The Birth

It is 2:30 a.m. I am sleeping the drooling, snoring sleep of the exhausted intern, when my beeper, the bedside telephone, and the PA system all go off at once. My brand-new medical student, Chris, shrieks briefly in the bunk above mine.

Heart pounding, sweat starting from every pore, I wrestle with my socks and blood-stained sneakers, the only articles of clothing discarded before dropping on the bed.

“Damn,” I mutter, “Never take off the socks.”

Certainly this call will be breech twins, or a tubal pregnancy bleeding internally. All these dreaded emergencies shove me smack up against my own inexperience and apprehension, along with the added burden of the patient’s real terror and peril.

“Dr. Lyons, Code 90. Dr. Lyons, Code 90.”

A birth in the emergency room. Great. How could the hospital planning committee have placed Labor & Delivery and house staff sleep rooms on the top floor, the 16th, and the emergency room in the basement! As I frantically pound the elevator call button, Chris staggers up, and Margie, the night nurse, joins us with the “Birth out of Asepsis” kit. Our crew calls it “Baby on the Fly”. (“She’s crowning in the parking lot, bring ‘Baby on the Fly’!”) It has clamps for the cord, a bulb suction to remove the gook from the baby’s mouth and nose, a stainless steel bowl for the afterbirth, and more—everything one needs to perform a routine vaginal birth anywhere.

As the ancient elevator moans in the shaft, Margie and I share a grimace of impatience. Margie is someone I like and admire. She has an unpronounceable Polish name and thick black hair. Braver than me, she smokes, dates cops, and has delivered more babies in her ten years of nursing than I have as a second-month intern. I am glad she is here. The elevator arrives, a behemoth to be rushed by no one, and we three descend into the maelstrom.

The emergency room greets us with a blast of heat, noise, confusion and the smell of half-digested Thunderbird wine. Around us people reek, bleed, sweat and pray. It is surreal.

An enormous scrub-clad blonde, with blank disc eyes that betray too many nights in this raw environment, waves us in the general direction of cubicle number 7.

“In there… Montgomery’s layin’ an egg.”

Montgomery is the internal medicine resident assigned to the emergency room nightshift this month, a nice guy who will someday be a fixture in his native New York. His distaste for obstetrics is common knowledge. As we enter the room, I see him pale, distraught, holding his gloved hand against the perineum in the manner of a traffic cop.

“Stop!” he bellows.

In this fashion, he is impeding, rather than assisting, the birth.

“Christ!” he explodes. “It’s about time you got here!”

I pat his shoulder briefly, with affection. He has saved my butt at many “Code Blues”. In residency, the premium is on “Knowing What to Do Next”, and there is too much for any one intern, no matter how dedicated or bright, to know.

Despite my own misgivings, I wink reassuringly at Chris as Montgomery leaves, and notice that there are too many people in the 9 x 9ft. cubicle. Many wear the paper and plastic bracelets that identify them as patients. They crowd into the room, watching “ER” on a Saturday night, intent on glimpsing a bit of truth in the bloody perineum and the woman’s cries. I evoke my father’s persona, hoping to borrow, or at least imitate, his inarguable authority.

“If you are not DIRECTLY involved in this birth, GET OUT!”

A few timid souls scatter. Others stand their ground. The bold stare of a well-muscled youth challenges me.

“Are you the father?” I snarl.

“No way,” he replies with disdain.

“Then piss off, before I call Security.”

I show him my scalpel, and he melts away, as do the rest. Margie, Chris and I are now alone with the laborer. Chris shuts the door, but the odors of Baltimore and imminent birth remain.

I look at the most visible of my two patients and try to smile at her, but she is well beyond polite contact. In the throes of second stage labor, she howls. Her hair is red, naturally so, and curled. She is wearing only an oversized tee shirt, its hem now blood-stained, that reads “Eat Bertha’s Mussels.” A lizard is tattooed, inexpertly, on her ankle, which is level with my nose as she writhes in the stirrups. No one has accompanied her.

I am ignorant of the status of the fetus, and this frightens me.

“Get the Doppler ,” I snap.

