The Fight Inside

Every good book needs a hook, right?  You know, that short story or scene that draws you in and makes you unable to put the book down.  The same is true for blogs.  Consider this entry that post.  While the names have been changed, this story is true.  It begins in my residency…

I was on call for obstetrics.  After a long day of welcoming babies to planet earth, I finally was getting a rest.  I retreated to the call room to get some sleep.  The call room was basically a closet with a cheap discarded hospital bed and a phone. Despite this, when it’s 2 in the morning and you’re beat, the mattress feels like a Beautyrest welcoming you into it’s comforting embrace.  I settled in and drifted away.

BEEP!  BEEP!  BEEP!  My pager… letting me know the sandman had been scared away.  I checked the number and knew it all too well… the ER.  I fought obscenities as I dialed the number.  Dr. Scott picked up and quickly filled me in.  A pregnant woman had come in for abdominal pain and he wanted me to check it out.  I hung up, grabbed my white coat, took a swig of the Monster energy drink and was on my way.

She was in room 4 and judging by the screams, she was in pain.  I did a quick assessment and called my preceptor, Dr Peters.  I quickly filled him in with the fast no-nonsense medicalspeak, “This is a 32 year old G12P9 female at 25 weeks here with abdominal pain.  Labs show an anemia and she is having vaginal bleeding.  Ultrasound shows a placenta previa. She’s likely having an abruption.”  Translation: this young woman was on her 12th pregnancy and had delivered 9 babies.  This pregnancy was at about 5 months.  The placenta which nourishes the baby was connected to the uterus over the cervix and was starting to come up off the inside of the uterus causing bleeding.  He advised me to admit her and check on her through the night. Good plan, I thought, maybe I’ll get some rest.

I started writing orders and was interrupted by the nurse running out of her room yelling for a crash cart.  Her blood pressure had dropped and she needed resuscitation.  She was revived and a repeat bedside ultrasound now showed that there was blood collecting in her abdomen.  I again called my preceptor who immediately said to prepare an OR and he would meet me there.

Not more than 10 minutes later, Dr. Peters slid the razor sharp scalpel across the patient’s lower abdomen to gain access to the abdominal cavity.  We were met with blood.  The anesthesiologist was pouring in O neg and fluids to keep her stable while we started the process of finding where the bleeding was.  The uterus had burst open and 3 quick clamps over the arteries stopped the bleeding. We both had suction removing blood and were reaching in to remove clots that had formed.  Dr. Peters was on her right side and was reaching in with his arm all the way up to his elbow to remove blood from around the liver when he shot me a wide eyed look.  I saw it in his eyes, something was wrong, and just as quickly he said it, “You’re not going to believe this.”

I looked down and followed his arm as he slowly removed it revealing a tiny leg the size of a GI Joe’s attached to a 5 month old fetus.  He removed the baby and quickly handed it off to a waiting anesthesiologist who started CPR.  We finished removing the blood and completed the operation.

The baby didn’t make it.  The woman got an involuntary hysterectomy after we tried to repair the break in the uterus unsuccessfully.  Of the previous 9 deliveries, 6 were C-sections and those surgeries had healed over and over making the front of the uterus paper thin.  This caused the current pregnancy to break open after only 25 weeks and made it impossible to stitch back together.  The uterus had to be removed.  She recovered well and returned to her normal health.

I didn’t sleep that night.  Not because it continued to be busy; things actually quieted down.  I was trying to reconcile the feeling of sadness for the baby with my duty to calmly complete the operation.  The internal struggle ensued but eventually I suppressed the sadness and continued working.

Perhaps we all fight this.  We fight against something that is an integral part of who we are or what we do that challenges us to question why we should go on.  Do we continue and compartmentalize or live in the moment and allow the emotions to affect our behavior and performance?  I chose to compartmentalize and now I regret it.  It allowed me to work without feelings, which translated to success, but it spilled over into my relationships and personal life.  I was unable to enjoy my son’s first birthday party as much as I feel I should have.  I had to work to recover from it.

I’m still not there. I still suppress feelings so I can be objective and make the best decision.  But I’m getting better.  You can too.  It starts by allowing yourself to cry.  Allowing yourself to laugh.  This opens the world to your emotions and opens you to the scary world of vulnerability.  But it’s worth it!  Start with family.  Cry with your brother over his divorce.  Play tag with your kids and just laugh when they inevitably tackle you.  Weep with your wife over her miscarriage.  Let your heart feel the warmth of a hug or embrace.

I invite you on this journey towards discovering emotions and enjoying life.  I invite you to cry with me!  Laugh with me!  I invite you to live.

7 thoughts on “The Fight Inside”

  1. Thankfully many residencies and hospitals are now conducting debriefings and optional continuing counseling for situations like this. I remember sitting in the physicians’ office of an Emergency Department of a large hospital and crying with one of the other physicians. We both attempted resuscitation of a 12 y/o boy who had a seizure while taking a bath, resulting in his drowning. Physicians will regularly go from a procedure room where something like this happens and have to continuing seeing the patient who is waiting in the next room with a different medical complaint. We don’t tell them what we just came from. We just give them our full attention as if their case of pink eye or ear infection is the most important thing occupying our attention. That is the job of a physician.

  2. Thank goodness there is support to help process these moments. Reading this, I recalled memories of a miscarriage, and how I didn’t understand how there was nothing more medically we could do to save my baby’s life. Like when you found the GI Joe sized baby’s legs, that unspoken moment you knew what it meant. For me, I was struggling to survive living beyond knowing I was going home empty-handed, and even though I could hear what was happening my heart’s mind did not understand drowned out by grief. This was 2004. My heart has never been the same. I have known the joy of becoming a mother and bringing home my beloved son.

    1. Thank you for your comment. I understand completely what you have gone through. I have experienced the heartache of a miscarriage as well as the joy of having a child. I have three children now and feel that only with my youngest was I completely awash in the joy of a new child. I now allow myself to cry in those moments. I hope you too have had so much joy it floods your eyes with tears.

  3. Thank you for writing so openly and honestly about this situation, and the emotions that doctors experience during things like this. I’m looking forward to reading much more of your blog!

  4. I’m very grateful to you for allowing us lay people to see, or be reminded of, the fact that you often have decisions to make – sometimes heart-wrenching ones – that often produce feelings which you have to deal with and, too often, without the benefit of time to process them before you have to see your next patient, or go home to your family at the end of your day.

    1. Thanks for the comment Adrian. It can be an emotional rollercoaster but the relationships I have and fulfillment I get from knowing I am helping make it all worth it.

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