Saturday, June 2, 2018

Pregnant Doctor Delivers

Now that I’m older I have the true luxury of remembering. Those who died young didn’t know this.  As a physician I’ve been blessed to be present at so many pivotal, and one might well say ,sacred times.  I’ve heard countless stories and felt the lives of those who have come to me to share.

This morning, for no reason, these memories seem to rise up like that, I don’t even know of a trigger. Yet this one came to mind and I smiled as I so often do remembering work, the colleagues I knew and the patients who brought us together.

This occurred in a busy teaching hospital.  An obstetrics ward in the wee hours of the morning.  We were all gowned and masked.  We had these little paper booties that covered our shoes.  I remember them most.  The white walls and bloody red sheets. The laundry piling in the corner as all were needed for the work at hand. Later there’d be time but at that moment it wasn’t something we could think about.

“There must have been a power outage over the whole city 9 months ago,” the nurse joked.  

I was at the foot of the bed watching as the cervix dilated and the woman pushed. She’d been screaming for an hour before between contractions when the pain should be least. In addition the anesthetist had just given her a spinal block and begun to administer epidural analgesia.  She should be feeling less pain and be screaming less. If anything her screams had grown louder. 

 I’d asked the nurse about that, as an aside, concerned that something might be amiss.  She nodded to the door where a thoroughly terrified young man was there at the window peering in. He’d come to the little square glass then walk away with an older man comforting him.  I’d seen the older one put his arm around the younger man’s shoulder.

Then the father to be would pull back his shoulders, stand tall and return to peer in the little window.  There were tears in his eyes as he waited helplessly, overwrought I presumed with his inability to do anything but wait.   I’d been glancing out at him now and then while waiting, patiently, for the delivery to progress. 

While the anesthesist was speaking to the patient, the nurse was reviewing the continuous monitoring data strips.  In a low voice , beyond the hearing of the patient, who was either  listening to the anesthetist or screaming her lungs out, the nurse shared. 

‘That’s her husband and father,’ the nurse told me. “They’re old school Portuguese.  Our patient is okay but the more she screams the more the men will care for her and the baby after.  They’ll be helping her now for the whole of the coming year,’ she said smiling.  “It’s a good thing. It’s cultural. She’s going to be okay and she and her baby are going to get a lot of well deserved breakfasts in bed.’ She laughed.

I reflected on the aboriginal patients I’d delivered who’d been a different challenge. Their stoicism and silence had been the means to recognition in the family and  community.  As a doctor I had so much to learn about how people express themselves in sickness and in health.  I had to listen for the different cues that something which might be normal had changed to something that might be more concerning. The older nurses especially in Obstetrics were a wealth of experience and insight. Early days I felt like a hamster on a wheel forever playing catch up. 

I was brought back to the present, not by a fresh crescendo of screams but by the door bursting open and another gurney rolling in as it was pushed quickly  in place  by two sweating hurrying orderlies.   

“We’ve run out of anesthetists.” One said smiling as our anesthetist began to busy himself with the new arrival.  “All the delivery rooms are full and we’re  doubling up.”

I was suddenly very anxious. I was very new to this, only a few deliveries under my belt. My lady was almost fully dilated and here was this new lady well on her way by the rate of the her contractions.  

I think the older anesthetist could see I was concerned if not outright terrrifed.  He said, “Her doctor will be on the way. She was just delivering another lady before I came here.  If all else fails I’ll gladly help at your end.  I’ve been there many times before,” he laughed with the infectious confidence of maturity and experience.  My patient screamed. The other patient screamed.  The nurses eyes twinkled.  It was already a long night.

At that moment a very very large young female doctor burst into the delivery room and went to the side of the newest patient taking her hand, speaking kindly and calmly to her as she looked over the monitor.  

“You didn’t think I’d miss this for anything,” she quipped to her tired but smiling patient. “We’ve been planning this for 9 months.  Now we’re going to see that it was all worth it!:

The doctor was 10 months pregnant herself if she was a day.  Bigger than a house and nearly the size of a whale. She’d moved fast into the room but could hardly bend to speak to the patient.

Going to the foot of her patients bed she peered down and said to the nurse.  “Already crowning”.  To the patient, she said,   “ We’re doing very well.’ Not much longer now especially given how well your last delivery went. “

“Hi Charley’ she said to the Anesthetist. 

“Hi Annie,” he replied, in the tone of old friends.

“Good morning, Doctor, “ she acknowledged me kindly. 

Looking over my shoulder she saw that my patient was just beginning to crown too.. 

“Primip” she quearied,  smiling at my patient.

“Yes,” I replied

“This is Sarah’s second, could be a close match! ‘ she said looking at her patient and returning to where she could view her.  Turning to me she said, “I’m not going to say it’s a race but if this were Vegas they’re be laying close bets as to which child would come out first.‘ 

“Not much longer now , just a few more pushs Ladies.” She said to both.

It was clear that my patient was more relaxed now that this marvellous woman doctor had arrived, even if she was the size of a house and some at Vegas might be including her in the betting . 

