It was 2 a.m. and I was downward-dog in the call room. Earlier during this maternal/child health rotation night shift, I had labored with three other moms in so many different positions that my back felt like it might actually break.
I was hoping that a few minutes of sun salutations would help when my phone and pager rang out at the same time. I stood up dizzyingly fast to answer.
“Doctor, the baby is coming in 303. Right now!”
A flurry of thoughts immediately bombarded me. Go! Wait, you don’t have shoes on. You can go wearing socks, it’s fine. No, obviously you cannot deliver a baby in socks. What is wrong with you?
To my left were the tennis shoes that I kicked off without untying them first. I don’t have time to untie and retie my shoes, my sleep-deprived brain declared.
To my right were a man’s pair of Crocs at least three sizes too big for me. Jackpot.
I sprinted out of the call room, nearly tripping out of the rubber shoes on my way to room 303. Take a deep breath, I told myself, This is not going to be easy.
Only eight hours earlier had I met the patient in room 303. When I walked past her room at the start of my shift, I saw a picture of a white rose on her door, and my heart sank. This was our hospital’s way of delicately communicating that a patient was experiencing or had experienced a stillbirth.
I looked down at my own stomach and then back at the white rose. I was 32 weeks pregnant. Oh my God. How will this mother ever be okay?
During sign-out, I learned that this woman had experienced a healthy pregnancy for the past 34 weeks. In fact, she had four other children at home, all with very healthy pregnancies and deliveries. She had no risk factors or no red flags: nothing that could be blamed for this horrible loss. That morning, a headache prompted a doctor’s visit, and a hand-held ultrasound doppler scan and the silence thereafter. This doctor’s visit ended with a trip to the hospital for an ultrasound that confirmed everyone’s worst fear. The heartbeat was gone.
The incredibly difficult conversation that followed was made even more difficult by the fact that this patient’s primary language was Arabic while the providers spoke primarily either English or Spanish. She also requested female providers due to cultural and religious preferences, but the daytime resident was male. Respectfully, he excused himself as the primary physician while the female attending explained the next steps through an interpreter phone. The patient would be induced and then deliver her stillborn child later that evening or early the next day. I was told that the patient and her family had been mostly silent during the conversation. Silence is often challenging for physicians. Did the patient fully understand? Was everything translated correctly? How many times can we ask patients if they understand before it becomes rude or condescending?
As I ran to her room, I contemplated calling the interpreter. I have to communicate with her, but at 2 a.m., it usually takes five or six minutes to get anyone on the line. I guess I’ll try. But, her sister speaks some English, right? She can help. No, that feels wrong but…
I turned my frantic thoughts into action and dialed the interpreter. I made it to the patient’s room before anyone had answered.
With the on-hold music playing from my phone, I walked into the room to see the baby crowning. We just checked her cervix 30 minutes ago, and she was only dilated to four centimeters. How can she be delivering right now?
The female attending physician had gone home around midnight but said all I needed to do was call her, and she would be back in five minutes.
I don’t have five minutes. I asked for the in-house OB/GYN to be called. He came to the room but stayed at the door to respect the patient’s cultural preferences.
“Pence, you know what you’re doing. Let me know if you need anything,” he said to me.
Wait! I am just an intern, I thought desperately. Panic set in before I forced myself to take another deep breath. You do know what you are doing. You can do this.
In what felt like either three seconds or three hours, I delivered her stillborn baby. At some point during the delivery I heard, “Pacific Interpreters! How may I help you?” from the phone tucked deep in my pocket.
I almost laughed, but then the patient asked, “She is alive?”
My heart, already unbearably heavy, sank. I softly and slowly said, “No she is not. I am so sorry.”
A single tear dropped down my cheek and fell onto my pregnant stomach. I had never been so aware of how I looked physically. I immediately felt guilty for having a healthy pregnancy while this mom was experiencing such a horrible loss. My daughter had kicked multiple times during this delivery, and I felt selfish for being reassured by those kicks. Take a deep breath and keep going. You have to take care of this mom and her baby right now, I told myself.
I clamped and cut the cord and looked at the mother, gesturing if she would like a moment. She shook her head no, so I handed the stillborn fetus to the nurses. Heavy breaths filled the room. Oh my God, this is what a stillborn baby looks like, I thought, realizing that I had never seen one outside of a textbook. The nurses and I shared glances that said more than words ever could. I turned my attention quickly back to delivering the placenta.
“Are you also pregnant?” the patient’s sister asked me while I was applying gentle traction to the cord.
The voice inside my head begged. Oh no. Please don’t ask me that right now.
I self-consciously looked up. “Yes.”
“How far along are you?” she continued.
Oh no, no. Please don’t ask that question. I know you’re just trying to be kind, but this cannot be helpful. “I’m 32 weeks pregnant,” I said.
“I was 34 weeks pregnant,” the mother said softly. It was the first thing that she had said since I walked in the room. Another tear fell from my eye, and I was reminded of a moment in medical school. During one of my first deliveries on my OB/GYN clerkship, I happy-cried with a patient as her healthy baby boy was born. Afterwards, my attending sharply scolded me. He told me that it was “foolish” and “inappropriate” for a physician to cry with a patient.
Don’t think about that now, I thought to myself and continued working.
After the placenta was delivered, and the mother was situated with a clean gown and bedding, I returned my attention to the baby. This was the first time I had witnessed, let alone delivered a stillborn baby by myself.
Oh my God, was the only thought that filled my head. I will never forget the way she looked: so fragile and frail. The mother’s sister asked if I would bring the baby over to them once she was cleaned. I looked towards the mother who gave her approval with a soft nod. I took another deep breath, wrapped the baby in a blanket and placed a pink, knitted cap on her head. I started to hand the baby to mom, but she asked if I would sit beside her and hold the baby instead. So I did. We sat silently for many minutes before the mom started to cry. I could feel the lump in my throat swelling. She looked at me and asked me to take her baby away.
As I stood, she placed her hand on my arm motioning me to sit back down. In broken English and between tears she asked, “Can I place my hand on your stomach to feel a baby kick one last time?”
We sat silently with my left hand over hers on my pregnant stomach, and my right holding her stillborn child. When my daughter gently kicked, the tears that I worked so hard to keep back came flooding forward. I thought back to that attending whom I had in medical school.
How foolish, I thought. But not of myself. I was instead thinking of him. How foolish to not recognize the power, the beauty, the pain and the awe that is being someone’s physician. How foolish to forget that behind every illness is a person; a person who may be scared, lonely or devastated — someone who needs another human to recognize the pain. How foolish to suggest crying with a patient is a sign of weakness.
I am fully aware that there are many instances in a medical career in which a physician must act quickly and dispassionately to save a life. But at that moment, I let my tears fall without shame. Sometimes crying with your patient is the only thing that you really need to do. Sometimes, it’s all you can do.
Image credit: sand by Dean Hochman licensed under CC BY 2.0
Resident Physician Contributing Writer
McGaw Medical Center of Northwestern University
Ari Pence is a second year Family Medicine resident at McGaw Medical Center of Northwestern University. She earned her MD from the University of Illinois at Urbana-Champaign. Prior to medical school she worked at the University of Illinois as an instructor in the Department of Interdisciplinary Health Sciences teaching courses on the socioeconomic determinants of healthcare, as well as a lab coordinator in the Department of Psychology and Neuroscience with a focus on the effects of exercise, nutrition and injury on memory and cognition across the human lifespan. She is passionate about the intersections of women's health, mental illness and integrative medicine in the primary care setting, and providing holistic, person-focused care to the most vulnerable and underserved patients.