During the first hours of labor and delivery the miracle of life escapes your eyes. There is a puffy, bloated woman there that is clearly either uncomfortable or in agonizing pain. She can hardly mount the bed and then you plug this weird thing to her belly to measure all sorts of things. And then the fun part comes, where you take two fingers and insert them where they need to go, and now comes the dramatic part, the pinnacle of every obstetrician's professional life - how is the cervix doing!
Well, he is doing fine, thank you very much. He is sometimes soft, and sometimes hard, he is sometimes dilated, and occasionally effaced. If you are lucky to get more involved in the drama you might feel the baby's head way up there (or way down there if "baby comin' out").
When Mr. Cervix is impressive enough the poor woman is cordially transferred to the delivery room, where the miracle takes place, but not just yet. first she is in a little more agonizing pain. some want pain medication, some want an epidural, some want to feel it all the way to a stress ulcer.
And then the amniotic sac ruptures (if it hadn't before), and then baby comin' out, but not quite yet. first she needs to feel that she needs to push. that, too, is very important. how do you know you need to push? oh, you do, believe you me. It's like a bowel movement, and funny i'm mentioning that, because baby is not the only thing coming out.
This is actually a dual process. two separate entities are actually seeing the light of day for the first time, and occasionally one might get confused on which is which. You see, the most repetitive process during labor and delivery is wiping a pregnant patient's behind.
And now comes the times to push.
So she is pushing, and everyone around her is hysterically encouraging her to push push push push, and push she does, and there you see a little bit of hair.
"let's lubricate", says the wise midwife, and a nurse pours incredible amounts of a vaseline-equivalent, which she smears and rubs very proficiently in the vaginal canal.
baby almost comin' out, but not just yet.
So she keeps pushing and pushing, and you take her legs and pull them almost all the way to her head and around her neck, and you implore her to push, to not give up, just a few more pushes, and people count to ten, and people count to twenty, and baby slowly comin' out, and Mr. Turd during a much better job at it, and nurse wipes it, but then she forgets, and that piece is stating right at you, and at some point you take a piece of gauze and give it a good wipe, and now you know you've done your time. and the the contraction ends and everybody relaxes for a bit. you hear the fetal heart tones and know they are not too slow so that's OK, and you look at the monitor and see that things are fairly in order, and not two minutes pass and there's another one coming up!
"push, push, push!", an excited family is shouting cheerleader style, I can almost see them going "give me a P! give me a U! give me an S!" and so on, and the poor woman is pushing and pushing, and Mr. Turd is actually beating Mr. Baby again, but baby's on his/hers way out, that's right, he/she is right down there and comin' out.
It is very symbolic that birth is involved with so much shit. it's almost like god is telling you, kind of very subtly hinting you, it's going to go hand in hand from now on. don't you be expecting any good stuff without a good dose of crap with it. However we don't quite seem to get it, we don't even remember that Baby-Turd race until we find ourselves in the delivery room, and something kind of sort of feels familiar.
another contraction.
and she's pushing. and pushing, and it's really quite incredible an entire head can fit right in there, which makes you feel a little incompetent. and baby's pushing against vaginal wall and it looks like he's going to make it this time, but not quite. mommy's pushing pushing pushing, but then needs to rest. we need another contraction.
and another one comes along, and baby's pushing, and slowly, gently, almost there, and you support the head so it won't pop out too quickly, and gently, baby pops out, and leaving that remaining turd way behind. it's looking to the side, my right side this time, and I grab him by the neck, my god this is scary, and I make sure there is no umbilical cord around his neck, like I had when I was born, and then I pull on him a little, and I pull him outward and downward to deliver his/hers upper shoulder, and I pull a little longer and this time upward to deliver the lower shoulder, and then head and shoulders coming out, and all that's left is to give a little tug and entire baby's coming out, and he looks dead.
but they often do, and sometimes they look blue, too. and a good rule of thumb is that pink baby better than blue baby, and you immediately start ticking him off, you rub his belly really strong, and you stick a nozzle in his nose and mouth to vacuum secretions, and after a few seconds there is usually a cry, and you want to cry with him, because you have been working too much and have been around for 30 years (my god has it been that long?), and so you really have something to cry about. but instead you clamp the umbilical cord one time close to the baby, and then one more time a few inches up the cord, and then you might let the dad cut in the middle, if there is a dad around, or maybe a grandmother, or whoever, and then baby is ready for shipment. and next stop is little baby thingie in the corner of the room, with the nurse waiting to tug on his and annoy him a little longer, and after that give him to mommy for warmth and breastfeeding and just bring mommy and baby together. but for this you have to carry baby, who is slippery anyway, and wiggling as well, on your bloody gown from mommy's stuff, and you are terrified that right then and there baby's gonna splatter all over the floor, and you are going to hit the news, and he will sue you when he's older, and you will harm him, and after all he just got here. but then you overcome this fear, and you hold baby real tight, you grab him by the ankles and support his head, and you bring him close to your bloody gown, and you say "please god don't let this thing drop off my hands", and these three feet seem like a half marathon, but eventually you make it, and you put baby in his baby bed, and you say thank god, and you go back to mommy, and now the battle of the placenta commences.
