Through the Looking Glass

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[Ann Emerg Med. 2009;54:841-842.]

Seventeen hours into the induction and things were not going smoothly. My wife and I were expecting our first child, and it seemed like the pitocin began sometime between forever and an eternity ago. In that period of time, my wife had slowly progressed and was now dilated to 5 cm, with an effacement of 80%. However, something had abruptly changed. Despite receiving an epidural, she was now in intense pain.

“It's going to hurt,” I said in my best analytic-physician voice.

“Not like this,” she shot back, glaring at me in anger.

“Try taking deep breaths,” I said, trying now to sound like a thoughtful and caring husband. My coaxing didn't help.

Writhing in pain, she yelled, “It feels like ice picks are stabbing my cervix!”

This got the attention of the OB-GYN. A check of my wife's cervix revealed that she was still 5 cm, but her effacement was now 60% according to the OB. This confused me. I am pretty sure babies do not move backwards. The OB explained that my wife's cervix was swelling, which would explain why it appeared to be getting thicker instead of thinner. The baby was not in distress, the OB assured us. But labor was not progressing the way it should. The baby's vitals were still good: her pulse rate was ticking along in the 140s to 150s, with great variability on the monitor. However, the OB felt that the best way to proceed would be to go ahead with a cesarean section. My wife and I were both physically and emotionally exhausted. We agreed that this was the best plan.

My wife's surgical history consisted of wisdom teeth extraction and LASIK. Suffice it to say she was scared. I tried my best to explain the procedure, but I didn't really provide anything different from what she had read in her birthing books. Nor did it matter. It wasn't the logistics of the procedure that made her scared, but rather the idea of having, as she put it, her “insides cut open.” No scientific description or analytic approach could make that fear dissipate.

We were at a small, somewhat rural hospital, where, not by coincidence, my program sends residents during their third year to obtain the proverbial “community” experience. Like many such hospitals, staffing at night and on weekends is scarce. It was about 10:30 pm when the decision was made to proceed with the cesarean section. The OB who was on that evening needed an assistant, and there were no residents on duty. Therefore, at this hospital, when a cesarean section is performed after hours, the house surgeon on call assists the OB in the procedure. My wife was introduced to the surgeon, as well as the anesthesiologist and nurse anesthetist, and she was prepped for surgery.

I came into the OR after they had prepared my wife for surgery. The blue drape was elevated at shoulder level, cutting off my wife's field of view from the rest of her body and protecting the sterile field. Because she already had an epidural, no further anesthetic plan was needed. They just turned up the juice, so to speak, and were ready to proceed. My wife was scared. She asked me to talk to her. I am not usually short on words, but at that point, I had little to say. I focused on reassurance and optimism, telling her that everything would be OK and that we would be parents soon. I stroked her hair and tried my best to calm her.

It was at this point that it happened. From behind the big blue drape came the voice of the surgeon, “I hope I don't hit the bowel; it's been a long time since I've done this.” This comment was not directed at my wife. It was directed at the OB.

I knew this was an attempt at humor. I happened to know that the surgeon was competent, and I think he most likely forgot that his patient, my wife, was actually still awake. After all, he's a surgeon; his patients rarely have the ability to talk, let alone listen, while he is working. I knew all of this. My wife, on the other hand, did not. The fear she had was now replaced by a look of sheer terror. Sensing the tension created by that seemingly innocuous comment, our OB worked quickly to defuse the situation. In a cool, calm manner, she expertly joked, “do you want me to come over and do that side too?” This led to a successive ribbing of Joe Surgeon by the anesthesia staff and scrub nurses. I had some pretty funny things to say, too, though I kept them to myself. About 15 minutes later, we became the proud parents of an 8 lb 11oz healthy baby girl.

For all intents and purposes, this incident mattered little; my wife and daughter were well and I was capable of moving on. Or so I thought. My mind kept returning to the moment the surgeon cracked a joke during my wife's cesarean. The protective, doting husband in me wished I had jumped across the big blue curtain, punched the guy in the mouth, and stepped in to play first assistant. The physician in me empathized with the surgeon, and was thankful I too had emerged unscathed from similar situations. I am grateful, however, for the guy who won out, the soon-to-be father who remained focused on his wife's immediate needs.

I do not condone what the surgeon said. In fact, I was utterly shocked and disgusted by it. However, as I reflected on the comment, I realized how callous we all can be from time to time. Think about your work environment. Think about how busy things can get. Think about shift change when you walk from bed to bed discussing different patients. Think about when you talk “shop” with your fellow coworkers closer than you probably should to patient care areas. I know that I am guilty of saying things just as callous as, if not worse than, the surgeon did. I suspect many of you are, too. It is interesting being on the other side of the proverbial “curtain,” and it makes you appreciate the patient perspective. With our training, we can do amazing things medically to help those in need, but we must never underestimate how much harm can be done by failing to act in an appropriate, respectful, and professional manner.