April 30, 2013

Pure, shining love

My favorite part about deliveries is just after the baby is born.  The two or three minutes where I'm holding this absolutely brand new life in my arms, covered in clinging fluid and membranes and blood, and once the cord is clamped and cut--for a brief instant, I am the only thing the baby knows outside its mother.

I sometimes am not even aware of speaking, but I usually find myself talking to it, saying, "Hello, baby! Welcome to the world!  We've been waiting for you!"  Cradling it in my arms, feeling it warm and sticky against my sterile gown, is amazing.

This moment is heady, sure, but the instants that come next are intoxicating.  Twice, now, I've gotten to hand the baby directly to the mother, through her legs to a waiting blanket on her chest.  I go from the main stage to side show immediately, and I love watching the mother's face when I give her her child.

The love is pouring out of her.  If love were electromagnetic waves, and if our eyes had love-cones and love-rods, the moment when I hand over the child to the mother would be blinding.  The dads, too, are radiating.  He bends down over the woman and child, and the three of them form a perfect image.  It's no wonder the Nativity was such an enthralling subject for tableaux; birth has always been a miracle.

April 23, 2013

Work harder, harder

This is what anxiety feels like.

We had our mid-course feedback with a senior resident and the clerkship director today.  They had mostly good things to say, with a few (useful and not wholly unexpected) constructive bits of feedback for me.  I don't know if it was their expressions, or their tone of voice, or what it was, but somehow even though they were saying reasonable and mostly good things, I still felt sick to my stomach.  I still felt that gut-punch of rejection.

This was toward the end of the day, and after work I went to a cappella practice and really threw myself into the music.  I've missed the last couple of rehearsals (somehow, they seem like too long a commitment after a full day on L&D) but being there made me happy and lifted my mood.

Even with that, though, leaving the distraction behind me let my simmering emotional state break free.  I got home and made a quick dinner, watched a little TV, and hauled myself into the shower.  Something about the warm water raining down on my face always prompts tears, even when they're hiding behind a chin-up attitude.  I let the water beat down on me and for some reason I just sobbed and sobbed and sobbed.

Every day, I find myself mulling over the mistakes I make on rounds, or the stupid things I say, or when I do something silly or betray some essential lack of knowledge.  I guess I never had a rotation that I cared as much about how I did as I do on this one: of course I have tried hard on all my rotations, but none of them were what I want to do with my life, and the weight of that seems to accentuate all my fears and insecurities.

I delivered a baby by myself on Sunday night (okay, 90% by myself.  The attending helped with the head, a little).  I love this field so much: the babies, the surgeries, the controversies, the history of it.  All of it.  I want to do this so much and the fear that gnaws at my insides is the fear of failure, of not matching, of not being wanted by someplace enough that they would train me.

I know most of this is irrational: after all, an objective listener would really have said "But they said reasonable and nice things.  They just pushed you to push yourself."  But the fear is still there.

Ugh.  Now I can't breathe, because my nose is running.  (Thanks, lacrimal ducts-nasal passages-sinuses.  Intelligent design, my ass.)

April 13, 2013

Delivery

"If our patient starts to deliver...what will I get to do?" I asked the resident, tentatively.

"You can deliver the baby, if you want!"

"Really?!" I was incredulous.

This was my patient's fourth baby, so it was hardly her first day at the rodeo. She came in the morning, and right before we examined her cervix, her water broke. We left to do a cesarean section and when we came back, she hadn't changed very much. She didn't change much throughout the morning so we started some oxytocin. She was nervous, maybe because it had been a while since her last baby.

In the afternoon, once the epidural was in, she relaxed a little and her cervix opened right up. By early evening, she was starting to feel like she had to push. We checked and she was just shy of complete, a thin rim of cervix all that remained between waiting and pushing. The resident and I hurried to eat sandwiches we had bought at the hospital cafe and we had hardly finished before the nurse poked her head out of the door:

"She really, really feels like pushing...and she looks like a person who's ready to push."

We went in to the room. I put on the lavender nitrile gloves while the resident put on sterile gloves to check the patient's cervix again. The patient's aunt and mother helped hold up one leg while I held the other, and when the next contraction started we helped her curl her body around her belly while she bore down. The energy in the room was palpable. I had a brief moment of wonder where I realized that the scene I was in was as old as humanity: women surrounding a woman in labor, supporting her and giving her the energy and encouragement she needs to get her baby out of her belly and into the world.

