When you begin clinical rotations in medical school, people encourage you to be as involved as possible in patient care. They tell you to take initiative, to challenge yourself. They also tell you that there will be times when it is most appropriate to stand back and observe. It is in some of these moments that the most valuable lessons are learned.
You are in your second rotation — obstetrics and gynecology. You walk into the resident’s room as you do every morning before meeting with the attendings. As the team discusses the patients on the service, the nurse calls regarding one of them. You head to the patient’s room with the attending and the resident on call. On the way, the resident explains that this patient came in overnight because of bleeding, with workup indicating intrauterine fetal demise.
You walk into the patient’s room. This is not the same as the countless other times you have walked into the rooms on this floor. There are no feelings of nervousness and excitement, there are no carefully pre-packed hospital bags and decorations. The sadness in the air feels almost palpable as you see a young woman your age experiencing what may be the worst day of her life. You had not even learned about cervical entrapment before this moment.
It feels impossible to process what you are witnessing. You see this tiny, perfect baby in the process of being delivered breech. You can count its fingers and toes. You observe as the attending assesses the patient and tries to explain that she is not yet dilated enough for the baby’s head to pass. You notice her partner, teary-eyed, holding her hand. This patient is well into her second trimester; you wonder if she followed the general rule of thumb to wait to tell others until after the first trimester, when it is “safer” to announce a pregnancy. You wonder if she had a gender reveal celebration or if she had the baby’s name picked out.
Does anyone else notice when the resident looks at you and mouths, “You okay?” Does anyone notice when the attending lowers her voice to speak in your direction, asking about another way to phrase the medical explanations in Spanish because the patient is not processing her words? Is anyone else noticing the young boy, presumably the patient’s brother, sleeping on the couch in the corner of the room? You think about how the patient’s mother must have been woken up in the middle of the night and had no time to arrange child care, meaning she had to bring the patient’s little brother with her to the hospital in order to be physically and emotionally present for her daughter. You wonder if he will remember this day when he gets older.
The team leaves to give the patient a moment of space after administering the medication to increase dilation for the delivery to complete. You notice the white wreath on the patient’s door, a signal to staff to avoid unnecessarily going into their room due to the circumstances. You wonder if any other patients have noticed the white wreath and have presumed what it signifies. Or have they walked past it, blissfully unaware?
In this moment, the resident again checks in on you. She tells you that she feels no one ever checks in on the medical students, not realizing that it may be their first time experiencing moments like these. She tells you to feel free to go into the residents’ room for as long as you need if you ever need time to yourself. Before you know it, the nurse calls the team to head back.
Back in the room, it is eerily quiet. There are no more cries for help to finish the delivery as quickly as possible. All you hear are silent sniffles as the patient and her family hold back tears. The resident shows you the placenta and begins to explain to the patient that it appears she had a placental abruption, going into detail about what that means. After a few moments of silence, the resident asks the patient if she knows why she is explaining this to her. She tells the patient, “This is not your fault. There is nothing you did to cause this.” Those few words, as simple as they may seem, hold so much weight. This is when you learn that those were the questions the patient was asking when she was being evaluated at the labor and delivery triage in the middle of the night.
You notice the resident’s eyes begin to well with tears as she continues to reassure the patient that there was nothing she could have done to prevent this. You step out together and both begin to cry, finally accepting all that you have just witnessed. She suggests retreating to the residents’ room and you follow behind her.
You enter the room and see the intern you worked with last week, her very first week of residency. Her back towards you, she hears the door open and begins to ask a question about the EMR before she turns and notices you and the resident are both teary-eyed. She is one of your favorite interns you have worked with. You remember just last week when you were in a delivery with her — the nurse needed to grab something, so you took over counting to ten in Spanish as the patient pushed. Did the patient then notice the intern, who only speaks English, doing her best to count in Spanish with you?
Once you collect yourselves, you exit the residents’ room. As you walk out, the resident greets one of the attendings you have met previously with a smile. You wonder if the attending heard about the patient that you just spent the morning with. You follow the resident and think about how no one around you knows the sadness you just witnessed. They don’t notice that the resident was able to give her all to that patient and yet moves forward to continue helping others. You wonder if anyone even notices she is here past when she was supposed to get off shift. Have her patients noticed she has stayed with them through their entire labor, made possible by her moving her work schedule to see them through their deliveries without violating her maximum work hours?
You go home that day and begin crying when your mom asks you how your day was.
A few months later, you are back at that same hospital. Now, you are in your surgery rotation, and you are rotating through your cardiothoracic surgery elective. The resident you are working with tells you to wait outside the doctors’ lounge for a minute as she quickly grabs a coffee. As she walks into the lounge, the OB/GYN intern walks out. You make eye contact, and she recognizes you as the medical student who was with her those very first few weeks of her internship. You think of how when you first met her, you were offering to show her the way to the pre-operative area on her very first day of internship. You think of how much more comfortable she must be now.
As you catch up, the resident you had seen the stillbirth with passes by and begins talking to the intern. Seeing them both makes you remember that day and all the moments that came with it. Anyone walking past these three people in surgical scrubs would never notice how much it means to you to see these two doctors again and how you still wonder every now and then how that patient is doing. And just like that, as quickly as it began it was over — another moment that goes unnoticed.
Image credit: “heavens” (CC BY-NC-ND 2.0) by andrealeev
Contributing Writer
Florida International University Herbert Wertheim College of Medicine
Melanie is a third year medical student at Florida International University Herbert Wertheim College of Medicine in Miami, Florida, Class of 2025. In 2020, she graduated from the University of Central Florida with a Bachelor of Science in biomedical sciences with a minor in psychology. She enjoys making new recipes, pilates, and spending time with her husband and their dog in her free time. After graduating medical school, Melanie would like to pursue a career in oncology.