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Sometimes you cry... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Sometimes you cry...
Beautiful girl, young for this to be her third baby. One of those shining pregnant girls who is only belly and cheeks and the glow of youth. Notes on the chart: baby up for adoption.
I am in the tail end of conversations, overheard whispers, words and thoughts and half-completed discussions. The adoptive parents are here, they will be at the delivery. They want to stay with the baby but the hospital will not let them. Something happened in the past; adoptive parents now must obey visitation rules. Night charge head nurse talks to the head head high up and bargains: they will be allowed to go to postpartum and watch the bath through the glass windows in the nursery; they will be able to take the baby to the lobby and bond. Baby will have a security tag.
The adoption is only legal if the mother signs the papers after birth, and if the father does not object within a reasonable amount of time. My patient does not want to see her baby, touch him, do anything to him. She knows that if she looks at him she will love him and not be able to give him up. She cannot afford this child; she is on the verge of putting her life back in order, making something besides a scratched-out living. And the father is an on-again, off-again source of support. Not reliable. She has given this careful thought. She is certain that this is best, for her, for baby, for her daughter with her.

It is a strange tableau.
There am I: staff OB tonight is kind and good and hands-off; he hands me the towel and lets me deliver the baby from crown to placenta. There is she, her sisters holding her feet as she pushes; the epidural is good and she is determined. And there, near her head, in the corner, are the adoptive parents, watching, serious, nervous.
The delivery is good - what makes it good is that she pushes when asked to push, stops when asked to stop. My hands are becoming slowly more certain as they move over the crown of the infant, stretching the perineum, pushing against the contractions to control the head's delivery, turning it into an inexorable slide rather than a sudden tearing pop. Suction. Check for nuchal cord. Mother breathes, pants, waits. Grip the baby's head in two hands, fingers under jaw and occiput, pulling down as mother pushes, and feeling for the subtle give that is a shoulder sliding beneath the pubic bone, then completing the upstroke of a "J" to deliver the posterior shoulder without tearing the perineum. One hand slides down from occiput, fingers finding the arm, pinning it against the body - a baby's arm can lacerate as it pops out, turning a smooth delivery into a necessary repair. And once the shoulders are free, it's a hand at the neck and a hand at the ankle to catch this living thing that nearly falls into my hands. I may take up sitting to deliver; it's easier to hold the babies.
Normally, O Best Beloved, this is the cry of triumph - a proclamation of gender, a passing of a wet, bloody, squirming creature to its mother's belly, wrapping it in blankets, cutting the cord, all the while filled with jubilation. Normally, catching the baby is a glorious moment.

Tonight, I caught an infant boy sliding flawlessly from his mother's womb, by neck and ankle, held him, and said quietly, "I've got him." Dr. said to the mother: "Do you want me to cut the cord?" She flung a towel over her face and began to sob. We clamped and cut the cord. The baby went into the nurse's arms as soon as he was suctioned, whisked away to another room, gone. Where normally I deliver a placenta to the background tableau of outraged wails, cameras, and adoring commentary - tonight the room was silent but for the wracking, bone-deep weeping of the woman on the bed. She could not be comforted; the OB later told me that her reaction was that he had seen in women whose children are born dead.
It was business and nothing more, between her legs: look for lacerations (none), check the placenta, deliver the placenta, catch the placenta. Massage the uterus (oh, that Technicolour blood) until it stops pouring out clots and then clean her. Massage the uterus again; a little atony but not much. Business. The routine helped to quell the festering sense of despair that filled the room, but it could not consume it completely. I doubt that anything could have.

I went, after the delivery note was complete, to see the baby and the adoptive parents. They were awkward - it was awkward. I complimented the baby. The adoptive father said "She did well." The mother nodded.
I did not know what to say, O Best Beloved. We were talking about the delivery; she pushed with fantastic determination and did exactly what she was asked. But I could not erase from my mind that grieving woman in her bed, thighs painted with the blood of birthing a child she could not bear to break her heart by seeing. I could not tie together the tattered ends of pain and call it good. I was, momentarily, inside a hollow emptiness as wide as a Titan's drum, looking up at a black and barren, starless sky; I had no sufficient words and no name but sacrifice for the thing that she had done.
Yes, I said, she did.

Someday, O Best Beloved, I will perhaps be able to tell you whether I spoke truth or falsehood. But perhaps I will never know, in this world a thousand shades of grey. I know only that there is pain and blood to the bringing of life; I know only that there is ending and there is beginning and that sometimes the two are one.

Tags: , , ,
now feeling:: melancholy melancholy

15 whispers echo . o O ( ... ) O o . whisper a word
squigglz From: squigglz Date: July 21st, 2005 08:03 am (UTC) (etched in stone)
That just...made me cry my eyes out. Such a hard choice...such a hard job for you to do there...

