Metrics of Affection

Glancing over the patient list this morning, my eyes lingered on the bolded phrase "NbBoy X, Known Trisomy 21." My stomach sank as the possible complications of that diagnosis began running through my head.

A few minutes later, after we had discussed each patient with the residents, we began our morning rounds in the nursery to perform our newborn exams.

Walking into that patient's room I didn't really know what to expected. Disappointment? Sadness? Fear of caring for a child with disabilities? Whatever angst I was feeling quickly dissipated as we all piled into the room to a grandpa's happy and proud laugh. A dad grinning from ear to ear. And a mom gently holding her new baby, smiling that tired but completely content smile, as only new mom's can.

We spoke with the parents, wheeled over baby boy X in his crib and began examining him. Once we were done we wrapped him up snug and passed him back to mom, who was clearly already completely in love with her new baby.

Later that morning, when we were discussing patient plans, one of the interns asked if the parents were aware of the situation. My resident said yes, and that they had been informed a couple months ago. The two of them began tossing around the idea that maybe the parents were in denial or didn't fully understand the diagnosis.

And, while I am definitely new here, I don't think denial was it at all. Because watching the mom look into the eyes of her new son, I only saw one thing, and it was love.

Move over, Clement Clarke Moore

A call light flashing for a room with a 10cm dilated patient is pretty much the best thing that could ever happen on the labor and delivery floor. The nurses jump up, the midwife sets down her coffee, and the super-excited (but totally professional) medical student all rush down the hall, eagerly anticipating the birth of a fresh new little babe. Be still, my uterus.

I just finished up my Ob/Gyn rotation. Part of my rotation included two weeks on the Labor and Delivery floor which meant one thing: BABIES!!!  I've seen too many vaginal births to count, and was even allowed to "catch" a few babies myself. Because this rotation will forever hold a special place in my heart, I wanted to write something to commemorate my time with all the excited new mommas and (nervous as all get out) new daddies to-be. In lieu of another list (which we all know I love), I give you a poem...

“'Twas right after the call light flashed”

'Twas right after the call light flashed, when all through the floor

Not a person was sitting, waiting around was no more.

The nurse jumped up, right out of her chair

And the midwife, mid bite, set down her pear.

The medical student looked up, from her very dull text

And could only hope, she knew what was happening next.

The three of them rushed to the room down the hall,

When they walked in the daddy-to-be looked ready to bawl.

A look of determination swept across the mom’s face.

“Lets do this!” She said, “This baby won’t wait!”

Sterile gowns were tied, white gloves put on,

One last check was performed, that cervix was gone!

The midwife looked at momma, “You know what to do.”

“When the next contraction comes, you push right on through.”

A contraction spike began climbing, on the monitor screen

The poor woman turned red, and started to scream.

She gritted her teeth and moved that baby on down

Straight through the birth canal, until baby started to crown.

“Medical student c’mon! Put your hands right on mine.”

So I bent next to the midwife, and her hands I mimed.

“You can do it!” rang out, the nurse's loud cheer,

"Just one more push, she’s practically here!"

And sure enough, a head started poking through.

The miracle of life – with lots of other goo.

With all the strength she could muster, that momma pushed

When a head popped through, albeit kind of smooshed.

Then one shoulder came, and then one more

And finally a beautiful baby, met by no one before.

Up on momma’s tummy, new baby went

Momma smiled through teary eyes, her energy all spent.

The daddy carefully stayed at the head of the bed,

And bent down and kissed his new daughter’s head.

“You’ve done it,” we cheered. “You are such a champ!”

And I almost forgot, my scrub pants had gotten kind of damp.

The new momma glowed, and she thanked us all

“Baby girl 13:15!” was shouted down the hall.

And as another shift ended, on the L&D floor

That was awesome I thought, I’m ready for more!

I changed out of my gooey scrubs, and replayed it all

I smiled and thought, maybe I'll be an Ob/Gyn, after all.

~The End~

Hello, Darlin'

"Hello, Darlin'

Nice to see you.

It's been a long, long time..."

As Conway Twitty's voice rang out from the patient's buzzing cell phone, the very focused intern began inserting a catheter through the abdominal wall where it would drain almost 4 liters of fluid from Mr. X's very distended abdomen.

Just as the catheter tip was reaching our fluid filled money spot, I thought about all the other times that song may have been the soundtrack to moments in this patient's life. Driving a date to the movies. Playing to an empty house after his kids went off to college. Serenading him now when he goes to his favorite local diner for pie. And then I thought about this moment. The one we all found ourselves starring in. The setting: a quiet ICU. The supporting characters: a seasoned attending, a couple of nervous interns, and one third year medical student, trying desperately not to contaminate my sterile gloves. The leading role: a man in his early seventies, currently grappling with the harsh reality of decompensated heart failure.

I originally began this post during my last week of internal medicine. And while there were moments that I absolutely loved working on the floor, there were also many that left me disillusioned. There have been stories that I've wanted to share on this blog, but ultimately chose not to. Mostly because I felt that my writing was inadequate. But also because coming home after ten-plus hours surrounded by sickness, the last thing I wanted to do was write about it.

A lot of those posts, like this one, would start off with a person, their story eventually interrupted rudely by an illness. And that's where it would stop. Because as much as I tried I couldn't find a nice way to wrap it up. A final point or "Scrubs-like" realization to conclude those posts would elude me. It just wasn't there. And I guess that's what made those moments in the hospital, like the one above, so heavy. Those moments remained absent in my writing because they did not exist in real life. Sickness is cruel like that. It so rarely provides the luxury of a satisfactory conclusion.

It is the singular commonality I've found in all the really sick patients I've seen. That no matter how many pack years they've smoked, how severe their coronary artery disease is, or how much their cancer has metastasized, no one ever imagines the hospital is how or where they will end. And when they do find themselves in those moments, faced with the end of it all, it just doesn't seem to fit. Kind of like Conway Twitty in the ICU.

"Thank you, darlin'

May God bless you

And may each step you take

Bring you closer

To the things you seem to find."