Breaking Down a Wall

I woke up at 6am to my daughter’s annoyingly, loud alarm. Since I was on call, my first reflex was to look at my iPad to see if I had patients in labor. I am part of an 11 doctor call group, so when I am on call, I cover all the patients of those doctors that come into the hospital.  I scrolled through the patient list and see three on “the board,” listing the laboring patients in our group. It looked like I didn’t need to rush in, so I hung out with my two high schoolers until they left, put on my scrubs and left the house with coffee in hand as well as everything I would need to stay at the hospital for 24 hours.

As I drove into the hospital, I called labor and delivery to talk over each patient with the resident who was managing them. There was a preterm patient with concern for the baby – the baby had been monitored all night and the baby’s heartbeat looked worrisome indicating delivery needed to happen soon despite being premature. There was a patient in early labor, her first baby. And lastly, a patient that had come in at 2am, refused an exam, so no one knew where she was in her labor. Apparently, she was a victim of sexual abuse as a child. The relationship with the father of the baby was good and he was present in the room. If an exam was traumatic, how could she possibly go through labor and push out a baby?  I questioned the resident about  whether an elective c-section had been discussed with this patient and her primary OB in the office.

When I arrived, labor and delivery was busy as usual. I looked at the board to find what rooms my patients were in and started making the rounds to introduce myself and assess each one. I first talked to the patient with the preterm baby. Since the baby’s testing this morning was not reassuring, we needed to proceed with a c-section now. The baby looked compromised from the heart rate information and wouldn’t tolerate labor. Although the patient was disappointed, she knew this path was best for her baby.  As the nurse was prepping her, I went to the next patient, the one who refused an exam.

I entered her room and found it overflowing with people, all chatting away as if this were a party, seemingly unaware that someone was in labor. Admittedly, I dislike these type of laboring scenarios with too many visitors, as I find it distracting from the importance of the moment and the laboring patient gets lost in the crowd. I sidled up next to the patient, without anyone really noticing me except the nurse, and introduced myself. She was a young black woman and her boyfriend towered over her. The patient was actively contracting and in pain, the nurse was impatiently rattling on about how the patient wouldn’t let anyone touch her. I tried to talk with her quietly but it was impossible with all the people, so I told everyone but the boyfriend to leave.
Finally, some quiet and space to get to know my patient. I asked her about her history and how her experience had been at the hospital. I explained the importance of being able to examine her to properly care for her. My discussion was broken up by her contractions, but she finally agreed to let me try. As she rolled on her back, her boyfriend was shaking his head, muttering “oh lord,” yet he took her hand in support. I sat down on the bed and told her what I was going to do, but she couldn’t relax and clenched her legs together. Ok, time for plan B. I explained she had the option of an epidural, then she would be essentially numb and wouldn’t feel the exam. Otherwise, she may need a c-section. She was agreeable to the epidural. By this time, I needed to get back to the first patient and start her c-section. I figured by the time I was done with that c-section, this patient would be comfortable with her epidural and I could try to exam her again.

Off I went to the operating room. The c-section went smoothly, the baby came out crying although small with a skinny umbilical cord, a set up for a cord accident. The placenta looked ragged, obviously incapable of feeding this baby anymore. Thankfully, we finished the c-section uneventfully and I left quickly to check the other patients.

The one in early labor was coping well and baby looked good, so I moved on. As I walked back into the last patient’s room, it again was crowded with people. And, to my surprise, I could see the nurse and resident were readying the patient for a c-section. ” What is going on here?” I asked the resident. The resident said she couldn’t examine the patient and called for a c-section. What? That’s not how it works! The resident can’t make that decision. And I was not ready to give up on this patient. So, again, I told everyone to leave but the nurse and the boyfriend. I sat on the bed and looked into my patient’s eyes. ” We can do this.” She was comfortable with the epidural and didn’t feel the contractions at all anymore. I knew now I just needed to quell her old fears. Gradually, she relaxed her legs, I kept reminding her that she was fine, that she was safe, that I wasn’t going to hurt her. She let down her guard and trusted me to examine her. She was 6 centimeters, well into her labor. With a big smile on my face, I excitedly told her how great she was doing. I reassured her she could do this and I would be there to help her. Smiling back at me, she agreed. I left her room to do rounds.

