The Other Side of the Operating Table

Here's another article I wrote for a medical conference about a year ago. A medical student's up-close perspective on his daughter's birth. Enjoy...

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It's 11 pm on a weeknight and I'm in scrubbs. I'm taking my last call night for the OB-GYN rotation, and I'm hanging out on the Labor and Delivery floor at the University Medical Center waiting for some action. The patient I've been following had her water break before she got to the hospital. Now she has a fever. The OB on call is worried about chorioamnionitis (infection of the placenta), and the baby has had some heart-rate decelerations during the mother's contractions, so it looks like we're headed for a C-section. Within the hour, I find myself scrubbing in. This is the 5th C-section I've been a part of, so I'm used to the routine. Before I begin to scrub in, the patient is given spinal medication for anesthesia. She has to sit up on the table and bend over, arching her back for 20 to 30 minutes while the anesthesia resident tries to find the right spot to put in the needle. It looks mighty uncomfortable - she's been having contractions the whole time. Time passes and we're finally ready. Just before we begin, her husband comes in and sits next to her behind the surgical curtain on the anesthesiologist's side, so he isn't able to see the surgery. He is very conspicuous, with his white "husband/dad" gown over his clothes, while all the medical staff wear blue.

The first incision is made. I'm right there in the surgical field, along with the senior OB resident and attending physician. Even though this is my 5th time in a C-section in the last few weeks, it's still fascinating. Everything goes pretty quickly. We move through skin, fascia, muscle and fat layers, making use of the cauterizer to stop bleeding as we go. I say "we", but really all I'm doing is holding a retractor occasionally to pull skin and fat down for the doctors as they dig deeper. Finally we're in the peritoneal cavity, and I see them moving aside the colon, I think I see spleen, a little bit of liver, and of course, the big thing in the middle is the uterus. Thin cut on the uterus… sploosh - here comes the rest of the amniotic fluid and there's the baby's head! Out comes the baby, head first, then shoulders, then the rest. Nice loud cry, baby slightly bluish but mostly pink skin, moving around nicely - looks like an Apgar score of 9 (anything over 7 is good). The resident holds up the newborn daughter for mom and dad to see for a few seconds… then the baby is whisked through a window and taken care of by the NICU transition team. Baby's out of sight now. In a routine manner, the uterus is whipped out of the body cavity, sewn up tightly, then put back inside. Soon the attending gives me what I asked for before the surgery - practice suturing on the abdominal muscles, which is relatively easy for a first-timer. This is my very first suturing job, and it's something I have to do to get "signed off" if I want to pass my OB-GYN rotation. Of course, now everything slows down. It's so much harder to suture on a live person than when I practiced with string at home! After several failed attempts to make a surgeon's knot, I just tie a regular one, and then things get faster. During those few seconds when I was fumbling, I had just a few fleeting thoughts about what the husband must be thinking. Even though he couldn't see, I'm sure he could hear the attending physician’s words "you can do it - it's just like tying your shoe" and "there, you got it… oh almost". I didn't dwell on this, though. Finally, the attending leaves me and the resident to staple the skin incision closed. After a few minutes of clean up, the patient is pushed out and down the hall, holding her baby for the first time - a touching moment.

It's 4 months later now. It's 5 am, and once again I'm at the University Medical Center on the Labor and Delivery unit. This time, I'm not in my scrubbs - I'm in shorts and a T-shirt, and my wife has been in labor for 17 hours. For the last 3 hours, she hasn't progressed past 6 cm of cervical dilation. Our OB physician comes in and very compassionately explains to us that she really feels we need to do… that's right - a C-section - because our baby is likely too big to pass through the birth canal. Several nurses and the doctor wheel my wife out of the room and down the hall to the operating room - the very same one I'd been in several times as a medical student just 4 months previous. Now I'm the husband. Now I get to wear the white gown while all the doctors are in blue. This time, I'm not allowed in the operating room until my wife is completely situated and they're ready to do the incision. As I sat beside my wife, who desperately needed to hold my hand and feel my support, I couldn't see what the doctors were doing. I was on the other end of the operating table this time. But I knew what they were doing. With each sound, I knew what stage of the operation they were at. I was very thankful that day that we had a private doctor. No OB residents were part of our medical team. But even better, no medical students were in the room, waiting for their chance to try their first suturing job. Suddenly, I knew we were close to the moment of truth. The doctors had opened the uterus and were getting the baby out. It sounded like they were having a bit of a difficult time at it though… oh, there she is! Wow, she's a big baby! 8 pounds, 11 ounces, even though this was only the 37th week of pregnancy! All covered with vernix and blood, crying loudly - that's my girl! Then she was in the next room, and I held my wife's hand during the closing up of the incision. A few minutes later, and I was in the room with the pediatricians, with my little baby girl. While my wife recovered, I gave my newborn daughter her first bath, and took part in the physical exam and hearing tests. Then we went to be with mom, and we were quite the happy family.

The next 4 days in the hospital were difficult. Taking care of a baby is a big job! Especially when mom is trying to recover from a C-section. And then our baby became jaundiced, and she wouldn't latch on to breastfeed. Two common problems that happen with healthy newborns. These are things that as a medical student I wouldn't have thought a big deal at all. Not so when you're the parent! Each day the pediatrician would come in and report to us the total and direct bilirubin levels (they kept rising) and the percent weight loss (this also kept rising). It was somewhat frustrating and difficult. I kept thinking about differential diagnoses for jaundice and weight loss in infants. Would my daughter eventually eat better and clear the bilirubin, or did she have some pathological hemolysis (destruction of red blood cells is a cause of jaundice), and end up needing to stay in the hospital? Would she develop failure to thrive?

None of these bad things happened, thankfully. Now a little over two weeks later, things have been settling down. Baby is healthy and eating well, with the jaundice receding and her weight increasing. Mom is making a fine recovery and doesn't need as much pain medication anymore. Yes, we're a little bit sleep deprived, but it's not even close to being on call as a third year medical student and getting paged by your resident to do a history and physical on a newborn in the E.R. after 1 hour of sleep. I think the most important thing I learned through all of this is that even minor problems and concerns of patients and their family members are a really big deal. Being a patient or the close family member of one is no fun. However, the experience can be made easier by wonderful, compassionate, supportive doctors, nurses, etc. (of which we thankfully had an abundance). I hope that this experience will make me a better doctor and healer.