The poor patient  was no longer dependent on me a young doctor obviously wet behind the ears. Her screams had changed  now to more like grunts as she pushed responding to the nurse who’d taken a position right beside her head , letting the patient  hold tight to her hand. 

“Here we go”  Dr. Annie said to her patient just as my patent  became fully dilated and the crown  began to appear.   There was no need for an episiotomy. Everything was going smoothly.  I reached forward as the baby came , cradled the  head, then the shoulders and the bum and finally the legs came too.. The nurse was there beside me taking up the baby in clean linen and, wiping off the amniotic fluid, then giving the beautiful little boy baby to the mother.  The placenta delivered. All the bits were there. The new mother was smiling beautifically, pleased with her little boy. I clamped and  cut  the umbilical cord.  

Normally the father would be invited into the room but with the two deliveries happening and the nurse being more aware than me she’d wheeled this bed out into the hall where the father and mother and family and in laws were all waiting to celebrate the new addition to their family. The nurse returned immediately to be there for the second delivery.  I stood by waiting to be of assistance, not knowing what else to do. 

Just as my lady was being wheeled out, with her baby clutched to her chest, the other baby was delivering.  I’d only glanced over to see the mountain of a pregnant woman doctor between the woman’s legs in stirrups.   She’d been leaning awkwardly forward , stretching out and over the mound in front of her  assisting the delivery.  Her arms had the vague resemblance to the Tyrannasaurus Rex but somehow she managed.   Lifting the baby into the air she exclaimed,  “It’s a girl!”  as she handed the baby to his mother.  

I was about to leave then when the lady doctor said, “I’d appreciate if you ‘d not go  just yet. “

“Sarah” , she said, “Congratulations, but if they don’t get me another bed I might have to ask  to share yours.  My waters broke in all the excitement of your delivery! “ She laughed. It was obvious thought she was  just a bit strained. 

The nurse with the strength of a Sumo wrestler and the speed of a jaguar  muscles  another bed into the room with my helping with the guidance.

 Sarah’s husband had joined her and the two were google gaga over the new baby as the two sweaty orderlies were moving the bed out of the room. I don’t even think they noticed us so caught up in love they were.

Dr. Annie was now  standing partially bent over grabbing hold of her thighs and Lamaze breathing as another contraction passed.  The anesthetist,Charley,  was right by her side. 

“I’m going to have to ask you to help me up on the bed,” she said, “ I don’t think I can stand much longer.”  Together with Charley I helped her onto the stool the nurse had brought forward.  Together we hefted her up onto the bed where she collapsed with a huge sigh.  Lying on her back she looked like an Anaconda who’d swallowed and elephant. I couldn’t believe how far along she’d been and delivered two babies that night before she was about to deliver her own. 

‘Could you tell me how far along I am?” she asked between panting.   Charley was establishing an IV.  The nurse  was spreading the jelly for the  ultrasound monitor.  The baby’s heart rate was suddenly visible and looking just  just fine on the screen.

I examined her then. She was fully dilated and just beginning to crown.    I said so.

“I thought as much, “ she said, between breaths and pants. “I called my own doctor before Sarah. If he doesn’t get here,  I’d appreciate you’d stay and assist. I’m rather occupied myself. “ She smiled and I could see Charley’s eyes twinkling as well.  I really was rather awkward and uncertain in those early years. I stayed of course. Never thought I’d do otherwise. 

“Of course,” I said. 

Her beautiful face was flushed and sweating profusely as another contraction took hold.  The nurse had given her her hand and she was squeezing tightly.

At that very moment,  another rather  tall doctor,  burst through the doors. He stopped abruptly beside the patient and said. 

 “I’m glad I’m not late, Annie. I hope you didn’t wait just for me. ” Another contraction came.

“Good to see you, Charley,” he said coming down to the end of the bed beside me. 

“All’s well?” He said, Charley, myself and the nurse nodding. 

I never was more happy to stand aside and let an older doctor take my place.

“I see a head Annie.  Shan’t be long.  Just another push or two if you don’t mind.”  Dr. Annie gave a powerful push and the baby’s face began to slowly appear, the obstetrician carefully guiding.

And sure enough, another baby girl was delivered that morning.  A lovely little girl.  Five fingers and five toes.  

Dr. Annie’s smile was as beautific as the other women’s.  Her husband came in as I began to make myself scarce.  Even as I was leaving, Dr. Annie, turned her beautiful eyes on me, and said,  “Thank you. ” Then her attention was all for her baby and her man.  I looked back over my shoulder at this wonderful family tableau knowing I had been blessed to be there this night. .  

I made my notes at the nursing stations surrounded by the doctors who’d been called in for this most productive night. 

 I will never forget that beautiful lady doctor 9 months pregnant delivering another woman’s baby before giving birth to her own.  That’s a memory I feel  blessed to have. Looking back I’m just thankful to have been there and thankful to have been of some service to all those amazing colleagues and patients and especially Dr. Annie.  Sacred times. 










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