When I came back, the room was not only filled with people again, but food, fried food. It really stunk. I cleared the room and had everyone take their food. The boyfriend turned to me , ” you like the police, clearing out the room every time you come in.” I giggled at the thought, me, all of 5 foot 2 inches, clearing a room. When I sat with the patient, she seemed so much more calm and was readily agreeable to me examining her. By this time, she was completely dilated and ready to push. Her mother came back in the room, so she could be a part of the delivery. With her strong and steady pushing, she delivered her beautiful baby girl in an hour. After I delivered the placenta and sewed up a small tear, I sat with the patient again. She reached for my hand and thanked me quietly. We both knew she didn’t just deliver a baby, but pushed down a wall that had haunted her for years.

I was elated, I felt I really made a difference today. I walked through the nurses station smiling. Many of the nurses congratulated me, amazed that this woman did so well.

The next day, I looked online to see how the patient was doing. I saw she had been visited by a social worker who had offered her resources to get help for her childhood trauma. Disappointingly, I saw the patient had refused the help. She was also considering not letting the boyfriend be involved with their baby. Sigh… the elation I felt the day before slipped away. I thought I had opened a door for her, I thought she realized she could take help and start to heal, I thought she saw a new path for her life. Sadly, I realized, I barely cracked her shell and then the moment was gone. How silly of me to think that the small victory yesterday could rectify the huge trauma she had endured as a child.  I hope though, at some time in her life, that she will remember her strength on that day and start working to break away her chains that shut her down so many years ago.

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4 thoughts on “Breaking Down a Wall

  1. This is an amazing story! I love that you believed in your patient’s (and your own) abilities so much that you persisted in your efforts to allow her a regular delivery as opposed to taking the (quicker? easier?) route of the c-section that the resident favored. I also encourage you to consider that the outcomes you saw online do not at all negate the enormous healing you brought her. The reasons for her rejecting the social worker – and the boyfriend – may be complex. Perhaps she didn’t click with that particular mental health professional but will follow up with another. Perhaps rejecting the boyfriend is actually a sign of health; your observations of their interactions during that short time wouldn’t necessarily show you either way. Speaking as someone who was sexually assaulted and lived with such fear and shame I wouldn’t submit to a pelvic exam until I was in my 40s – and someone who had a deeply healing experience with a gentle and compassionate primary care physician – it feels important to me to reassure you that the elation you felt was valid. It is possible – even likely – that the healing you thought you saw did indeed occur. It was not silly at all for you to think that experience could have set her life on a new path. Healing can occur in an instant; it doesn’t always but it can, and it is most likely when one is at their most vulnerable and someone comes to them and provides care with awareness, gentleness, respect, and persistence. That is the healing power of Love, and it is what you bring each of your (fortunate!) patients. It is likely you aren’t even aware of a fraction of the ways you have changed lives. Unfortunately, we patients aren’t very good at thanking our doctors. I never told mine how much she changed my life, but perhaps, in some small way, I’ve righted that with this response. Thank you for your writing – I love reading your stories – but most of all, thank you for being a doctor who is not afraid to Love her patients.

    Liked by 1 person

    1. Thank you for sharing. As I thought about it more, I agree with you that perhaps the boyfriend (and even the social worker) were not people she needed in her life. That even it was the boyfriend who invited all those people in her labor room!
      I find having a baby is the great equalizer – it puts women in such a vulnerable state and exposes so many things from their past, issues that never were resolved.

      Liked by 1 person

  2. That is a great story, left me with much to think about. I’m just a bit uncomfortable with the details about the woman’s ethnic background and not sure that was necessary or added to the story. My feeling is there was some reinforcing of stereotypes.

    Liked by 1 person

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