She was very brave. So were you. And I hope you both know that.
ayradyss From: ayradyss Date: July 21st, 2005 08:49 am (UTC) (etched in stone)
One little miracle at a time...
reynardo From: reynardo Date: July 21st, 2005 08:19 am (UTC) (etched in stone)
I think you told the truth. I think she made a brave and very hard decision, and you did what you could to make it as easy for her as possible. To decide that you know you cannot support a child and give it the best possible chances you want it to have, and that the best way is for that child to have different parents, is ... hell.

I know.

Oh do I know.

I pray that she knows in her heart that she made the right decision, and that one day she confirms that indeed she did. As I did.
reynardo From: reynardo Date: July 21st, 2005 08:42 am (UTC) (etched in stone)
For "right" , I mean "Best possible"
ayradyss From: ayradyss Date: July 21st, 2005 08:48 am (UTC) (etched in stone)
Thanks for sharing.
reynardo From: reynardo Date: July 21st, 2005 09:10 am (UTC) (etched in stone)
You are most welcome. I have been lucky enough to find out that my wonderful son quatranoctal has had all the advantages and love and support I wanted him to have when I put him up for adoption when I was 19 and him 5 days. And yes, it was a hard choice. And yes, no single choice was completely the right one. But in my case it was the best one.
staralyn From: staralyn Date: July 21st, 2005 08:24 am (UTC) (etched in stone)
the OB later told me that her reaction was that he had seen in women whose children are born dead.

I hope that during your rotation in OB, you never have to deliver a dead baby.
ayradyss From: ayradyss Date: July 21st, 2005 08:47 am (UTC) (etched in stone)
Your hopes are mine, in this matter.

But death happens, and I can only hope that if it happens I am prepared.
From: silmaril Date: July 21st, 2005 01:28 pm (UTC) (etched in stone)
I can't really say anything that won't sound trite; except that I hope you won't mind that I'm linking to this from my own journal.
alythe From: alythe Date: July 21st, 2005 01:54 pm (UTC) (etched in stone)

I ask....

I ask you a favor, dear lady. Do not forget the joy of the parents who, for whatever reason, have decided to adopt such a tiny bit of beauty. The mother has made a tough decision, its true, but think of this:

Those parents have probably, unless they've been very lucky, waited YEARS for this moment. A chance when they could adopt a child into their loving relationship and share their lives with a new member of their family. That child, though the birth mother could not have supported him well, is still given the opportunity to grow up with loving parents who CAN support him and who wanted a child of their own badly enough to go through the process of adopting. He is not 'unwanted' or 'uncared for' now that he has joined the world. And his adoptive parents are blessed with this joy.

Do not only grieve. There is happiness here too.
turnberryknkn From: turnberryknkn Date: July 21st, 2005 02:44 pm (UTC) (etched in stone)
As I wrote to silmaril earlier this morning: when I saw your entry a little after you wrote it, my first thought was to link to it in my diary and encourage people to read you. And then I realized that it would have been the third or fourth time I've encouraged folks to do that, and so it might be a bit awkward to do it yet again.

But it doesn't mean this entry -- or all that you share about the work we're a part of -- isn't worth reading.

And, like so often: thank you for sharing.
janezanaddict From: janezanaddict Date: July 21st, 2005 05:01 pm (UTC) (etched in stone)
This is the most touching thing I have read in a long time. As a mother I can understand the sobs of the poor woman. Too many women know all too well that feeling of loss and I am thankful to God that I have my child and did not have to suffer that. There is rarely a word to say in moments like this but hopefully the mother (reprsenting all mothers like her) found peace knowing that her baby was alive, well and loved.
ayradyss From: ayradyss Date: July 21st, 2005 05:32 pm (UTC) (etched in stone)
It is a comforting thought, isn't it?
blistermoth From: blistermoth Date: July 21st, 2005 06:01 pm (UTC) (etched in stone)
Absolutely beautiful writing here. My boyfriend is adopted and knows nothing about his birth parents. I pray whoever delivered him has a spirit like yours.
From: (Anonymous) Date: July 25th, 2005 02:50 pm (UTC) (etched in stone)

In a perfect world

But it's not a perfect world. The pain of birth, the pain of seperation. Her, beautiful child, you have parents who will love you as their own. Treat you well - and try their best to carry you into adulthood so that you won't have to suffer as your ancestors did.

This girl in the delivery room, alone: This is the climax of many months of self doubt, second guessing, and hope. And though I am not a religious person, reading this causes me to send a well-wish into providence: little child, may life treat you well.

But I beg to differ: This is a glorious moment, though mercifully rare - the birth of a child, delivered into the hands of love by a mother who cares.

There are much crueler fates.
15 whispers echo . o O ( ... ) O o . whisper a word