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CHAPTER 1
THE ORDINARY WORLD
In order for you to understand my hero's journey so I can help you map out yours, let me share with you a snapshot from my Ordinary World. Come back with me to Illinois in the late '90s, when I was a third-year resident at a university in the Midwest, working a 36-hour shift in labor and delivery.
"Doctor Rankin, Room 305--stat!"
I burst from the doctors' lounge as if poised on sprinters' blocks, flinging blankets and barbecue potato chips in my wake. I race through the tiled hallways and slam open the door of the delivery room, where the adjustable hospital bed perches, like a throne, in the center of a pink- walled haven that is as homey and cozy as you can make a hospital room. Lying in the center of the bed, I see my patient, Sarah, straddled in the stirrups, her face scarlet as she grabs her knees and pushes until a tiny blood vessel in her eye bursts. Seeing a swath of bright red hair crowning, I throw on a blue paper gown, don a pair of 61/2 sterile gloves, and assume the catcher's mitt stance.
The baby's father is counting, "One . . . two . . . three . . . four . . . five . . . six . . . seven . . . eight . . . nine . . . ten. Okay. Deep breath. And again." Queen's "We Are the Champions" blares from the stereo.
Massaging Sarah's perineum, I stretch the skin to make room for the baby's head just as she pushes it out with one last grunt. When I angle the baby's head down, the front shoulder pops out, and when I pull up in the opposite direction, the baby boy slips out like a greased watermelon. The father bursts into tears, which leaves me misty. (Something about watching big, burly guys cry at births gets me every time.) As I place the baby boy on the towel waiting on his mother's belly, the nurse dries him off and rubs his back. Sarah nuzzles her son's wet hair against her cheek.
While the parents bond, I focus on delivering the placenta. But then I hear the nurse press the call button and order, "Call NICU. Stat!" I deliver the placenta and rush to the incubator, where the nurse is inserting suction tubes into the limp newborn's mouth. The nurse whispers, "Baby's not breathing." He looks a dusky shade of purplish blue.
I rummage around for a stethoscope while the nurse covers the baby's mouth with an oxygen mask. My heart races when I realize I'll have to intubate this baby myself if the team from the neonatal intensive care unit doesn't arrive soon. As a third-year OB/GYN resident, I've only intubated a few babies--and they were all plastic dolls in a controlled setting. I swallow hard, running through the steps in my mind, all the while praying that the NICU team will save this baby--and me.
Sarah yells, "What's happening? Why isn't my baby crying?"
The charge nurse pushes the worried father aside and says, "Stay there. Please."
I can hear Sarah wailing in the background as I'm sorting through the equipment, trying to find just the right tube, with the baby getting bluer by the minute.
I pray, "Please God please God please God," and then just, "Help."
I beg the charge nurse to grab my senior resident, the attending physician, the neonatologist--anyone more senior than me who happens to be standing around labor and delivery right now. The stakes are too high. But the charge nurse whispers back, "Lissa, you're it right now."
I feel a sense of mounting dread. I've never done this before, not on a real baby. What if I screw up?
I'm just about to insert the tiny laryngoscope into the newborn's mouth when the NICU team races in and someone with more experience than me grabs the instrument from my hand. I breathe a huge sigh. I'm off the hook.
Within seconds, the baby is intubated and a respiratory therapist starts bag-ventilating him while the NICU nurse listens to his chest with a stethoscope. The NICU nurse yells, "Call a code."
This is not good. The baby is still blue. My heart sinks.
The NICU attending neonatologist, Dr. Bosco, blasts in moments later. Without a word to Sarah, he puts a line into the freshly cut umbilical cord, injecting drugs; pushes medication down the endotracheal tube; and, finally, compresses the tiny baby's blue chest, performing CPR.
By this point, Sarah and her husband are officially freaking out, and my whole body is quivering with adrenaline. The charge nurse sits with her arm around Sarah, and I'm racing between Sarah and the NICU team, trying to translate. But the NICU team is working silently, and I have no clue what's going on.
