The first birth my wife Jillian witnessed was also the first death.
It happened many years ago, just a few days before Christmas, when she started her journey as a new specialist in Obstetrics and Gynecology (OB-GYN), working the graveyard shift in the labour and delivery ward.
Walking into the Columbia University Irving Medical Centre as the sun descended, Jillian went to the doctors’ lounge to meet a senior fellow resident on duty.
Inside, she saw a dark-haired young woman lying on a couch, chomping furiously at a sandwich while watching TV and reading a journal article.
The woman introduced herself.
“Oh, hi,” she said.
“I’m Melissa. I’ll be in here or in the call room if you need me. Probably the best thing for you to do is keep an eye on patient Garcia. She’s a twenty-two-year-old, here with preterm labour and twins. Everyone else is pretty standard.”
Between bites, Melissa briefed Jillian with a barrage of facts and information: The twins were only twenty-three and a half weeks old; the hope was to keep the pregnancy going until they were more developed, however long that might be; twenty-four weeks was considered the cusp of viability, and every extra day made a difference; the patient was getting various drugs to control her contractions.
Melissa’s pager went off.
“Okay,” she said, swinging her legs off the sofa.
“I gotta go. You can hang out here if you like. We have good cable channels. Or you can come with me.”
Jillian followed Melissa to the nurses’ station.
One wall was lined with monitors, displaying wavy telemetry lines.
“What’s that?” Jillian asked.
“That’s the output of the tocometres and the fetal heart rates. Let me show you the patient. She doesn’t speak English. Do you speak Spanish?”
Jillian nodded her head.
Melissa brought her to the room, where the lighting was soft but not too dim.
The mother lay in a bed, resting, quiet, monitor bands wrapped around her belly, tracking her contractions and the twins’ heart rates and sending the signal to the screens Jillian had seen at the nurses’ station.
The father stood at the bedside holding his wife’s hand, worry
etched on his brow.
Jillian whispered something to the couple and then escorted him out.
For the next several hours, things progressed smoothly.
Melissa slept in the lounge.
Jillian tried decoding the indecipherable scribbles in Garcia’s chart, which was like reading hieroglyphics and came away with the knowledge that her first name was Elena, this was her second pregnancy, she had received no prenatal care, and she had no insurance.
She wrote down the names of the drugs Garcia was getting and made a note to look them up later.
Jillian walked over to nurse Karen and asked her to teach how to read those little squiggles on the monitor, which were no clearer than the doctors’ handwriting but could apparently foretell calm or disaster.
Karen nodded and began talking through reading a contraction and the fetal heart’s reaction to it.
“… if you look closely, you can see …,”
“Stop right there,” Jillian interrupted, double-checking her notes.
Worry flashed across her face.
Without a word, Jillian got up and ran into Garcia’s room, then burst back out, grabbed the phone, and paged Melissa.
A minute later, Melissa arrived, bleary-eyed, glanced at the strips, and rushed into the patient’s room, with her trailing behind.
Melissa flipped open her phone and called the attending physician (A medical doctor who is responsible for the overall care of a patient in a hospital), rapidly talking in jargon that Jillian only partially understood.
The twins were in distress, Jillian gathered, and their only shot at survival was an emergency C-section.
She was carried along with the commotion into the operating room.
They got Garcia supine on the table, drugs running into her veins.
Karen frantically painted the woman’s swollen abdomen with an antiseptic solution, while the doctor and Melissa splashed alcohol cleanser on his hands and forearms.
Jillian mimicked their urgent strokes, standing silently as they cursed under their breath.
She was standing next to the doctor as he sliced open the woman’s belly, making a single long curvilinear incision beneath Garcia’s belly button, just below the apex of her protuberant womb.
A small face appeared, then disappeared amid the blood.
The doctor’s hands plunged in, pulling out one, then two purple babies, barely moving, eyes fused shut, like tiny birds fallen too soon from a nest.
With their bones visible through translucent skin, they looked more like the preparatory sketches of children than children themselves.
Too small to cradle, not much bigger than the doctor’s hands, they were quickly passed to the waiting neonatal intensivists, who rushed them to the Neonatal ICU (NICU).
As Melissa told Jillian earlier, twenty-four weeks in utero was considered the edge of viability.
The twins had lasted twenty-three weeks and six days.
Their organs were present, but perhaps not yet ready for the responsibility of sustaining life.
When Jillian returned to work the next day, she was assigned to a new mother, Carrie.
Things were as routine as possible; today was even her actual due date.
Along with Karen, she followed Carrie’s steady progress, contractions racking her body with increasing regularity.
Karen reported the dilation of the cervix, from three centimetres to five to ten.
“Okay, it’s time to push now,” she said.
Turning to Jillian, Karen said, “Don’t worry—we’ll page you when the delivery is close.”
After some time, the OB team was called into the operating room.
Outside the door, Melissa handed her a gown, gloves, and a pair of long boot covers.
They entered the room.
Jillian stood awkwardly off to the side until Melissa pushed her to the front, between the patient’s legs, just in front of the doctor.
“Push!,” Karen encouraged.
“That’s it. Now again! Just like that.”
The screaming didn’t stop and was soon accompanied by a gush of blood and other fluids.
The head appeared with each push and then retracted with each break, three steps forward, two steps back.
The doctor’s voice guided Jillian’s hands to the emerging head, and on the next push, she gently guided the baby’s shoulders as she came out.
She was large, plump, and wet, easily three times the size of the birdlike creatures from the previous night.
Melissa clamped the cord and cut it.
Jillian walked out to the waiting room to inform the extended family of the happy news.
The dozen or so family members gathered there leapt up to celebrate, a riot of handshakes and hugs.
She was a prophet returning from the mountaintop with news of
a joyous new covenant!
All the messiness of the birth disappeared; here she had just been holding the newest member of this family, this man’s niece, this girl’s cousin.
Returning to the ward, ebullient, she ran into Melissa.
“Hey, do you know how last night’s twins are doing?” Jillian asked.
Melissa darkened.
Baby A died yesterday afternoon; Baby B managed to live not quite twenty-four hours, then passed away around the time Carrie was delivering the new baby.
As my wife recounted the story, my thoughts wandered to Samuel Beckett—the 1969 Nobel laureate whose works I had dissected during a LitHum project, especially Waiting for Godot and the metaphors that, in those twins, reached their terminal limit:
“One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.”
“You think that’s bad?” Melissa broke the silence.
“Most mothers with stillborn babies still have to go through labor and delivery. Can you imagine? At least these guys had a chance.”
From room 543, Garcia’s wail pierced the corridor.
The father’s eyes, rimmed with searing red, overflowed silently with tears, streaking his face.
This was the flip side of joy: the unbearable, unjust, and unexpected presence of death.
What possible sense could be made, what words were there for comfort?
“Was it the right choice, to do an emergency C-section?” Jillian asked.
“No question,” Melissa replied firmly. “It was the only shot we had.”
“What happens if we don’t?”
“Probably, they die,” she said bluntly. “Abnormal fetal heart tracings show when the fetal blood is turning acidemic; the cord is compromised somehow, or something else seriously bad is happening.”
“But how do you know when the tracing looks bad enough? Which is worse, being born too early or waiting too long to deliver?”
“Judgment call, Dr Jillian.”
The views expressed here are those of the columnist and do not necessarily represent the views of Sarawak Tribune.