the battle of the placenta includes you, mommy, and a pair of clamps. you see, baby coming out is really nice, but delivery is not over just yet. Ms. Placenta is actually part of baby, and like any chick, she is taking her time, she might take up to 30 minutes to come out or even longer, and like any chick that's getting ready to go out, you better not rush her, otherwise something bad is going to happen. so you are giving little tuggings to the umbilical cord, just to see if she is ready yet, and you hold the uterus on her lower abdomen so it won't come down along with her, and you give the little tuggings, but placenta ain't comin' out just yet. she needs her time. so you wait there with the clamp clamping the umbilical cord, and your back hurts by now because you are bending forward all this time, and eventually, when you give a little tug, you can feel it giving way, and then you put a bucket underneath and you tug on placenta as she moves, and lotsa blood comes gushing out, and now it's time to give a uterine massage, a deep, decisive one, so the uterus will constrict, and there won't be as much blood coming out, and also to make sure everything that needs to go out will. and you give that massage and you check the placenta, that everything that needs to come out really did, and then you tell yourself that delivery is over, but we are not over yet, because now comes damage control.
so there is a lot of pushing going on during delivery, you could call this the defecation of your life, and a lot of pressure, and an entire baby coming out of there, so you can understand why there might be tears and bleeding and stuff like that, and some of them need to be fixed. so you need to check all over there if anything is bleeding, if anything is torn, and you might want to suture that, so there will be no bleeding, and also to keep the husband happy, and of course to keep mommy happy, because you don't want her to curse you all her life, because you never know which one of those actually work.
and after you have done your laceration repair you take all the fluids and blood and tissue and shit and you wrap it in a big plastic bag, and you put it on the table and you tie everything nicely, and you tell mommy "felicidades" and they shake your hand, and they are happy, and you are kindda happy, although you still have to stick around until the end of your shift and you are tired anyway, but then again, that's life, right?
And then I see my name on the poor thing's birth certificate, and now I know he is branded for life, and that he might come get me one day, when he is all depressed, and fed up with it all, and probably wishes I shove him back in there, because i'm the first person to see him out, but to tell the truth, I can't help a smile in the corner of my lips, because me and him are in some weird kind of bond from today on, and he doesn't know it, and I don't realize it, hell, i don't even know his name because his parents haven't decided yet, but maybe one day he will cure cancer, or be the president of the united states, or abolish commercials, or legalize nudism, or something important like that, and I wouldn't know it because I wouldn't recognize him, but I can say I was there where it all started, when baby beat a turd and came into this world.
Wednesday, September 2, 2009
A Visa to freedom
Dr. Noah won the lottery and wanted to go to America.
Seemingly this should not pose much of a challenge, especially post-lottery-winning. However, he faced some difficulty.
"Try again in 2 years", the guy in the governmental office told him, and Noah thought he actually got lucky - some people wait for years before they are allowed to go to America.
And he knew what he had to do now.
As an expert in minimally invasive surgeries, one of only a handful in his home country, he knew exactly what the government now expects him to do, and indeed, he worked harder. He worked hardest. He worked hardestest. He hardly saw his wife and son, as he worked 8, 10 12, 20, 30, 50 , 50 , 80533452 hours a day, a week, a month. And they loved him at the hospital, he was the best minimally invasivologist in town, and even doctors from out of town came to see the him at work.
But after two years he got a letter from the government. It congratulated him for his fine work and was cordially informed that he was so good, they want to keep him. He can, if he wants, go to Venezuela and be a part of a doctors program. If he works hard enough, after 4 years he will get 10000 dollars. After he comes back home, of course.
Realizing this is not really going the way he wanted, he decided to make a run for it. Well, that is hard to do when you are on an island, which is exactly why Hector, his buddy's friend, who is a very talented carpenter, came in handy. Hector used to built ships from the time his father would sail into the ocean to catch fish and lobsters. When Noah told him he wants a ship he agreed, but on one condition - "I come too". I guess if you are about to cross an ocean, it might be nicer if there was a doctor on board, and Noah thought to himself that a ship builder most probably also knows how to handle ships, and though he was very wrong, he didn't know it yet.
So the ship was built, and they all hopped on board. it was actually more secret than that. Hardly anyone knew about the plans. Noah's mother wept quietly. It was so quiet that the air molecules weren't sure if they should vibrate or not, which is exactly why Noah himself always thought he is hearing his mom crying. Even now, when he tells me this story. He hears her mostly at night, even though she is thousands of miles away.
A GPS is a useful tool when you are about to embark on a sailing mission to a far away destination with a carpenter as your captain. Two problems persisted, though: 1. you just can't get a naval GPS on Noah's island. 2. The captain is the one making the decisions anyway and, being the happy, carefree person that he was, he decided a GPS is not really necessary. With Noah trying to convince him, because he was genuinely fearing for his life, Hector made a compromise - "we sail to Cayman islands and we buy there. And", he added, "that is where we will have our first breakfast".
It's been 5 years from that journey, and Noah hasn't been to the Cayman islands yet. Maybe one day, on his way back home from America he will go back there, just to check out what he might have missed.
