A hard goodbye to the last first cry

Newman, Peter R.

This year the first baby I delivered turns thirty. I delivered her in Fort Rae, Northwest Territories, where I was working with Dogrib Indians in my final year of medical school. This woman and I may well be going through a life crisis together: She’s turning thirty, and I’ve decided to stop delivering babies. I’ll deliver my last baby this year.

Over these years I have heard new mothers murmur first words of love to their babies in Dogrib, in French, in Russian and Hebrew. I have heard them in English with accents from the Philippines, Ireland, India, the Caribbean.

The wear and tear has been getting to me. Take one recent night’s drama, for example. I began feeling tired during the afternoon while seeing patients in my office. I pushed myself, but I was having trouble staying mentally alert. Later came chills and symptoms of a virus. Back at home, glancing at the dreaded telephone, I went to bed with a silent wish: “Just let me sleep through this night. Please, let there be no deliveries.”

I am part of a loosely organized family physician obstetrics group. We have an on-call schedule for weekends, when we can “sign out” to each other. During the week, however, we like to deliver our own patients, and we keep ourselves available to them 24 hours a day. We try to be considerate to each other. We would never dream of a last-minute call to our overly busy, stressed colleagues, asking them to take care of our deliveries in the middle of the night.

The phone rang harshly, cutting through my deep sleep like a knife. A second ring. The clock said 3:20 AM. Desperately tired, I prayed, “Please, let it not be the hospital.” It was, of course. The voice was harsh and abrupt, not introducing itself or even acknowledging waking me.

“Dr. Newman, your patient has just arrived by ambulance, she’s pushing, and you’d better get over here right away.” I remembered that I had four patients who were due or overdue to deliver. I asked who the patient was. “I don’t know,” the nurse said brusquely, “Maria somebody, there’s been no time to admit her. Just come, NOW.” She hung up.

I now had fever, but I could allow myself only a few seconds to feel sorry for myself. There was nobody else to do the job for me. Aching, I got out of bed, dressed quickly, stumbled out into the frigid night. The urgency of the moment sunk in now, no time to warm up the car. At the red light of a deserted intersection I stopped for a moment, looked both ways down the empty street, then gunned the car across.

3:35 AM. Fifteen minutes after the nightmarish awakening. I climbed the stairs to Labour and Delivery two at a time. The delivery room presented a dramatic scene. The cast- my patient and her husband, a nurse, a beginning resident, and a medical student. This was not one of those wonderful, calm and controlled labours, the kind with an epidural anesthetic and a relaxed mother. The patient was in a world of her own, distressed, not coping with the pain and emotion of the last minutes before birth.

The nurse briefed me about the labour, and we reviewed the electronic fetal heart recording. I examined the patient and the position of the baby’s head. Despite the atmosphere of alarm, everything was actually going well. Now I needed to get my patient’s attention, to cut through her panic. I tried to reassure her, and to get her to push more effectively. She was so focussed on her pain and anxiety that it took me several minutes to even get her to hear my voice.

With our shouts of encouragement, she began pushing well. The baby’s head came slowly down the birth canal. Then wet, black hair appeared. More hard pushing, an episiotomy, and finally the big head was delivered. The slippery body slid out easily, almost an afterthought.

“It’s a boy!”

I watched closely, tensely, for a few, long seconds, holding my own breath until his first breath. Then came a strong, high-pitched cry. Resuscitation wasn’t needed; I could relax now. I cut the cord, dried the amniotic fluid off the perfect, tiny body, and carefully handed him to his mother. The new parents sobbed for joy. My eyes were moist, too.

The baby and the entire delivery room now became quiet. The tumult of a minute ago faded, silenced by the presence of a new life.

Until 5 AM I taught the resident and the medical student- how to sew up lacerations, how to examine a newborn baby. We discussed the management of delivery complications, breast-feeding problems. I felt part of the long, wonderful tradition in medicine: willing teachers and keen learners.

In the elation I forgot my fever, exhaustion, and the lost night of sleep.

The following day was another story. Exhausted again, I struggled to handle the full roster of patients in my office. This is the crux of my dilemma. I find it harder and harder after a long, intense day of work in my office to get out of bed and deal with these dramas during the night. Then, after little or no sleep, to return for another full, intense day of medical practice.

Yet it has been a very difficult decision to give up deliveries. I have been putting it off for years. Whatever surgical skills and obstetrical judgment I have acquired have been hard-won; I hate to let them go. We all enjoy doing what we do well.

More important, I love the close relationships with my patients that obstetrics brings. The actual deliveries are but a small part of it all. Obstetrics in family medicine is a big package. One deals with people’s fundamental aspirations, providing birth control, genetic counselling, psychological support; confronting the grief of miscarriages and, sometimes, a tragic stillbirth. And the close relationships continue long after the deliveries. As family physician I have the satisfaction of being the babies’ doctor, then looking after the growing children, seeing them through adolescence and into adulthood.
Obstetrics has been a real part of who I am, not only as a physician, but as a whole person. I am reluctant to sever that part of me.

Yet for everything there is a season. I need to make more time for my family, and for many other interests. I’ve heard that most people, when ill, can go to bed at night and expect to be allowed to sleep. I’m looking forward to that.

But I will miss that wondrous, spine-tingling first cry in the middle of the night.

New beginnings now, for all of us.

Theme: Birth | Naissance
Theme: Physicians | Médecins

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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