Was it me? Did I do something wrong? The baby looked great on the fetal monitor all through labor, and the delivery went smoothly. I second-guess myself, which is what OB/GYNs always do when the baby doesn't come out pink and screaming. I wonder if there's anything I could have done to prevent this baby from being so blue. Had I missed some clue on the fetal monitor? Should I have recommended a C-section? Should I have rushed the delivery with forceps or a vacuum? And the unwelcome thought that always needles its way into the minds of obstetricians when the baby comes out blue: Will I get sued?
Finally, Dr. Jackson, the attending OB/GYN in charge of me, flings open the door and bellows, "Will somebody tell me what's going on in here?"
I start debriefing him, but he brushes me aside and starts barking at Dr. Bosco, asking questions in a brusque voice. Dr. Bosco shoos him away. He's fully focused on trying to save the blue baby in front of him. Without a word to any of us, the NICU team pushes the incubator out of the delivery room and runs down the hallway. Dr. Jackson races after them, still barking questions.
The room is suddenly still with only Sarah, her husband, the nurse, and me left. Sarah and her husband are both sobbing, and when I place my hand over Sarah's hand, she withdraws it, as if I just burned her. I feel helpless. All I can do is stand there and be present, which doesn't feel like enough. Doctors don't like to feel helpless. At all. It triggers our greatest fear-- that others will finally realize that we're imposters, that we don't know what we're doing, that we can't really help our patients, that everything we do is just a finely orchestrated ruse to cover up the truth that we're not in control of whether or not someone lives or dies.
I feel the sinking sensation in the hollows of my stomach that I always feel when I realize I can't control what happens in the hospital, and just at that moment, when I'm feeling really nauseated, my pager blares a 911 message, which means, "COME NOW." I apologize to Sarah and excuse myself from the room.
I feel the tears starting to come, but I can't indulge them because there's a baby about to be born in Room 309. Doctors become masters at stuffing their emotions. We can't cry when we're grieving or when someone has hurt our feelings or when we're sad. We can't let on when we're scared. The only emotion doctors seem to give themselves permission to express is anger. Doctors tend to yell a lot. But when you're a resident, you're not even allowed to yell much. You can only yell down to your medical students or junior residents. You can't yell up to the attending physicians. Either way, yelling isn't so much my style. I'm more the crying type, but my professors have been criticizing me for years when I cry, so I try to hold it together and not let anyone see when things get to me.
It's not just feelings that doctors suppress. We literally have to suppress our urges--to sleep when we're tired, to eat when we're hungry, to stop retracting in surgery when our shoulders are killing us, even to urinate. Looking at the clock, I see that it's past midnight, and I'm so tired and hungry and dizzy from adrenaline that I have a hard time mustering up the energy I'll need to deliver this next baby, but nobody in this labor room needs to know that I'm scared about what's happening to Sarah's baby or that I really want to go to sleep. Let these nice people think I've been hanging out in a call room, reading a good book, just waiting for this very special moment.
Wiping my eyes and pasting on my smiling game face, I open the door.
The baby's head is halfway out of Olive's vagina, and the nurse is playing quarterback, holding the head in with one hand while the other hand pulls back for instruments in case the baby comes before I don my gloves. I get there just in time and step between Olive's blue-draped legs as a contraction comes and the baby shoots out like a cannonball. I fumble the baby, barely catching him in the crook of my arm. Then I clamp the umbilical cord twice and invite the dad to cut it. He can barely chop through the rubbery cord, but once he does, he looks so proud, like he's just thrown a touchdown. With the baby boy untethered, I nestle him onto the blanket over Olive's breast.
Olive gushes, "Oh, my beautiful boy," and the dad tears up and grins. I start to tear up, too. They really do get me every time. But then I look away so I can keep it together.
While I deliver the placenta and inspect a small tear in Olive's vagina, I say, "Happy birthday, baby. Welcome to the world."
