“The baby’s out,” shouts one of the labor & delivery residents as her hands firmly grab and pull the baby’s shoulders with the mother’s final push. A nurse holding the mother’s leg during the delivery walks over to the pediatric team and whispers, “cleft lip,” as if the baby had committed a crime. Instantly, we fall silent.
Once the baby girl is placed onto the nursery crib, everyone huddles to assess the damage. A full term baby cries fiercely, showing two ridges in her upper lip.
“She is adorable!” I thought. I fixate on this cute little adventurer who just endured an amazing journey, head full of dark hair, legs and arms waving, little pink cheeks glowing under the heat lamp, and I feel a knot in my stomach and become teary-eyed.
Despite knowing that this baby will undoubtedly receive reconstruction surgeries with high success rate, I couldn’t help but wonder: Will she have a scar? Will the children at her school make fun of her for the “imperfection?” I fancy that maybe, inspired by her own experience, she will grow up with a kind heart and a grand desire to help others.
I glance at the mother, who senses that something is wrong, exchanges worried looks with her husband and anxiously glances over at the crib. Not sure how to muster words, I try to give her a reassuring smile.
Should I congratulate her? Simple gestures have all become questionable in this delicate situation.
2,165 grams, full term baby, APGARs 9 and 9, no evidence of acute distress. After a thorough examination looking for potential neural tube defects or other craniofacial anomalies that are commonly associated with a cleft lip, the NICU team announces that the baby only has a cleft lip, but she is going to NICU for further evaluation.
Despite this healthy baby having only one visible defect, caution and melancholy permeate the tense atmosphere as everyone huddles around the crib and whispers to each other, looking for other imperfections. “The mother does not know. Do you want to tell her?” the nurse asks the NICU team.
Again, we fall silent.
Seeing the hesitation, one of the labor & delivery residents walks over to the mother and informs her that her baby has cleft lip. I cannot decipher the mother’s facial expression at that moment, but as the NICU fellow explains and reassures the parents, they become more relaxed and fully immersed in the new member of their family. Their excitement and smiles make me suddenly realize how beautiful this moment is. The heaviness in my chest and tears in my eyes disappear. The room is filled with cheerful remarks as people congratulate them.
As health care providers, our instinct is to diagnose medical problems and alleviate people’s suffering. We assume the worst and look for any abnormalities in order to avert medical disasters: that patients will develop adverse reactions to medications we prescribe, are dissatisfied regarding treatment or lack of symptomatic relief, or worse, decompensate and code on our watch. We are so hyper-vigilant that we forget to stop for a moment and enjoy a beautiful miracle of life, even in the face of “imperfection.”