فصل 12

12

The first birth I witnessed was also the first death.

I had recently taken Step 1 of my medical boards, wrapping up two years of intensive study buried in books, deep in libraries, poring over lecture notes in coffee shops, reviewing hand-made flash cards while lying in bed. The next two years, then, I would spend in the hospital and clinic, finally putting that theoretical knowledge to use to relieve concrete suffering, with patients, not abstractions, as my primary focus. I started in ob-gyn, working the graveyard shift in the labor and delivery ward.

Walking into the building as the sun descended, I tried to recall the stages of labor, the corresponding dilation of the cervix, the names of the “stations” that indicated the baby’s descent—anything that might prove helpful when the time came. As a medical student, my task was to learn by observation and avoid getting in the way. Residents, who had finished medical school and were now completing training in a chosen specialty, and nurses, with their years of clinical experience, would serve as my primary instructors. But the fear still lurked—I could feel its fluttering—that through accident or expectation, I’d be called on to deliver a child by myself, and fail.

I made my way to the doctors’ lounge where I was to meet the resident. I walked in and saw a dark-haired young woman lying on a couch, chomping furiously at a sandwich while watching TV and reading a journal article. I introduced myself.

“Oh, hi,” she said. “I’m Melissa. I’ll be in here or in the call room if you need me. Probably the best thing for you to do is keep an eye on patient Garcia. She’s a twenty-two-year-old, here with preterm labor and twins. Everyone else is pretty standard.”

Between bites, Melissa briefed me, a barrage of facts and information: The twins were only twenty-three and a half weeks old; the hope was to keep the pregnancy going until they were more developed, however long that might be; twenty-four weeks was considered the cusp of viability, and every extra day made a difference; the patient was getting various drugs to control her contractions. Melissa’s pager went off.

“Okay,” she said, swinging her legs off the couch. “I gotta go. You can hang out here, if you like. We have good cable channels. Or you can come with me.”

I followed Melissa to the nurses’ station. One wall was lined with monitors, displaying wavy telemetry lines.

“What’s that?” I asked.

“That’s the output of the tocometers and the fetal heart rates. Let me show you the patient. She doesn’t speak English. Do you speak Spanish?”

I shook my head. Melissa brought me to the room. It was dark. The mother lay in a bed, resting, quiet, monitor bands wrapped around her belly, tracking her contractions and the twins’ heart rates and sending the signal to the screens I’d seen at the nurses’ station. The father stood at the bedside holding his wife’s hand, worry etched on his brow. Melissa whispered something to them in Spanish, then escorted me out.

For the next several hours, things progressed smoothly. Melissa slept in the lounge. I tried decoding the indecipherable scribbles in Garcia’s chart, which was like reading hieroglyphics, and came away with the knowledge that her first name was Elena, this was her second pregnancy, she had received no prenatal care, and she had no insurance. I wrote down the names of the drugs she was getting and made a note to look them up later. I read a little about premature labor in a textbook I found in the doctors’ lounge. Preemies, if they survived, apparently incurred high rates of brain hemorrhages and cerebral palsy. Then again, my older brother, Suman, had been born almost eight weeks premature, three decades earlier, and he was now a practicing neurologist. I walked over to the nurse and asked her to teach me how to read those little squiggles on the monitor, which were no clearer to me than the doctors’ handwriting but could apparently foretell calm or disaster. She nodded and began talking me through reading a contraction and the fetal hearts’ reaction to it, the way, if you looked closely, you could see—