Joe Andrie ~
It's another day for me as an intern on the labor-and-delivery floor of my large urban hospital--another day scrambling to help pregnant women deliver and trying to keep pace with the unpredictable timetable of the birthing process.
My hospital phone rings. I'm really starting to dread that sound.
It's the triage nurse. We're admitting a patient: Mrs. Harris, age thirty-four, who's had several prior deliveries and therefore carries the label "multiparous," or just "multip."
Flipping through her records, I see "G5P4" noted. "G" means the number of pregnancies; "P" indicates how many children she has.
A mother of four who's at term and having contractions...I've seen such women give birth within a matter of minutes. In plain language, Mrs. Harris's chart means "HURRY!"
I arrive in triage to find Mrs. Harris and her husband huddled in the small examining room. She reclines uneasily on the stretcher, hands clasped calmly over her hugely distended stomach. A silk scarf swathes her head, and various tattoos hug the contours of her arms. I'm intrigued by the contrast between her smooth silk scarf and her jagged, dramatic body art.
Her gaze is focused inward, but her face radiates the intensity of a woman on a mission. Mentally revisiting her chart, I reflect that she's raising four children--a teenager, a toddler and two in elementary school--in an environment that's stacked against her family. As her body language makes clear, she means business.
Our eyes meet, and I can practically see the thought-bubble above her head: Well…that doctor looks young, and I've done this four times. He better know what he's doing.
I check the fetal heart monitor. Its tracings reassure me that the baby is doing well. On vaginal exam I find that her cervix is dilated to four centimeters, almost halfway to complete dilation.
This baby will be here soon, I think.
"Mrs. Harris, everything on the monitor looks very reassuring, and your contractions are coming quite close together, which is a good indication that you'll give birth soon," I say.
Mrs. Harris breaks her focus long enough to mutter, "Okay, I hope so."
Her husband glances at me, then at the door behind me, as if hoping that someone with at least one grey hair will walk in and confirm my assessment.
"I think you're getting very close to meeting your baby," I say, with a rookie's excitement.
"It would seem that way," replies Mrs. Harris. She resumes her inward focus.
"Okay," I say finally. "Let's head to the labor-and-delivery suite."
As if on cue, nurses enter and start prepping the gurney. Soon Mrs. Harris is wheeled from the room, her husband following close behind.
"I'll see you soon," I say as they pass me.
Quickly, I complete Mrs. Harris's admission orders and discuss her with my attending physician, who tells me to monitor her closely, as the baby will likely arrive within the hour.
Thirty minutes later, a nurse calls me.
"Can you come look at this tracing? There are some decelerations."
Sure enough, the fetal heart rate has slowed markedly--a sign of distress--and refuses to climb back up. For the first time, Mrs. Harris looks worried.
I give directions: "Apply face mask...Start oxygen."
A look of uncertainty appears on Mr. Harris's face: The nurses have already done these things. When my attending physician walks in, Mr. Harris looks relieved.
We have Mrs. Harris move to her hands and knees, maximizing the blood flow to her baby. Its heart rate rises. Crisis averted, but we need to keep a close eye on things.
For the next four hours, our team battles to beat back the dips and sags in the baby's heart rate. At each cervical check, Mrs. Harris shows slow progress, but nothing dramatic. This is surprising in a woman with four prior deliveries. It doesn't fit the expected template—-which, in medicine, means that something must be wrong.
I'm feeling pretty anxious, but I try not to show it. The last thing I want is to make Mrs. Harris lose what little confidence she has in my abilities.
On the bright side, the delivery's slow pace gives me a chance to go beyond my first superficial observations and try to get to know her better as a person.
Entering the room for another assessment, I find her alone, her husband having left to grab some refreshments.
"Are your other children excited for a new sibling?" I ask.
"Yes, they can't wait to have another brother to play basketball with," she says, sounding surprisingly jovial.
"Are there many areas where they can play near your house?"
"Now there are. Where we lived before, not really."
"Where was that?"
She mentions a neighborhood I've heard of--mainly on the nightly news--but have never visited. Her expression turns serious.
"I started off my life with the wrong group of people; my husband did, too," she says, her words coming as if from a great distance. "It's difficult to get away, when every part of your life seems to include them. But we did get away, for the most part...Now I worry for my children."
Surprised by this deeper turn to our conversation, I pause. Before I can speak, another contraction arrives, and we return to the present challenge. I see her summoning the determination and intensity that have made her a survivor, and using them to guide her baby out of her body and into the world.
During a pause between contractions, she takes a deep breath. As if addressing a roomful of skeptics, she declares, "I've done a lot wrong with my life--but if I do one thing right, I'm gonna be the best mother for my children."
Unwittingly, she reminds me of something that I'd almost forgotten: Vital signs and data points only tell you so much about a patient.
For Mrs. Harris, I realize, her G5P4 status is what gives her life meaning. Every "G" is a building block; every "P" is a crowning achievement.
I imagine that my own mother, who for exactly twenty-six years has viewed herself first and foremost as a devoted mother, feels the same.
It's been nearly twelve hours, and emotions are running high--but so is adrenaline, as we near the climactic moment.
Finally it arrives: Mrs. Harris is completely dilated and ready to push. Despite a grueling, tumultuous labor, she delivers a beautiful, healthy baby boy.
I'm thrilled. A thought emerges:
It's a great day to have a birthday....
And, as it happens, today is my birthday, too.
About the author:
Joe Andrie is completing his residency in family medicine at UPMC St. Margaret Hospital in Pittsburgh. This is his first publication, although writing has been a hobby since medical school. "In medicine, we deal with challenging and emotional situations every day, for better or for worse. Writing allows me to reflect on these scenarios and to process the lessons learned from each patient I see. It also helps me not to lose sight of the reason I initially found family medicine so fascinating: the people and their stories." When not working, Joe spends his time enjoying the beautiful Pennsylvania outdoors, whether hiking, bike riding, swimming or kayaking.