Play the character. Be the character. This is what we learned in school. We are told to enter with a knock, make eye contact, and establish rapport. We learned that physicians sit a certain way, they speak in a certain way, they are a certain way. We are given tools to imitate their behavior, in hopes that we ourselves will one day embody that behavior. Mechanical checkboxes on the standardized exam with standardized patients. Cannot forget a single step. But life is not standardized, is it?
Bright-eyed and new on the labor and delivery floor, my oversized crisp white coat hung off my body like a cape. So far, my second day is turning out better than my first. The first day was a whirlwind of being pulled into seeing my first vaginal delivery with a room full of happy excited family members and later seeing how skillfully the surgeon closed up the uterus so quickly after a goop-covered baby had emerged just a few moments earlier. It was exciting but passive. “See one, do one,” my attending told me with a wink. That’s what I did.
But today it was time for me to emerge from behind the scenes and take on a role. So, I take a deep breath outside the patient room, ready to get into character. I rehearse what I’m about to say. I am going to start by introducing myself. Congratulate the soon-to-be new mom and ask her about her labor. I’m going to be the calming presence in the room. How? I’m not sure yet. I just know that that is what a real physician would do. I recall my days as a singer. The excitement and the anxiety of going on stage. Knowing that all eyes would be on me. It’s the same feeling I feel now.
Three sharp knocks on the door. Let the patient know you’re about the enter the scene. I smile and introduce myself. “Hi, I’m the medical student working with your doctor today.” No response. I take a slow shaky breath, unsure what to do next. The patient is sitting with her face in her hands, resting her elbows on her swollen belly. Nobody else is in the room. This is unlike any other labor and delivery room I’ve entered before, which is normally filled with balloons, flowers, and a nervous but excited partner.
“She’s coming too early,” the patient squeaks. “It wasn’t part of the plan.” I take measured slow steps across the room to her, “What do you mean?” I ask softly. “My family is across the country. They were going to come next week. My husband is overseas, he’s taking an emergency flight now,” she says with sadness overwhelming her voice.
I found myself confused about what to say next. “I’m sorry to hear nobody is here with you,” I said while offering the most reassuring smile I could from behind my mask. I put my clipboard down on the overbed table, next to her phone and her purse. I found my hand had then reached over and placed itself on her shoulder. “Can I do anything to make you more comfortable? Or would you like me to contact your family?” I ask. She slowly removes her face from her hands and looks up at me. My leg pulls the small rolling stool towards me, as I place myself down on it bringing the patient’s eye level to mine.
“Thank you, could I just get some water? I just hope my husband gets here on time. This is my first, and I don’t want to do this alone,” she explains. “I understand, but I’m here for you if you need anything while you’re here,” I say while patting her arm. It worked. The patient slowly lifted her head and gave me a small smile. “Let me get you that water,” I respond, energized by this small victory. A quick stroll down the hallway and back, as I return with her water. “Now,” I start, after handing her the water and another reassuring pat on the shoulder, “tell me about when your contractions started.”
The rest of the chat was standard. She was 37 weeks along. Labor started a few hours ago and had not yet had a rupture of her membranes. Started at 8 minutes apart and were now occurring every 5 minutes. As I exit the room, I let out a sigh. Scene. I suppose I was convincing? I belong. Or do I?
Time to plan. I return to my attending and fill her in on what I had learned. “Great, she’s your patient. So follow along with her progress,” my attending tells me. Every hour I would go in and check on her, each time making small conversation about her baby, her family, her husband and bringing her more ice chips. Slowly but surely, the character I was putting up front of me was starting to flicker like an old lightbulb. Before I knew it, only a few hours later, it was time.
I run down the hallway on the heels of my attending, as the nurses pushed the cart into the room loaded up with everything we could need in there. The scene is chaotic. A nurse is crouched next to her saying “Alright mama time to push,” in a loud but determined voice. Meanwhile, I follow my attending’s lead and gown up. It’s time for the finale.
I smile at the patient as I ready myself at her feet. “You’re doing great,” I say as she begins to push again. My attending steps to the side and says, “All alright bring your hands here where mine are.” I follow her instructions and bring myself to center stage. I feel the searing heat on my back as everyone watches me. I steady my hands around the baby’s shoulder as she makes her way out. She’s here. Every inch of her covered in slippery fluids. The overwhelming feeling of beautiful new life fills me, and a tear escapes my eye. I am the first one to ever hold her, but she will never know. Am I still the character I was playing? Or am I just me?