They made their way to America eventaully, overcoming stormy weathers and ridiculously high waves. Noah lost 20 pounds, but he probably needed it anyway. There were lots of fish to catch, but no Einstein thought of bringing a fishing rod, or anything like that. I am thinking about those fish right now and I know they are fresh and delicious. They ended up on the coast of some south American country, which I can't remember right now, and somehow found their way to the promised land.
Noah told me this story while sitting on a bench during a 5 minute break we had between patients. We were interrupted a few times by the nurses who came to update us on this or that patient's condition. He looks tired and over worked, like the rest of us. he is in his first year of residency, like myself, but in a different field. It is much different than his lifestyle as a surgeon. as a senior surgeon. However, it's more practical for him right now.
I am looking at his tired eyes, and know that he is actually happy. ier. he made it, he is here. He beat his government, and they did not break his spirit. Just a few things to take care of right now, like bringing his parents. They won't let them leave, and they won't let him, the traitor who escaped his country, to go back. He tried once to come back, when his grandfather was dying. He knew he didn't have a chance, but owed it to him to give it a shot. "We are unable to approve your request" was laconically written on a sheet of paper that was sent to him in an ugly little envelope, and that was it. His grandfather is now watching from above, as his grandson broke the watery wall and made it into freedom.
He just misses those damn cigars.
Seemingly this should not pose much of a challenge, especially post-lottery-winning. However, he faced some difficulty.
"Try again in 2 years", the guy in the governmental office told him, and Noah thought he actually got lucky - some people wait for years before they are allowed to go to America.
And he knew what he had to do now.
As an expert in minimally invasive surgeries, one of only a handful in his home country, he knew exactly what the government now expects him to do, and indeed, he worked harder. He worked hardest. He worked hardestest. He hardly saw his wife and son, as he worked 8, 10 12, 20, 30, 50 , 50 , 80533452 hours a day, a week, a month. And they loved him at the hospital, he was the best minimally invasivologist in town, and even doctors from out of town came to see the him at work.
But after two years he got a letter from the government. It congratulated him for his fine work and was cordially informed that he was so good, they want to keep him. He can, if he wants, go to Venezuela and be a part of a doctors program. If he works hard enough, after 4 years he will get 10000 dollars. After he comes back home, of course.
Realizing this is not really going the way he wanted, he decided to make a run for it. Well, that is hard to do when you are on an island, which is exactly why Hector, his buddy's friend, who is a very talented carpenter, came in handy. Hector used to built ships from the time his father would sail into the ocean to catch fish and lobsters. When Noah told him he wants a ship he agreed, but on one condition - "I come too". I guess if you are about to cross an ocean, it might be nicer if there was a doctor on board, and Noah thought to himself that a ship builder most probably also knows how to handle ships, and though he was very wrong, he didn't know it yet.
So the ship was built, and they all hopped on board. it was actually more secret than that. Hardly anyone knew about the plans. Noah's mother wept quietly. It was so quiet that the air molecules weren't sure if they should vibrate or not, which is exactly why Noah himself always thought he is hearing his mom crying. Even now, when he tells me this story. He hears her mostly at night, even though she is thousands of miles away.
A GPS is a useful tool when you are about to embark on a sailing mission to a far away destination with a carpenter as your captain. Two problems persisted, though: 1. you just can't get a naval GPS on Noah's island. 2. The captain is the one making the decisions anyway and, being the happy, carefree person that he was, he decided a GPS is not really necessary. With Noah trying to convince him, because he was genuinely fearing for his life, Hector made a compromise - "we sail to Cayman islands and we buy there. And", he added, "that is where we will have our first breakfast".
It's been 5 years from that journey, and Noah hasn't been to the Cayman islands yet. Maybe one day, on his way back home from America he will go back there, just to check out what he might have missed.
They made their way to America eventaully, overcoming stormy weathers and ridiculously high waves. Noah lost 20 pounds, but he probably needed it anyway. There were lots of fish to catch, but no Einstein thought of bringing a fishing rod, or anything like that. I am thinking about those fish right now and I know they are fresh and delicious. They ended up on the coast of some south American country, which I can't remember right now, and somehow found their way to the promised land.
Noah told me this story while sitting on a bench during a 5 minute break we had between patients. We were interrupted a few times by the nurses who came to update us on this or that patient's condition. He looks tired and over worked, like the rest of us. he is in his first year of residency, like myself, but in a different field. It is much different than his lifestyle as a surgeon. as a senior surgeon. However, it's more practical for him right now.
I am looking at his tired eyes, and know that he is actually happy. ier. he made it, he is here. He beat his government, and they did not break his spirit. Just a few things to take care of right now, like bringing his parents. They won't let them leave, and they won't let him, the traitor who escaped his country, to go back. He tried once to come back, when his grandfather was dying. He knew he didn't have a chance, but owed it to him to give it a shot. "We are unable to approve your request" was laconically written on a sheet of paper that was sent to him in an ugly little envelope, and that was it. His grandfather is now watching from above, as his grandson broke the watery wall and made it into freedom.
He just misses those damn cigars.
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