Seeing patients in my OB/GYN office this morning, I try to stave off the mild nervousness rumbling inside of me. My good friend Monica is having a C-section this afternoon, and I’m performing it. We met ten years ago when I walked my three-year-old daughter into Monica’s preschool classroom for the first time. Monica sat on the floor, a child in her lap and others playing around her. Like them, I felt drawn by her calm, soothing manner and infectious laugh. Over time, our friendship grew: At school or social gatherings, we always ended up giggling together. We took family trips together, trained together for marathons and supported each other through heartaches — my divorce, the closing of her childcare business — and our respective struggles to find new paths. Monica confided to me the story of her father’s sudden, tragic death when she was twelve. Her shocked mother had tried to move on as if nothing had happened, leaving a messy house and neglected daughters in her wake. Fortunately, as an adult, Monica had met and married Brian, a good, steady man who supported and soothed her as she stumbled in and out of teaching and professional childcare, then returned to school, always wrestling with terrible doubts about whether she herself could ever be a good mother. After ten years of marriage, Monica decided to take the leap into motherhood, and she asked me to deliver her baby. I immediately said yes. During my OB/GYN residency, I’d seen attending physicians care for their friends. And in my own practice, I’d already delivered many friends’ babies. Monica was an especially dear friend; I felt honored by her request. At her first appointment, the ultrasound revealed a grapefruit-size fibroid as well as a healthy fetus. Soon we learned that the baby was a girl, and, once past the first trimester, Monica glowed with health and enjoyed the pregnancy. Unfortunately, as her baby grew, so did the fibroid. By the third trimester, Monica looked like she was carrying twins, and we joked about naming the fibroid George. But the doctor in me began to fear complications. As the due date approached, the fibroid had grown bigger than the baby’s head and was now completely blocking the birth canal, making a C-section necessary. Unfortunately, the fibroid also sat exactly on the usual incision site. Is it wise for me to deliver Monica’s baby? I fretted. Should I just be the assisting surgeon, or not take part at all? I consulted one of my partners, who replied, “Oh, you’ll be fine.” When I raised my misgivings with Monica, she took my hand. “I trust you to deliver my baby,” she said calmly. I felt reassured — but, as her C-section approached, I also arranged to have a backup attending physician with me in the operating room, a senior resident to assist and blood for a possible transfusion. Now the day has finally come. Briefly, I wonder again whether I should do Monica’s delivery, then let the question go. I drive to the hospital and cheerfully greet Monica and Brian in pre-op. They’re excited to meet their new daughter — any dangers seem far away. In the OR, I hold Monica’s hand as she gets her spinal analgesia. I finish scrubbing, then stand by her side, glancing into the eyes of the resident standing opposite me. I take a deep breath, and we start. Because of the fibroid, I need to make a big incision, around and above the belly button. Quickly, I cut through the layers of fibrous tissue sheathing the abdominal muscles. Even seen from outside the uterus, the fibroid looks enormous. It’s fed by blood vessels the size of hoses and covers nearly the whole front of the uterus. Seeing it, I feel my mouth go dry. Knowing that Monica can hear our words, I talk softly with the resident about strategies for cutting into the uterus while also avoiding the fibroid, preventing excessive bleeding and leaving enough room to deliver the baby. Meanwhile, I hear Monica and Brian chatting: “I wonder who she’s going to look like … I hope she has some hair, but she’ll probably be a baldy … I can’t wait to hold her …” I try to breathe in Monica’s calming voice and breathe out my own fear. The uterus is thick; after several scalpel strokes, I’m finally in. Now the clock is ticking: Once the uterus is open, the baby’s blood supply drops, so you need to get the baby out quickly. The challenge is how to do that through this unusual incision. It’s level with the baby’s chest, and when I put my hand in, I can’t reach the top of her head. My heart starts pounding. Sweat runs down my back. Instinctively, I reach for the baby’s feet and quickly rotate her. She emerges feet first into the bright, cold room, looking shocked. I know that she’s been stunned by the speed of the delivery. I hand her to the nurse, who whisks her off to the warmer. Let me hear you cry, is all I can think. Finally, there it is: a loud wail. I smile, then look back at the gaping hole in the uterus. It’s bleeding like crazy. “Oh, Andrea, she sounds beautiful,” Monica says. I want to hug her, but I can’t speak. I might lose her if I don’t work fast. The resident and I begin suturing the uterus. Blood keeps welling up, making it hard to see what’s there. Now it’s all hands on deck: Assisted by the other attending and the scrub nurse, we go into high gear–suctioning, sponging, throwing a stitch whenever we can see. The suction canister fills with Monica’s blood; the anesthesiologist considers a transfusion. Monica says something, but I can’t register her words. I need to work faster. It seems like an eternity, but it’s really only a few minutes. Finally, we control the bleeding and finish stitching the first layer. I realize that I haven’t been breathing. I take a deep breath. We’re not done, but the worst is over. As the scrub nurse hands me the next suture, I can finally chat with Brian and Monica, now holding their brand-new baby daughter. “She’s so chunky,” I tell Monica. “You fed her well.” “Yep,” Brian chimes in. “And you were right, she’s a baldy!” The rest goes smoothly. Monica has lost a huge amount of blood — about twice the usual. As tough as she is, this will make for a rough recovery. I start to tell her this, but I can see that she isn’t listening — she can only focus on her daughter. This discussion can wait; for now, she just needs to embrace her new motherhood and expanded family. I walk away completely drained, feeling the enormity of holding these two lives in my hands throughout the surgery slowly ebbing away. Afterwards, I keep reliving the delivery — and revisiting my own questions. What if things hadn’t gone as well as they did? What if she’d had complications, or died? Could I live with that? If I had to do it all over, what would I do? And what will I say when Monica asks me to deliver her next baby? I don’t know if I can answer those questions. How can you know the answers until you’re in the moment? I do know that, despite my fears, I was able to keep my head and perform at my best. I also know that, at different moments in Monica’s pregnancy, the usual doctor-patient equation was reversed: It was my friend who gave me strength and reassurance, not the other way around. Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN. This piece was originally published in Pulse — voices from the heart of medicine. Source
