Stillborn

In the middle of the night, I was called to the operating room where a woman in labor had been rushed because of a possible cord prolapse. As a medical student, I had anticipated this part of my pediatrics rotation; at the time, my wife was three months pregnant. When I entered the room, I was struck not by a sense of urgency but by a relatively minor detail. Instead of one neonatal bed, there were two. I realized then that I would be observing my first twin delivery. Within seconds, the first baby’s cry resonated as he was lifted from his mother’s womb. Moments later, the second baby was placed before me. Gazing down, I noticed that she was unresponsive, with a blackened umbilical cord, a large bruise encompassing her abdomen, and generalized skin maceration. Despite our resuscitation efforts, she remained unresponsive. Following a discussion among the medical team, our efforts were halted. She was declared a stillborn. A wave of emotion overtook me. The finality of it was eerie. Before me was a newborn baby whose parents were expecting to hold her in their arms. But now, she was to be wrapped up and covered in blankets, not to be seen at all. Pulling the father to the corner of the room, we revealed the tragic news. Incredibly, he maintained his composure. We asked him to decide whether his wife should be told immediately or later. I could only imagine what he was thinking. He must have been experiencing both joy and sorrow as he tried to balance the elation of becoming a parent with the unequaled pain of losing a child. There were probably already two cribs at home, the double stroller, the diapers, and the books, not to mention the extended family waiting anxiously by their phones to hear what they anticipated would be good news. There he stood, forced into the impossible position of needing to make an immediate choice for his wife. During that interlude, I could not help but identify with him, as I too would soon be a father in a delivery room. What if something went wrong during my baby’s delivery? How would I handle myself if placed in similar circumstances? The possibilities raced through my mind as I watched this new father silently and painstakingly weigh his options. Judging by the ear-shattering shrieking and sobbing that overtook the room, the path he chose was clear. Everyone present was affected. It was time for the pediatrics team to leave the room. At my previous deliveries, the members of the team reintroduced themselves before leaving, congratulated the parents on the birth of their child, and provided a short description of their role in the delivery process. But what should I do now? Do I congratulate the parents on the birth of one child? Do I apologize and say how sorry I am? No choice seemed right. Noticing that the parents were holding each other and crying, I awkwardly left the room without saying a word. As I removed my mask, gown, and gloves, I felt numb. I’m not ashamed to say that I cried and not just a little. How can one possibly prepare for calamity? I suspect no one was ready for what took place, yet everyone completed their duties in spite of the new mother’s cries. Countless other experiences have hit close to home since that night. Through them, I learned to allow patients and their predicaments to percolate just enough to allow for empathy, yet not too much so as to affect my ability to perform my responsibilities. While this lowering of my emotional barricade may lead to tears, I believe that it also has a cathartic benefit. Some would argue that this practice renders me vulnerable; I believe it reveals my humanity. I’ve also learned the importance of reflecting on these experiences with those close to me. Life and death are a part of what I do, and I should not be embarrassed or scared to share these moments or the emotions that they elicit. In the ensuing months, I had many sleepless nights. While I shared this event with a few colleagues and teachers, I was unable to talk about it with the most important person in my life—my pregnant wife. The result was an unshakeable sense of isolation, which writing this piece has only partly remedied. Six months later, I found myself in another delivery room, where my wife gave birth to our first child, a healthy boy of 8 lbs 11 oz. After he was born and my sense of apprehension cleared upon hearing his first loud cry, I did what fathers do. I carefully counted his 10 fingers, 10 toes, two eyes, and one nose. Yet perhaps more than most, I know how to count my blessings. Acknowledgments: The author thanks Dr. Allan S. Detsky for serving as mentor, for encouraging him to retell and reflect on this story, and for commenting on earlier drafts of this essay. He also thanks Dr. Ivor Margolis for his guidance and input on this essay. Baruch D. Jakubovic, MD B.D. Jakubovic is a resident physician, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; e-mail: [email protected]

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