The thing about deliveries is this: the physics and geometry do not seem to make sense. If you've ever seen a circle that is 10cm wide (just barely narrower than the length of an iPhone 4, if you're curious), and if you've ever seen a vagina, the fact that those two configurations could overlap is absolutely astonishing. It shouldn't work, and your mind says, "That baby is not going to fit through that hole!" and yet--it does. In fact, not only does it fit--most birth are completely capable of vaginal deliveries! How is that possible!? The mind boggles.

On the next contraction, the resident could feel the baby's head advancing. "I think I'd better get dressed!" she cheerily announced. I hurried to copy her, shoving my feet into knee-high waders, grabbing a gown and miraculously remembering how to sterilely gown and glove myself. Then I was there, at the foot of the bed, and the resident's hands were at the perineum and the baby was crowning. She put my hands where hers were, and I could feel the baby coming. I tried to pry my fingers into place. Everything was happening so fast! The patient pushed another time and the head was free. I had my hands around the head and the resident's hands were there too, and there was a little resistance, so she took over. I'm glad that she did because the baby came out fast and I would not have been prepared. We suctioned his nose, someone cut the cord, and we turned our attention to the placenta. I got to pull it out while the resident massaged the patient's uterus from above; it came out smoothly and with the same graceful swoop of the baby.

I couldn't stop smiling. My heart was beating so hard! and the adrenaline of it is still coursing through my veins now, two hours later.

This was the most powerful scene I have ever witnessed. This is better than any drug and twice as addicting. Even in surgery, elbow-deep in viscera, there is control and tension and protocol.

Here, there was chaos. Birth is chaos and raw energy and creation and life itself.

April 9, 2013

I want to do this forever

In the middle of the day on Friday, I had this thought: I want to do this forever.

I can't really pinpoint what I was doing, or what it was about the patients I saw that day, but there was this joyous surge of energy in me.  I went to a surgery in the morning, saw a case presentation at noon, and spent all afternoon in the clinic seeing patients.  I didn't even get to eat lunch, and I was tired and starving at the end of the day, but it didn't even matter.  As I left the hospital, I had this serene but energetic feeling of well-being and contentment.

Some friends and I tailgated at the Brewers game on Friday night, and as we huddled around the grills for warmth we were comparing stories about our rotations and what we had decided to do with our lives.  I couldn't stop telling everyone: I'd been holding out my judgment (and hoping OB/GYN was for me!) but now that I'd done it for a week, I was hooked.  I wanted every week of my life to be like that week: surgery and clinic and ED consults and laboring patients.

I held off writing this because I wanted to "be sure" and I wanted to have my first call night under my belt before proclaiming my love of my chosen field to the world (who am I kidding.  I wear my love for women's health on my freaking sleeve).  I wanted to have some kind of mythical origin story to recount, where I deliver my first baby on call and hear choirs of angels or see a light shining from above, calling me to do this work.  But the reality is this: I had two gyn consults in the ED last night, both of which were super interesting (a really awful labial abscess and a probable vulvar cancer), but the universe heard my selfish plans and gave me two slowly laboring patients and no deliveries.

I hesitate to admit this, but I was crushed.  I was disappointed, stupidly so, and heartbroken.  My classmates had all had these fantastic delivery experiences (one of them, a future orthopod, calls them "A Whole New World" moments, because he learns something astounding about the female body every day) and I desperately wanted to have one, too.

I came home from call, brushed my teeth (finally! they were gross), and fell sobbing into bed.  Yes, I'll confess: I was so tired/upset/disappointed that I literally cried because I hadn't seen any deliveries.  Not my proudest moment.

I woke up five hours later feeling much better, pretty damned foolish, and selfish to boot.  First, I don't need a specific delivery/event to know this is the "right" specialty.  If anything, I had those moments already (I have actually already seen a couple of deliveries when I've shadowed doctors in the past) and I've felt a calling to work in women's health since my first year of medical school.  Hanging all these expectations on a single call night was silly and set me up to be disappointed.  Second, I should know better.  The patients on L&D aren't there for my amusement, but because they are about to bring another life into the world.  That's freaking amazing, and if it didn't happen in the middle of the night so that I could bear witness to it, that's okay.  I'm on call on Saturday, too, and three more times after that.

Actually, I have the rest of my life.  I want to do this forever.

April 7, 2013

Somewhere in Ohio...

...my poem is hanging in the atrium of a medical school!  I found out a little over a month ago that my poem "Still Life with Body and Hands" received an honorable mention in the William Carlos Williams poetry competition!

I could not have been more surprised or pleased or flattered!