Margie systematically charts the gravid abdomen with a miniature ultrasound probe. Ominously, there is only static. Where is the reassuring, washing-machine, “swish swish” sound of the heartbeat? Margie’s eyes meet mine, grim, and I am gripped with the horrifying image of delivering a dead baby. I panic.

“Get me some Simpsons!”

I have never before used these forceps without supervision.

“Call the second year!”

I manage, with the imperative of that awful vision lending substance to my soprano, to penetrate the corona of suffering that surrounds the woman in labor. She hears me, and for just an instant I can fix her rolling eye.

“Push!” I command.

She does, with vigor, and the infant’s head, full of blood and amniotic fluid-matted hair, leaps from the introitus. I wince, knowing this will mean many stitches for the mother, and silently curse my own lack of control.

After briefly suctioning mucus from the gray mouth and nose, I grasp the wet head and pull, first down, then up. As the infant slithers into this precarious world, I catch a glimpse of her tiny, swollen, labia. I secure the slippery fish in my arms, and hear, with relief, the miraculous outraged wail and see the cyanotic skin become pink. My trembling gloved fingers clamp and cut the cord. Behind us, Chris quietly vomits in the sink.

The mother, now quiet after her excruciating ordeal without comfort, companion, or analgesia, lifts herself up on her elbows and eyes the new arrival.

“Jesus, a girl”, she laments, and flops back down on the gurney, crossing her arms over her face. We try to show her the scrappy mite, now dried, and wide-eyed, blinking at the lights, but she won’t look.
Just then Melissa, the second-year, appears at my elbow.

“What the hell’s going on?” she says, “I was just about to scrub in on this great case, and I get this crazy message about you wanting forceps in the ER.”

I feel ashamed.

“I got scared”, I whisper.

She taps me gently on the head with the patient’s paper chart and smiles. This is a kindness. Then she leaves.

I sew the third-degree tear, feeling rotten. I try to talk to the woman, but we have no common ground to build on. She is impatient:

“Ain’t you done yet?”

After she is deposited into the post-partum ward, I am swept away into the chaotic rhythm of our busy city labor and delivery ward, and forget about her. It is not until 6:00a.m. after delivering a handful more of white, black, and Mideastern babies, that I think of her again, and venture to the nursery.

There she is! A standout, carrot-top, eye-catching amidst the muted tones of the rest of the newly born. Her large eyes are open, and she frantically sucks her fragile fingers, which have somehow found her mouth.

A nurse sees me, waves through the glass, and runs to the hallway door.

“Hey,” she greets me in acid tones, “the Madonna’s gone.”

“What?”

“You know, the ER delivery. She left in the night.”

I run to the woman’s room, and it is indeed empty. She has taken all the clean sanitary pads.

“Good,” I think, absurdly.

She has stripped off the flowered hospital gown, and left it balled on the linoleum. Looking for clues, seeking some understanding, I enter the bathroom. There is only a bloody footprint on the floor, soon to be obliterated by Housekeeping.

Dizzy, fatigued, and with pounding head, I return to the nursery window and lay my hot forehead against the cool surface. My eyes are angled downwards, and after a moment, I make out two drips of blood, barely dried, looking up at me from the floor, and I know. She stood here. She looked at her tiny girl, in the plastic bassinette, and thought. What did she think? Did she view her own act as abandonment, or the most piercing form of bravery? Did she resolve not to risk her small daughter in her own world, where 17year-olds sport home-made tattoos and bear their children alone, in pain, among uncaring, gawking strangers? Or could she feel nothing but her body’s incessant screaming for the next fix? I don’t know, and I’ll never know. Would I never see “Bertha’s Mussels” again, or would she arrive in the ER three weeks hence, with a raging post-partum infection?

As I lean against the glass, watching the waif begin to fuss, and then squall angrily, I feel very young, and ridiculously naïve. Only one thing seems certain: that I know nothing, understand nothing, of these people whom I had fantasized myself saving. My years of sterile study, Anatomy, Physiology, seem suddenly beside the point. Here begins my true education. I will have to wrestle repeatedly with harrowing coursework such as this, before earning my true degree.

Paula Lyons, MD

First published:

The Journal of Family Practice

Vol 44, No.1 (January) 1977