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A witness to the birth of everyday miracles

Special to The Times

Medical textbooks taught me exhaustively about disease processes, medicines and interventions. Conveniently, the textbook patients behaved as predicted.

Ten years of medical practice, however, have taught me that many times, actual people do not respond as planned. I have learned to listen to the subtleties, never mentioned in books, such as a patient’s faith, support system or stress level, and to expect a few unknowns, such as prayer or even the lunar calendar, because I now realize that all these things can affect a patient’s outcome.

I began to understand this as a third-year medical student during my first night on call in the obstetrics department of a county hospital. Early that morning, I had read and memorized the stages of delivery. When I arrived, the obstetrics nurse looked at me knowingly. I’m sure she figured I had been up half the night practicing my stitches on an orange. She muttered that it was a full moon. Tonight, she said, was going to be crazy. I wondered what she meant by that.

The nurse explained that “intern for delivery” meant there was an uncomplicated delivery coming in, and the interns and students could handle it. As she explained this, “intern for delivery” sounded over the loudspeaker. We hurried to the delivery room, where a young Latina was draped with a sheet, feet up in stirrups and ready to push. Many of the patients at this county hospital lacked insurance and didn’t have access to regular medical care. For some obstetrics patients, the first time they have seen a doctor is when one shouts at them -- empuje, senora! (push, lady). The intern showed me where to sit and where to put my hands.

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“Empuje, senora!” I yelled.

She screamed. I shouted “empuje” again. She screamed, and the baby’s head started to appear.

As if by magic, the head turned to fit through the pelvis, and during the next push it turned again, just like I had read about that morning. Amazing. With one last grunt, the baby -- a boy -- was out.

When a delivery proceeds smoothly, the mother’s contractions and the baby’s body work in concert. The baby’s twisting in time with the mother’s contractions is synchronous and natural, nothing short of miraculous.

“Intern for delivery” sounded again, and a nurse looked at me. It was my turn.

I walked into the next delivery room and fumbled as I gloved up. The woman, in her 30s, shouted to me that this was her 10th baby, and that I had better hurry. I ran over just in time for her to practically hurl the baby into my arms.

The rest of the day proceeded similarly, with “intern for delivery” punctuating the brief silences. A few times I saw nurses shaking their heads and muttering; they believed that the forces of a full moon produce more births than usual.

About 8 p.m., hospital workers wheeled in another woman, obviously in active labor. She looked to be about 16 and stared up at me, her eyes wild with pain and fear. We placed her on the table, and I was about to yell “empuje, senora” when I looked down and realized she had already started pushing, and had pushed out a tiny foot.

The baby was breech. I knew enough about breech deliveries to know that rarely is a vaginal delivery attempted and almost never in a first delivery. Under my breath I told the nurse to get help, while out loud I told the woman “no empuje.”

Thankfully, the second-year resident came quickly and said the woman would have to try to push the baby out. The junior and senior residents rushed in to help, and I grabbed the woman’s head. I held her hand and tried to fix her terrified eyes on mine. The senior resident screamed for the woman to push muy fuerte!

The woman’s eyes dilated with pain and she squeezed my hand and pushed. Just then the baby’s heart monitor alarm sounded. The heart rate was dropping; the baby was in distress.

The senior resident yelled that we would have to “crash” her -- medical parlance for an emergency caesarean section.

“Anesthesia for delivery! Peds for delivery!” boomed over the loudspeaker, and those two teams of doctors ran in almost immediately.

The room erupted into chaos. The pediatricians were readying the resuscitative gear; the anesthesiologists were mixing their drugs; the senior obstetrics resident was barking orders, while the whole time the baby alarm was blaring.

Struggling to remember my high school Spanish, I whispered to the woman “esta bien” (it’s fine), as her darting eyes glazed and shut from the anesthesia. She loosened her crushing grip on my hand, and I moved back into the corner, watching, my hand over my mouth.

The junior and senior residents opened her abdomen in one movement, while the second-year pushed the baby’s feet from below. The senior resident hissed for the junior resident to push the foot, but it was stuck. It seemed like forever. The foot finally dislodged as the senior resident reached in practically to his elbows and pulled the baby out. He passed a limp-looking baby to the waiting pediatricians, who gathered the baby up and whisked the child to the incubator.

Then there was silence. Everyone was watching the huddled group of pediatricians.

And the silence lasted longer. And longer.

Feeling very small, under my breath, I said, “Please, God, let it be OK.”

And then it happened.

Softly at first, a whimper. We strained to listen and a few second later -- a louder cry.

I gulped and looked around the room. I was not the only one wiping away tears. The mother awoke a few minutes later to the sounds of her daughter’s cry.

I walked to the parking lot a few hours later, my head spinning. I realized that doctors, for all the knowledge and technology that we have, occasionally are just witnesses to events bigger than ourselves. I looked back at the hospital, its stately 1920s-era architecture hiding the cacophony within. Above it, large and low, was the full harvest moon, its orange glow embracing it all.

*

Dr. Jackie Yaris is an internist practicing in Beverly Hills.


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