Wednesday, July 27, 2005

The Big Squeezy

I didn't think it could happen. But today, I started to feel it creeping up my neck like a slow growing rash as I sat in the charting room twirling back and forth on the wheely chairs, checking my email, trying to look busy, and waiting for the day to end. I hate to say it, but I just wanted to get out of there and go home. After just one week, the novelty and thundering awe of participating in the birth of a new human onto this planet has become job. I guess it was inevitable--after all, as soon as the babies come out we medical folk leave almost immediately to go tend to the other mothers-to-be, the other unfinished progress notes, or maybe even lunch. Some people look forward to the last item they will have to do a price check on, others for that last meeting they will have to run; but the fact is, anything that I do on someone else's clock, over and over again, no matter how amazing, will at some point feel either rote or tedious, an obstacle between me and my own time.

Or maybe I'm just annoyed that there was nothing for me to do after about 11am today. My residents couldn't exactly let me go home that early, so I just tried unsuccessfully to be helpful for the subsequent six hours until I was finally released from med student custody. It's bad enough that I have a hard time doing nothing (note: I don't mean "wasting time", the process of doing something but getting nothing important done--I'm great at that--by nothing I'm talking about literally just sitting and breathing, waiting, etc) in my spare time; but I'm paying roughly $200 *a day* to get this so-called education--I damn well better be getting some bang for my buck every day!

Or maybe I'm just ready for the weekend. It has, I admit, been a pretty incredible (and incredibly exhausting) ten days on Labor and Delivery. Today I helped deliver my first set of twins by C-section. "Baby A" was a little girl who shot headfirst out of her mom's belly; "Baby B", a boy, decided to switch things up a bit by sticking his feet out at us through the incision. It was quite a sight--those cute little toes poking out of the open abdomen, followed soon by some tiny fingers, then the kissable tuchas, and finally, with a bit of tugging, his head. It was a tense minute while we waited for our boy "B" to realize he had just been born and give a welcome yelp to the world. But he came to after a vigorous rubdown and some oxygen. I found out afterwards that it probably would have been fine to deliver them vaginally, but as their obstetrician pointed out, the legal ramifications of ever erring on the wrong side of safety are too great, and anyway, she said with a smirk, "now I'll be back home in an hour."

One might think at first that C-section kids have it easy, just getting lifted out gently and set down--delivered, one might even say--on their first hard surface like a UPS package. But I'm not so sure anymore. They're just floating around in their uterine home, dozing carelessly to the lullaby of heartbeats and bowel gurgles, when--WHAM!--a slash of lightning across the dark sky widens into a wide crescent of searing light, and an enormous hand as big as their entire torso reaches down and grips their soft head, dragging them towards--and then through!--the hole in the sky. Instantly, they are transported from the old comforts of womb to the startling sounds and lights of their new life. No wonder it takes C-section babies a bit longer on average to get a grip on life. They had no preparation, no chance to pack an overnight bag, and definitely no role in the drama.

At least with a vaginal delivery the kid senses that something major is happening--when your whole world starts closing in around you and you suddenly feel compelled to shove your nice round skull into a space so tight it gets molded into an oblong egg shape, and you essentially feel like something better give or you're going to implode; you're probably quite thrilled when a pair of hands grab ahold of you and pull you into the open air, releasing the pressure on your baby lungs so that you can suck in your first breath. That's how it was with my third successful delivery yesterday, little Emily, whose mom was the first I've seen since I started last week who had a completely natural, drugless, childbirth. She had contractions, they hurt, she breathed through them, they got worse, she dilated fully, we came in, she started pushing, we saw some hair, she pushed some more, I gently cupped the oncoming head with my hands... and before we could say episiotomy, Emily's whole face popped right out. She had part of her cord wrapped around her neck, so we had to clamp and cut it earlier than usual, but after that I just guided Emily's shoulders out one by one, drawing my hand down her slippery back as she slid out easily into my arms. Emily launched into the Aria of the Newborn right on cue, was soon in her mother's waiting embrace (no incisions to close, epidurals to pull, or other wires 'n gadgets to remove), and when I saw them at 6:30 this morning for a postpartum check, mom and babe were sleeping peacefully in bed together, both, it seemed, happily wiped from their hard journeys.

Not that there's anything wrong with a necessary C/Section--but almost a third of babies are now delivered that way, way more than is truly medically indicated; and I don't think the outcomes are necessarily better. Also, it's really hard to feel like something as profound and special as childbirth is happening when everyone's gloved and gowned under the glare of the sterile OR lights, with mom chatting on the other side of the drape with the anesthesiologist and a sterile paper jumpsuit-clad dad. It feels more like...well, a surgery. Duh, I guess. But I find it strange, and maybe a little sad, that doctors and mothers today so willingly give up the sacred for perceived safety, and sacrifice consciousness for convenience. It is, partly, the era in which we live, this world of fast food and Tivo, of conducting entire businesses with the click of a mouse. Maybe the C-section babies will grow up better adapted to this e-climate, better prepared to spend their lives floating in the ozone-less smog, dozing to the lullaby of refrigerator hums and cell phone rings, better-equipped to deal with the benefits of instant transformation over slow and arduous progress...but inexplicably afraid of thunderstorms.


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