching it between the supplies I had picked up to fulfill my secondary role as a human storage closet. In my right pocket, I stored a doubled-over black stethoscope next to my orange notebook; in my left pocket, I amassed a hefty wad of dressings, packets of lubrication jelly, and a few extra pairs of gloves.
I introduced myself to Carol, a woman in her mid-thirties with brittle brown hair and a tendency to bite her upper lip during pauses in the conversation. I went through the motions, learning about her current pregnancy in relation to the others. It was her third pregnancy; she had two boys aged eleven and fourteen. Despite objections from her husband, she wanted a third son and after some persuasion, he finally acquiesced. They were happy to learn that their efforts had yielded a new baby boy and came up with a name: Leo. I jotted down her other medical conditions and promised I would be back later. Presenting her case to the healthcare team, both the attending and the residents agreed with my initial assessment of the situation. She had a relatively uneventful pregnancy and came to the hospital at the beginning of her labor; it would probably be best to keep her in the hospital overnight and wait for her baby to be born sometime during the upcoming day.
Knowing that the rest of the staff was busy with other priorities, I checked on Carol throughout the night. She wanted her epidural early so that she can could get the pregnancy over with, and we made sure to carry out her request. For a woman who had given birth before, however, it was taking longer for Carol’s labor to progress than expected. Carol initially laughed and chalked it up to “her husband not wanting this baby,” but our concern started to grow steadily throughout the night.
A few hours later, her husband arrived from out of town. He stood by at the bedside, running his fingers through her hair while Carol’s knuckles turned white gripping the bed during her contractions. When the resident and I attached a monitor to the baby to detect its underlying heart rhythm, we found that each contraction was putting Leo under stress. Confirming our findings with the attending, we moved swiftly to give Carol fluids through her intravenous lines and some oxygen with a facemask. The air flowing from the tank made it hard for Carol to enunciate, but the gaze from her umber eyes underscored her message to all of us: “Please take care of Leo and me.”
In the middle of our labor and delivery floor, we have a large mounted TV screen that reminds me of the flight information display systems one might find at an airport. Each patient’s name, age, relevant medical history, and state of labor are methodically color-coded and arranged on the screen so that all members of the team were on the same page. The screen was always comforting to me. It was an attempt to create order and reason in a field where uncertainty and randomness often prevail.
As the night progressed, Carol’s segment on the television screen went from green, to orange, to finally, red. Leo’s heart wasn’t doing well, and we tried a last ditch effort to give him more space inside Carol’s body by providing fluids directly into her uterine cavity. Sometime before twilight, the team decided it would be best for both Carol and Leo to receive an emergency C-section.
One of the hardest questions I have had to answer as a medical student is also one of the most frequent: “Will I/ he/ she be okay?” Part of this is my lack of a solid knowledge base: I may or may not know enough about the issue to truly understand the patient’s prognosis. But I suspect the real reason why doctors tend to answer this question with deft and noncommittal responses boils down to something deeper. Despite our best efforts to create meticulous flowcharts and guidelines to treat and manage patients, we all can think back to an experience where it all went wrong, even when we thought that we did everything right. So when I helped Carol’s husband put on a pair of scrubs to enter the operating room, I phrased my response to his query in equally tentative language: “I believe so, sir. We will do everything in our ability to help Carol and Leo at this time. There are no guarantees in medicine, but I assure you that both the residents and attendings here are incredibly well-trained and have been in this situation before.” I truly meant every word of it.
I have always loved the operating room for its scrupulous and technical nature. The precise instruments, designated roles, and distinct order of operations all combine into a symphony of excellence. Standing in the corner of the room, I watched as the surgeons and anesthesiologists discussed their plans and got to work. It only took a few minutes before Leo emerged from Carol’s womb and was placed on her chest, crying and healthy. Carol’s husband, donning yellow observer scrubs and slightly-too-large blue covers on his feet, tepidly stepped into the operating room but let out a huge grin when he saw Leo for the first time. After about a minute of smiles and laughter, Carol’s husband and Leo left the room for his newborn well-check and the surgeons worked to finish the procedure. Shortly thereafter, however, the anesthesiologists raised their voice and asked how much blood loss the surgeons were seeing. The answer didn’t satisfy them; Carol’s blood pressure was dropping more than expected.
Suddenly, the symphony I was used to in the operating room exploded into a cacophony of improvisation. Carol was placed into a medically-induced coma as the voices in the room became more shrill. Time warped as I removed sterile gloves from the cabinet and tossed them to a bevy of staff who were not in the room five minutes prior. The surgeon’s fingers moved quicker than I had ever seen them move, their standard calculations of visuospatial awareness replaced by the ripping of sutures with their bare hands. A code crimson was called as we gave Carol every last unit of the blood our hospital had in the blood bank, giving her a red substance to keep the red numbers symbolizing her blood pressure on the OR screens from dropping further. Providers tunneled access through her neck to get a picture of her heart, but the fluid in its chambers started to balloon backwards like a child placing its finger at the tip of a garden hose. I held Carol’s arms in place while nurses, surgeons, and anesthesiologists performed chest compressions, as her body flailed around like a ragdoll on the operating table. The concerto of loud voices and rushed movements reached a zenith, and then finally, there was silence.
After Carol’s death was pronounced, the head nurse passed around towels and we wiped our faces of tears, sweat, and (occasionally) blood. Who was going to tell Carol’s husband? While the healthcare workers deliberated, I did my best to help prepare her body for viewing, dabbing as much rust-colored liquid off her face as I could. It was the least I could do. I had wanted to jump in and assist while she was alive, rather than simply being a helpless observer of this horror story.
When they brought Carol’s husband and Leo to see Carol’s body, I brought him an aluminum chair to sit on. I wished I had something more comfortable to offer him, but he thanked me nevertheless. He wailed and wept, his beard damp while holding his newborn son on the chest of his now deceased wife. In the face of such tragedy and suffering, it took all that I could to be one of the individuals to stand in silence alongside him.
But that’s what I did. I sat in silence with Carol’s husband, because nothing I could possibly say would provide comfort. The moment was too solemn to be ruined by platitudes from a medical student. The truest, most honest comfort I could provide was simply to be present, not to pretend I could understand the depth of his agony. At least that’s how I felt.
Until that night, it was easy to fall into a familiar routine during clinical rotations: go to the hospital, present my findings on patients, come home, study, and repeat. But over the course of a single night, Carol’s husband had received the gift of a son in exchange for the death of his wife. Like the electric defibrillators I had observed moments earlier, I was suddenly jolted out of my normal rhythm and forced to confront the impermanence of life and the callousness of death. I began to recognize that the privilege of practicing medicine involved a certain intimacy with that dichotomy. And in that context, I realized that the details of our verbal and nonverbal interactions with patients and their families in moments of crises can forever brighten or stain their perception of the experience.
The next day, the healthcare team and I prepared the morning report as the rest of the daytime shift arrived. There was a black line through Carol’s name on the central screen, a tidy footnote that alerted the remainder of the staff what had occurred the night prior. I tried my best to remain calm as we discussed the morbidity and mortality of Carol’s death the night before. After much deliberation, we moved onto the new patients for the day and the call team was dismissed. Before I went home, I swiped my badge into the newborn nursery, explained the situation to the doctor, and went to see Leo. I held him in my arms, feeling his warm body swaddled up in blue blankets. He was sleeping peacefully, but I could not help but think of his innocence and complete inability to ever really understand what had occurred the night before. Before setting him down and leaving the hospital, I promised to always remember Leo. He and I will forever share the same birthday.