Friday, August 26, 2011

The Last Baby

(Note: this was written a few years ago, in my last weeks practicing Family Medicine)

I think this was the last one.  I am planning a job shift in a month or so, and do not have anyone else due.  Oh, I suppose I might deliver one of my partner’s patients when on call yet, and there is always the emergency “doctor on a plane” scenario.  Heck, maybe I will do the Doctors Without Borders thing one day, but they sure would not need me for the easy, fun ones.

It went well.  It was a second time mom a week shy of her due date.  The OB nurse tried to put a scare in me, saying she thought the baby was presenting breech.  But I had checked pretty carefully a couple of days ago and was confident that things were going the right way.  These new, young OB nurses are just not made of the sturdy timber that the old school had in them.

It was just a couple of hours of labor and a few pushes.  No drama, beyond the usual “It’s a Girl”.  No scary drop in fetal heart rate, no gushing blood, no stubborn placenta.

I suppose in the grand scheme of things I have earned it.

Hardly anyone still does OB the way we do.  If we are in town, it’s not our anniversary, and we are not deathly ill; we deliver.  It is the main reason I wear a pager on my right hip.  In fact, it’s the main reason I feel undressed without the pager.

This time I was awakened from a living room sofa nap.  Spouse and I had gone out to dinner.  We deserve it, having been stuck home with kids off of school this past week, and fretting more than necessary about our respective jobs.  Dinner was swell, and I had, gasp!, a nice glass of wine.

That was several hours earlier, so I drove in with no more than the customary apprehension.  Maybe there is another up side to the projected post OB future-if I am off call and want a second drink I am by George going to have it!

Delivering babies is one of those activities that has in it the elements of high drama.  Societies ancient and modern have always had an interest in the continuation of life.  So I guess I could write reams of stories about labors and deliveries I have participated in or heard about.

Once I had the mother of a young pregnant lady call me up and fairly matter-of-factly say that they would sue me if I did not induce labor.

Two times I have delivered a baby to a couple where the husband was terminally ill, in one case he was released from the hospital temporarily just to be at the delivery.  Later that year he died of leukemia.

One time I had an experienced mom, a very relaxed person you see, do crossword puzzles for the entire labor process.  Other times I have had apparently calm women absolutely lose control, and skittish teenagers manage things with a graceful stoicism. 

Many of the stories blur together, defying my attempts to separate the components.  After 700 plus deliveries that will happen.  The children I have delivered would more than fill up an elementary school if you could gather them all together in one place.  Of course, some of them are parents of grade schoolers themselves by now.  I guess if you went all the way back to the babies I delivered as a medical student, a few of them might just manage to be grandparents.

It is fun to deliver a baby when everything goes well.  There you are, a robed celebrant at a sacred event.  The beginning of a new life is magical, and by association the doctor becomes the wizard that makes the magic happen.  Naturally, all concerned are quite aware that the laboring mother is doing all the real work, and that babies miraculously appeared long before things got scientifically organized and technological.

But underneath the fun there is fear.

A certain amount of risk can be predicted, and thereby controlled.  Obviously high risk patients should be referred out to perinatologists, and they are usually happy to be so referred.  And many years of doing anything gives you a certain familiarity with the possibilities.  It does not pay to scare easily.

But there are also unpredictable events.  The fetal heart tones that drop off for no good reason.  The baby with big sturdy shoulders that do not want to budge once the head has made its grudging appearance.  The seemingly non descript symptoms that sound innocuous over the phone, but actually herald impending premature delivery.

If you like to worry about really big stuff, consider comets.  They fly around out there unpredictably, and Hollywood aside, there is not a darned thing we can do about them.  Every few million years a big one plows into Planet Earth and we get Dinosaur Extinction. 

Big, bad obstetrical disasters are like the rare Dinosaur Terminator comets that are flying around all the time, just not happening to hit us today.

I’ve done my best over the years.  I have but a single neonatal death, and the circumstances were unavoidable.  And while I suppose there could always be that belated filing of a malpractice suit, I think my record is clean.

So I close the book on Labor and Delivery adventures. And I am feeling pretty good about it.  Sure, I will miss the new parents telling me I did a good job.  And the brand spankin’ new babies are pretty cute.  But I have a dominant emotion as I consider the Last Baby.


Addendum:  Since this was written I have indeed been called upon to deliver a couple of babies when their attendings could not be there in time, and in one scary case of stuck shoulders that needed a little more horsepower.

The instincts come back at need.  But I am in this aspect of medical practice still happy to be retired.

I no longer wear a pager.

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