At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Wednesday, September 04, 2002


WARNING: What follows is kind of heavy, so please don't read on if you're feeling fragile.

Just an update. The second patient I was waiting to deliver finally went into labor on Labor Day, which would seem ironic except about fifteen other women decided to do the same thing. It was a fast labor with a harrowing delivery. The baby's head delivered but then the body refused to come out. This is called a shoulder dystocia and is one of the most dreaded events in obstetrics. We had to call a Code OB (obstetrical emergency), a whole mob of people came running and some of them lost their heads and started yelling. I pulled and pulled and pulled on the baby's head, while another doctor was cutting an episiotomy. I distinctly remember thinking, Baby, if I break your clavicle or arm, so what? Just be born alive. The delivery nurse leaped onto the bed with the patient and pushed hard over the pubic bone to help the shoulder slip beneath it. My patient was screaming in terror. Everyone was yelling at me what to do next, and as I pulled the baby's head finally rotated into a good position and we pulled him out. It took a full minutes to deliver the body after the birth of the head.

He needed some resuscitation but got Apgars of 2 and 8. At first he wasn't moving his right arm very much, which worried me excessively--I might have damaged the nerves to that arm by pulling so hard on his head--but gradually he moved it more and more as the stress of his birth wore off. Here's the kicker: he weighed 9 pounds, 13 ounces--almost a pound more than the patient's last baby--and his chest measured 38cm (about 15 inches), compared to a head measurement of 35cm. Just to put his build into perspective, the chest measurement is usually within 1cm of the head measurement. Nature meant to make babies well-proportioned, to facilitate safe birth, but this big fellow--well, let's just say he looks like a miniature football player in the making.

Mom and baby both went home today. Mom is a very serene person, unworried, and very happy with her baby. I, on the other hand, have been walking around in a daze since the event. My whole body hurt for two days. It was not the worst dystocia I've ever witnessed, but the worst one to happen to my patient. I cannot express in words how terrified I was until the moment I saw him born.

So I've been trying to rest in a quiet, inner place. It was hard the day the baby was born, because I was on call and working with some people who didn't help me get quiet--I'm sure you've met the type. I think the fact that I couldn't get calm immediately after the event, but had to run to the next crisis instead, is prolonging my own emotional recovery from that endless 60 seconds. I'm much better today, and it helps to share the experience here--but I think I'll take a bit of a break from my usually fibery impulse, and just spin serenely for a few more days. I will be reading everyone else's blogs, because it cheers me up to hear about all your exploits, but not commenting much. I'm off this weekend, mercifully, and the rest will do me good. Hopefully I'll be back in top form by Monday! In the meantime, may all your families be safe.