As I sat down to reflect on my third year of medical school, I was once again unhinged by the feelings I thought I had suppressed only a few months prior. My monthly emergency medicine periodical had arrived, and I was looking forward to reading the unique case reports. It didn’t take me long to see this would be a more earnest edition; the topic was the familiar COVID-19.
I made it to the periodical’s more subjective pieces and was struck with a moment of stillness; maybe it was the impending rain outside. Two words from the page jumped out significantly: vulnerability and courage. These words have always had different meanings to me. Until recently, vulnerability meant weakness, allowing oneself to fall behind without a chance for recovery. Courage, on the other hand, had the opposite meaning: betting all my chips on prevailing at any cost.
These two words “vulnerability” and “courage” placed closely together reminded me of a particular patient I encountered not too long ago. Until that moment, I had not realized that she remained quietly in the shadows of my mind, watching to see if I would be vulnerable for my future patients. As the clouds darkened outside my dining room window, I began to relive this patient experience.
It was a night in early January, during my obstetrics and gynecology rotation. One of the weeks I spent there was a night call on labor and delivery. In retrospect, this was my favorite week of medical school besides being in the emergency room. The residents were cheerful, despite our lack of sleep. The nurses seemed to always be well-rested, maybe their secret brand of coffee. and even the patients, despite me being unable to understand what they were going through, made me feel as if I was doing them a rewarding service. My first night went well, three successful deliveries. It was the third night shift that upended everything I thought I knew and worked for.
I will never know her name because she never had one. The only history I was given from my resident was: “This mother is in labor, any minute now. She came to her first prenatal appointment with us last week. She lives miles away in a very rural town and had little access to care. Maybe you should just wait for the next delivery.”
I could not just give away a good learning opportunity. I had spent the previous week on day shift labor and delivery, so I was feeling more comfortable around childbirth. I was even beginning to enjoy the adrenaline of donning personal protective equipment and preparing for this “challenge.” Handing a baby over to mom is undeniably worth all of the time spent to get to this point. So, for this delivery, I did all the normal actions to prepare: shoe covers, gloves and gown. What I did not have was a contingency plan in case I experienced a personal emergency.
As we approached the room, my resident said, “prepare yourself.” She knew the seriousness of the situation long before but there was no time to explain. We walked in and the family was already crying. This was a natural reaction I had witnessed among other families during childbirth, but the air felt heavier than normal. Most rooms I previously entered had a board of patient demographics and the baby’s name. Some rooms even were scattered with beautiful flowers and balloons to celebrate the upcoming joy. This room had nothing besides mom’s name on the board. There was no indication of excitement centered around a newborn. While everyone sat quietly, I delivered a baby girl, at term, whose blood had stopped circulating long before we met.
I had never seen a family weep this severely, and I wanted to weep for them. Internally, I did, long enough to finish all stages of birth. I remember, as the resident and I delivered her, it seemed as if the air was sucked out of the room and the temperature rose drastically. I did not hear a cry as her head passed the perineum, nor did I feel the usual active movements of body tone.
What I saw was a lifeless, innocent face with blistered and discolored skin. We made eye contact for a brief moment; she looked perfect and still and had no way of knowing what occurred. The neonatal team stood ready for transfer to the warmer and quickly wrapped her in blankets and a homemade knitted hat. As I stayed to deliver the placenta. I heartbreakingly witnessed the family break down in tears at the sight of this baby girl. I stayed in the room for a brief period to console them, and then quickly excused myself so the family could have their time alone.
After I left the room, I was at loss as to what to do next. I sat and took the time to recover my thoughts. I knew the family would be assisted to a different unit with more privacy. I went back one last time to be a body of presence and hugged each of them. I honestly didn’t know what to say, which may have been for the best because they didn’t say anything either. Some moments in life speak for themselves.
For some time afterward, I was not quite sure what the lesson behind this experience would be. “Why should I make a lesson out of an innocent life lost,” I thought to myself. I am still seeking those answers. This morning, sitting in my dining room, those feelings re-emerged. I don’t know if this nameless infant walks the hospital halls at night, visits her family to support them or even holds my hand and guides me to ensure that I continue the right path. All I can say is that I felt an overly visceral reaction to those two words on the page: vulnerability and courage.
I cannot for one second say I was prepared for that situation, and I admit I could never be prepared for a moment like that again even if I was pre-briefed. What I can say is that it was those same two words, vulnerability and courage, that allowed me to share this experience and will allow me to continue to fight for my patients. In desperate times, families need us. They look to us for courage even when we are just as broken on the inside as they are. In that context, we must remain vulnerable for them. We are equally as human as the patients we treat.
As COVID-19 is the word on everyone’s mind, I hope sharing my experience of vulnerability can help others as we continue to face these daily challenges. In truth, the future will never be certain. As I prepare for my return to the clinical setting, my nameless hero stands with me. She will be there in good times and in bad. She will always have the same gentle, innocent demeanor and will carry this message: stay vulnerable, even when scared of the future and maintain courage in the face of adversity.