Detachment

I sit hunched over on a stool no more than 12 inches off of the ground. She lies no more than three feet in front of me. I find myself, no, I will myself to be a detached observer of the events that are unfolding. It is not that I am indifferent. It is my familiarity that pushes me to detachment. I have seen this more than a thousand times before. I know exactly what is going to happen. My presence is of only modest importance. It is likely the last time that I will bear witness to these events. I want to get it right. I want to remember the sights, smells and sounds correctly.

The room is dark, save for one small light fixture on a far wall which creates more shadow than light. It is no more than 64 degrees, intended for her comfort. Despite this, she wears no clothing and is still covered in perspiration. Her feet are up in stirrups, not the metallic devices of torture I remember from my early days. No, these are ergonomically designed, padded foot and leg supports that can pivot and rotate in any plane, ensuring her comfort and reducing the risk of a blood clot forming in her calves.

To her right, my left, is her partner. His elbows are resting on the side railings of the bed. He is repetitively dabbing at her face with a washcloth. Short staccato dabs, over and over again. First her lips, then her head, nose and cheek. Again and again, the same short, stilted dabs. They seem jarring against the quietness of the room and the relaxation of her semi-conscious state. He continually whispers to her that it is not that bad and that it will be over soon. Lucky for him, she is oblivious. One moment alive with pain and the work of labor, the next limp and unresponsive. Still to every movement and intrusion that the rest of us impose upon her. She knows best. I wish he would stop.

To her left, my right is the nurse. She records everything: blood pressure, pulse, temperature, fetal heart tones, and the frequency of contractions. These all become a part of her permanent record. For who? For what purpose? No one will read this, save for a lawyer or 'quality assurance hospital representative' -- a position that did not exist at the beginning of my tenure. The nurse continues to encourage the patient to push harder and longer. With each contraction she becomes more and more forceful in her encouragement. Her voice rises in volume and pitch and begins to sound more like an order. I find myself talking more softly and calmly to try and offset the intensity of the nurse. I wish she would stop. No, I wish she would go away.

I lean back against the now empty labor tub. I, like my patient, am not cooled by the room's air conditioner. I am wearing my blue gown, that while protecting me from body fluids, does not breathe. My double layer of latex free gloves only adds to my warmth, as does my exhaustion. It is three in the morning. A never ending loop of an Enya CD is playing on the room's boom box. Anesthesia.

Like most of my patients, this woman is amazing. Giving birth levels the playing field. A single, first-time mother of 17 and a married 35-year-old mother of three seem very similar in the throws of labor. Strength, determination, grace, beauty, and love are all mingling within her human form. Men rarely have the opportunity to be tested in such a way.

The baby's head begins to crown: my cue. Through sheer will and determination she has pushed and molded the baby's head through her rigid pelvis, stretching the soft tissues of her vagina and labia until the top of the baby's head begins to appear. I can help a little here. Ease the baby out, gradually. Push, but not too hard. Push, but not too long. There, the baby's head is out. Now the even broader shoulders turn. No lacerations. Better for her and easier for me. I suction out the babies mouth and nasal passages, clearing them of the birth stew of amniotic fluid, blood and stool. Now I dry the baby off, and while still tethered to its mother, I hold the baby up for all to see. I hold the baby as a ventriloquist might a dummy and pretend to throw my voice to the baby: "Hi Mom. Hi Dad." Laughter punctuates the transition from the pain and desperation of labor to the relief and joy of parenthood. As quickly as that, it is over. Her pain is almost forgotten. She is now alive and high from the adrenaline reserved for her bonding with the baby. If asked, she would do it again. A very different answer than if asked ten minutes ago. And so the species continues.

My turn is over. The reality of a small-town hospital that cannot afford to maintain back-up surgery coverage for the inevitable Caesarean section has forced my hand. The wonder and joy of participating in this role is to be passed to younger, more capable actors in larger cities.

This is good?

I am tired

and detached.

Marc Tumerman, M.D.

Class of 1979