The hospital room was dark when I entered. Soft music played in the background and behind a drawn curtain a nurse called out protectively, “Yes?”
Pulling aside the curtain, I led with my credentials, “It’s just the med student.” I tried to sound confident–like I belonged. “Max,” I added hastily.
This was my second week on the labor and delivery service and, blessedly, after a week of nights, I had finally been moved to the day shift. I was the only medical student on at the time and my instructions were simple: see everything, do as much as possible. This was me living up to that maxim. When new patients arrived in labor I would find them during a still moment and introduce myself. “Hi, my name’s Max. I’m a medical student. Would you mind if I participated in your delivery?” Some said no, but most acquiesced, and for a few moments we would chat, mostly about what was on the TV. Then I would move on to something else, an emergency C-section, a cerclage, a spontaneous delivery. The routine kept me moving constantly and just as I was shaking off the emotions of one room, I was heading into the next. In my downtime, I watched the blinking OR scheduling board or followed the seismic tracings of a dozen fetal heart monitors—waiting for a hint of new action.
The room I entered was orderly but seemed electric with a hint of chaotic anxiety. An expectant mother lay with her legs in the air supported by her husband and the nurse, as she rested between the rhythmic contraction and push. The nurse was one I had worked with before, extremely competent and kind. She supported the mother’s leg with one arm and typed orders in the computer with another. Wordlessly she signaled me to take up her position as human stirrup and she began whirling around the room in a controlled urgency, flipping switches and setting up the equipment for the task at hand.
I had met this couple, hours earlier when they were admitted, and asked how their last few hours had been. Dads always seemed too eager to discuss how tired they were and I had time to make a few jokes before the nurse pulled on a sterile glove and bent down to perform a cervical check. 10 cm dilated and 100% effaced with a rough tuft of slimy hair bulging outward—it was time to page the doctor, but the urgency of biology took hold and the mother said it was time to push.
“Deep breath. Push for ten! Good, deep breath! Push! One..two..three..Big push come on..five…six…more more more…eight…nine….And Ten! Deep breath and again…one…”
Her face flushed with the effort and the veins in her neck bulged like twisting cords. She screamed and I looked down to see the red and black matte of hair pushing out past the introitus. Then the contraction ended and we all breathed in unison. This baby was coming soon and I pulled out the plastic stirrups for each leg while the nurse rushed to the phone that hung from the wall. Suddenly the couple seemed to blur and the rote process of delivery took hold. I had to rush now to get everything ready. A spotlight snapped on above my head and the mother began to glow as if I was seeing her in a dream. Yet the task at hand demanded my full attention. I removed bedding and pulled a lever to slide the bottom third of the bed under and out of the way, leaving her buttocks near the edge with her feet perched on the blue plastic stirrups.
Another nurse came in and with the added help I was free to rise and begin to don my sterile garb. There was a cart on which gown and gloves were laid out for the physician, but mine had to be fished out from a drawer near the back of the room. I was meticulous and slow in donning my medical regalia and in the time it took me to get dressed, the doctor had already entered the room. Upon noticing me, she asked, “Are you the medical student? Have you ever delivered a baby before?”
I told her that I hadn’t but that I had assisted with many. She nodded and proceeded to talk to the patients and dress in the blue, sterile cloak. The call went up that she was contracting on the monitor and the ordeal of pushing began again while we all huddled around the bed.
Another push. The baby’s head shifted forward half a centimeter. I was now fully dressed in my sterile garb, clutching my hands at my chest like a choir boy and straining to see as much as I could. Once I had donned the attire I unconsciously took on a new persona. The joking of a moment prior was over, and I moved with the cool efficiency of the professional I was pretending to be. Another push and the head slid further out the birth canal. The doctor called her encouragement to the mother and her hands pressed down and outward, clearing a path for the nearly born child. Another push and we all breathed again.
My relief was short-lived, however, because as soon as the last contraction had subsided, the doctor looked me up and down and ordered me to sit at the foot of the bed. I obeyed without outward hesitation, but in my mind I screamed that I did not feel ready.
Perhaps sensing my anxiety, the doctor nodded to me and whispered, “First time for everything.” And as if on cue once I had settled into my stool, the tocometer registered another contraction and the pushing began anew. Beside my ear, the physician called out encouragement to the mother and guided my hands into position. Features of the baby’s face were starting to come into view, facing down and advancing further with every second. My throat felt like it was closing and it was all I could do to keep my hands from shaking as I pressed them around the vestibule. A third push and everyone began yelling, “Push, push, push! Hard, harder! Almost there!” the baby lurched forward and as she emerged her oblong head arched backward onto my expectant hand. I found my grip. Too softly at first, then more firmly and began to pull gently upward and outward at the direction of my attending. The nurses that had joined the room in preparation for the birth were now also calling encouragement, “So close! More, more, more!”
The umbilical cord was wrapped around the baby’s neck, and with a deft motion, the doctor unraveled it. In the background, the room was organized chaos. Instructions were being called and the mother was crying from the pain and effort. One shoulder slipped out, then the second, and in what seemed like less than a second, I had pulled out the last of the trailing feet.
A hush fell over the room, and the physician leaned forward with a suction bulb. Silence and the gurgle of the suction were the only sounds in my ears, and as I held the baby near my chest I began to feel the tears that had been welling up. I noticed the warmth of the child and marveled at the shimmering cast by the illuminating spotlight, and then suddenly with a shrill, high pitched cry all the sound came rushing back.
Hands took the baby from me and placed it on the expectant mothers chest. The new parents were in tears, and empty of my burden looked on excitedly. The father called out to no one in particular “It’s a girl!” and I smiled so wide that I thought my mask would tear. I smiled as I watched the new mother shake with grateful sobs, and I smiled as I looked up at all those beaming faces. I smiled so hard that tears rushed from my eyes, and I smiled as my hands began to shake. The room seemed so dark outside the beam of that single spotlight, and in that darkness, I wondered what kind of future this child that I delivered might have. In the stillness, I kept on smiling.