I load up my needle driver with a little 2-0 chromic, and just as I'm about to put the needle into Olive's flesh, my pager goes off. The nurse frees it from my waist and pushes the little green button, revealing a page from down the hall. I'm wanted in Room 301. I sew quickly, have my photo taken with Olive and the baby, and make my exit.
In Room 301, all the way at the very end of the labor floor, as far from the sound of happy screaming babies as possible, lies Eve. The charge nurse put her here as an act of compassion, to spare her from the joyful sounds of healthy childbirth, because Eve's birth will not be one of them. When I enter Room 301, I am struck by the unnatural silence. Labor rooms tend to be noisy, chaotic places, but in Room 301, no fetal heart monitor beeps the reassuring bleep-bleep-bleep of a healthy fetal heartbeat. No stereo plays power-pushing tunes or tinkly new age meditation music. The team of people who usually attend a birth are conspicuously absent. Even the grunts and cries emitted from a woman about to give birth are muted by Eve's heavily dosed epidural and a generous hand with the morphine, all aimed at making her as comfortable as possible for something painful on every level.
Eve was 35 weeks along when she wound up with flulike symptoms, which turned out to be caused by listeriosis, a bacterial infection that killed her almost full-term baby. Eve is now about to give birth to the baby she has already lost. When I first introduced myself to Eve earlier in the day, I sat on the edge of her bed, held her hand, and listened to her tell me about the garden mural she had painted on the nursery wall, the vintage christening dress she had found at an antique store, and the dreams for her future life with this baby that she will never experience.
Now the baby's head is right here, about to be born. I brace myself.
Eve pushes, and suddenly, I am holding a grey, lifeless shell of a baby. With silent reverence, the nurse takes the baby girl from my hands and wraps her gingerly in the hand-knit carnation pink blanket donated by the Ladies Auxiliary for women who have lost their babies. The nurse asks Eve whether she wants to hold her baby. Eve nods. We prop her up in bed, and the nurse hands her the baby she has named Amelia. Eve looks so alone with no family at her bedside. My pager is blessedly quiet for a change, so while the nurse finishes up the paperwork, I curl up next to Eve on the labor bed, with my arms around her and her baby. Eve falls asleep in my arms, still holding Amelia.
"Dr. Rankin to Room 315--stat!" I quietly extricate myself from Eve's embrace and leave the room.
In Room 315 a whole team of nurses are attending to Mallory. One holds the fetal monitor to her belly while another turns her first right, then left. Someone else is holding a fetal scalp electrode out to me, my signal to do the procedure that will let us more accurately monitor the baby's heartbeat, which is down in the sixties--half of what it should be. When I insert the scalp electrode, I tickle the baby's head, trying to stimulate the baby's heartbeat, but nothing happens. It stays in the sixties.
Mallory is only 8 centimeters dilated, so I can't grab a pair of forceps or ask her to push. Instead, I yell, "Open the back," my signal to get the operating room ready. Everyone springs to action. The whole time I'm scratching the baby's head with my finger and helping Mallory change positions in hopes that whatever might be compressing the baby's umbilical cord moves out of the way.
The heartbeat has been down for 4 minutes, but it feels like forever. Then, just as we are about to unplug Mallory from the fetal monitor and race her back to the operating room for a crash C-section, the baby's heart rate goes up. We all slow down and watch every beep of the monitor. I finally exhale. We're out of the woods, at least for now. I allow myself a moment of fatigue, the kind that washes over you like a wave and leaves you fantasizing about feather pillows and flannel bedsheets.
But there's no time for fantasies. I pull out Mallory's chart and start jotting notes, when the overhead pager goes off again. "Dr. Rankin to Room 307." Sometimes I seriously fantasize about disabling the damn overhead pager. And flushing my beeper down the toilet. And walking out of the hospital in my scrubs, ignoring all the demands and expectations. I imagine just walking and walking and maybe eventually winding up on a beach in California where I don't even own a phone.
But right now there's another baby to deliver. I run into Room 307; catch the pink, squealing baby; and hug the tearful, happy mother.
