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First Day

After our first week on clinical rotations, my third-year medical student colleagues laughed about the silly and awkward things that made their first days hard. Someone was shunned for bumping into the sterile field during their first operation. Someone else couldn’t figure out the scrub machines and was stuck mismatching for the day. I knew I could easily win the hard first day contest, but my stories did not fit in with their light-hearted anecdotes. We all got hit by a little real-world whiplash, trying to put everything we studied for two years into practice, but I still hadn’t quite made sense of what felt like the lifetime I lived on my first shift.

The night started with the day team presenting the patients to the night team. Different women were in labor, one dilated to four centimeters, one to eight and another waiting on a C-section. I frantically tried to take notes but to no avail; my head spun with all the Gs and Ps. One of the patients in labor had oligohydramnios and no fetal kidneys detected on ultrasound. The presenting resident said, “suspected Potter syndrome,” and my mind jumped to my first year of medical school. There was a picture in the textbook of a little baby with twisted legs and flattened facial features from growing cramped in a sac without fluid. The condition is incompatible with life. I had cried just reading about it years before. 

The attending quizzed us on the condition. What caused these babies to die? Lung hypoplasia. Why? Amniotic fluid is crucial for lung development, so without it, the lungs cannot develop properly. The fetal kidneys make most of the amniotic fluid in the second and third trimesters, so without kidneys, that process does not happen. Chance of survival? The residents all looked at each other. Zero. I was proud that I answered all the questions correctly, but somewhere down the hall, a mom was in labor with a baby that could not live. Her tragedy was our learning point for the evening. We continued systematically through the patient information. Then, we moved on to the next patient.

The first delivery that night was a C section — the third baby for a happy mom and dad. The resident tolerated my questions and explained the procedure. She let me suction blood and amniotic fluid and let me pass her tools. The surgery went as planned. The baby came out wrinkled and slimy, just as babies should be. They handed me the suction and instructed me to clear the airways. I was too gentle, so the nurse took my job. Back to the open abdomen, the resident started massaging the uterus and suturing it closed. I heard humming and looked over to see a beaming dad, singing lullabies to his baby in the middle of the operating room. It made me smile. Then, the resident shoved the uterus back into the patient’s pelvis; it was time to close the fascia. All of a sudden, it felt like a thousand degrees. I was hot and cold and sweaty. I felt nauseous and somehow could not get enough air. The resident told me I looked pale, and the attending kindly suggested I step out. Out I went, and suddenly my symptoms vanished except the lingering embarrassment. Afterwards, the resident joined me in the workroom for a midnight snack. She asked how I was doing, and I reported my rapid recovery. She told me the same thing happened to her in her first C-section and that I could still be a doctor. I breathed a little more easily. 

Next thing we knew, the delivery bell started to ring. The resident ran out, and I jumped after her trying to remember which of the women from the presentations that evening was the furthest along. Was this the baby with Potter syndrome? I entered the room and saw a baby with flattened facial features and twisted little legs, lying motionless on the bed still in the amniotic sac. The mom stared at us with a frightened look. She did not know what to do. I surely did not either. The nurse swept up the baby to clean him off, and the attending gave me instructions on placenta delivery: “Hold pressure on the cord, not too much, not too little. Then a gush of blood and out it comes. Twist the membranes and into the bucket just like the simulations. 

The nurse brought the baby back and handed him to the mom. She held him and smiled at his little, still face. The grandmother held the new mom, and they studied his features. I wondered if they noticed the signs of Potter syndrome that I memorized from the textbook. They did not sob, at least not while I watched. They just smiled and cuddled each other, with tears tracing their cheeks, soaking in the time they had with his tiny body. I walked back to the workroom, expecting the chief resident or attending to say something about it or for the residents to check on each other, but they went back to work as they normally would. It did not feel normal to me. A mom just lost her baby. 

Next came a call from the emergency department (ED). The chief resident sent me to find an ultrasound machine, but I ended up getting lost, wandering through the ED in the middle of the night with patients lining the halls and crying in pain. Night shift skeleton crew meant that there were not many people to ask for help. I felt out of place and a little unnerved. Eventually, I found the residents. The patient was 11-weeks pregnant and presenting with bleeding and cramping. The ultrasound and pelvic exam confirmed that she was having a miscarriage. The resident prodded the woman’s cervix with a cotton swab to pull away the clots and placed them into a specimen jar to send to the lab. The resident then explained to the woman that she lost the pregnancy. The patient tried to hold back tears, but she could not. Covid-19 precautions meant that she was alone in the ER. She was bleeding, cramping and losing her baby, all alone. I watched this happen and remembered reading that one in five women experience a miscarriage. One in five women experience this? 

For the rest of the night, I pushed ultrasound machines between patient rooms, mostly lost. The chief let me go at 7 a.m., and I drove home in a fog against the morning rush. I crumpled into sobs after parking my car. I wept and grieved the tiny baby that never took a breath, for his mother who carried him, birthed him and loved him. I cried for the woman who laid alone in pain in a busy emergency room, only to find out that she had lost her pregnancy. I cried over the silly things, too. I cried that I did not make it through my first C-section and had not even managed to get the ultrasound machines to the right places. I thought of the happy deliveries, and I remembered the father singing in the operating room. How strange that all of those things could happen in one place in one night. 

A year later, now a seasoned veteran, that first shift in the middle of the night on my obstetrics and gynecology service still feels sacred to me. The night was hard and traumatic, but somehow there was so much beauty. The image of a mom embracing her stillborn son is frozen in my memory. I still do not quite know what to make of it or the hundreds of similar moments I have seen since then or the thousands more I expect to have in this profession. I am sorry for the suffering endured by the people I met that night, but I am grateful for the privilege to share that space with them. The tiny baby boy taught me that my patients are not just the things I memorized, but real people with real hurt. I am glad he gave me that on my very first day. It is a burden and a gift to stand with people in their pain, to listen to their concerns and to encourage their fight. There are tears and purpose, exhaustion and fulfillment, death and life. These seemingly exclusive things that I never thought could exist together in the same space ultimately do, and they do so frequently. As I continue to be privy to these intricate moments, medicine has taught me how sacred it is to be able to remember them all.

Elisa Williams Elisa Williams (2 Posts)

Contributing Writer

McGovern Medical School

Elisa is a fourth-year medical student graduating in 2023. In 2019, she graduated from the University of Texas at Austin with a Bachelor of Science and Arts in biochemistry. She is also pursuing a masters in public health. She enjoys playing soccer, jogging, and being with family in her free time. After graduating medical school, Elisa would like to pursue a career in pediatrics.