An Obstetrical Christmas

Christmas means different things to different people: stories surface, myths revive and the more hopeful among us find solace in the often blatant messages of charity and benevolence they radiate. I’m not sure why this time of year tugs so much on the heartstrings, but it does. We expect it; we await it; we demand it… Maybe it speaks to an inner need for the redemption of a society gone mad with itself.

I suppose I am no different: a prairie boy come to the big city, but never fully captured by its ethos. And yet, over the years, I have adapted, I have become as accustomed to the indifference that sustains us in the crowd as any other of our kind that seeks independence of character. To fit into a group necessitates a certain pliability and compliance -surrender, even. To stand out is to invoke response; to individuate risks retaliation -if not in kind, then in spirit. Members fit in, outliers look in…

And this preferred anonymity is what I often see in those who find themselves in such desperate need that they have to seek help outside their group. Despite our boasts of cultural safety, there is still a barrier for those less fortunate, less educated, or differently acculturated than ourselves. And for some in extremis, it means withdrawal; safety lies in silence, feigned disinterest -detachment from the distress they must surely feel.

A few years ago I volunteered to be on call on Christmas Day. Perhaps I felt it would stand me in good stead with my colleagues, but more likely I assumed that it would be a quiet 24 hours on the labour ward: nobody expects a December 25th delivery; even with that as a calculated due date, it is commonly believed there is a special dispensation exempting all and sundry from the duty of Christmas labour. But for some, there is no choice.

It was early in the afternoon, when a woman was admitted to the ward in premature labour and I was called to assess her. At first glance she seemed older -perhaps mid forties- and somewhat dishevelled. Her hair was matted with sweat and her clothes seemed oddly ill-fitting. I assumed she had donned whatever was available when she began to contract, hoping the pains would subside. But they hadn’t; in fact when I entered the room, she was writhing in agony on the bed, sweating profusely, and seemed unable -or unwilling- to communicate. We couldn’t get a monitor on her abdomen to listen to the baby, and because the contractions were coming so frequently, it was difficult to get her to concentrate enough to tell us about the pregnancy.  One look at her condition suggested an abnormal separation of her placenta -an abruption- and since the placenta is what supplies the baby with nourishment and oxygen, her baby was in trouble. Serious trouble.

I did manage to piece together that she had not seen anybody for prenatal care and didn’t live anywhere in particular, but the rest was veiled: whether or not this was her first pregnancy, whether or not she had any illnesses or had used any illegal substances -even when she thought the baby was due. Despite her understandable reticence in the face of all her pain and her reluctance to cooperate -or more likely her fear of having the baby apprehended if she disclosed too much about herself- her eyes seemed to want to confess. There was terror written in those eyes -something deeper even than the agony etched in the lines of her face- a profound concern that seemed to transcend the pain. Something she wasn’t even allowing herself -or more likely me– to see.

As I stood next to the bed trying to reassure her and decide how best to help, I could see that I had misjudged her age: she was far younger up close -late twenties maybe. And despite her projected indifference, the veneer of courage and bravado was thin and cracking as the contractions became more insistent and piled one on top of each other without a break. She was just a frightened young girl, really -someone who had inadvertently wandered into uncharted and unexpected territory. Whatever had allowed her to adapt to her life outside, was out of its depth in here, in a hospital likely only glimpsed in passing from the street. The pain was unexpected and obviously never experienced before and it returned again and again no matter how she tried to ignore it… How can this be? her eyes screamed. Stay away! her body signalled.

But despite the courage of her body, the baby came and she was still for a while. So was the baby. I quickly retrieved it and attempted to resuscitate it, but with no success: it was too premature, and too deprived of oxygen from the untimely separation of its placenta in the womb. All the while we worked on the baby, huddled over its tiny spidery body, she watched, face impassive but eyes unblinking like saucers, intent on seeing any movement, ears listening for any sound. And when it was over, when it was clear even to her that there was no hope, she merely blinked and turned away -turned inwards I thought at first.

But one look at her face told another story: she was in pain again. I put my hand on her abdomen to see if perhaps she was bleeding internally and felt the uterus in spasm. Soon there was more blood that appeared on the sheets. Suddenly, another form emerged from between her legs and her eyes widened in surprise. Before I could interfere, or even decide what was going on, she reached down and gently lifted another, smaller body no bigger than her hand. It tried to move, but managed only a tiny sound before it, too, lay limp in her soft embrace.

And finally the tears gathered in her eyes and rolled slowly down her cheeks. She stroked the little head with her other hand -tenderly, lovingly, with a caress only a mother can bestow and put it down again carefully and reverently, between her legs. She lay back then and closed her eyes, a wisp of a smile on her tired and wizened face, the experience too much for her to comprehend. But as we were tending to the second baby, and swaddling it so she could see them both for a while alone, she opened her eyes and smiled at me this time.

“Thank you,” she whispered and wiped away a tear.

I walked over to her and sat on the bed to hold her hand; I didn’t know what else to do. “I’m sorry,” I said, my own voice quivering.

She reached over with her other hand and patted me on the arm. “I’m so grateful you didn’t take my baby right away,” she said, a smile reappearing under her sad, sad eyes. I was about to answer -probably with banal and reactive words, well-meant, yet meaningless- but something made me hold my silence. “You see,” she whispered, “I needed to hear it say goodbye,” and then she closed her eyes again and slept.

It is not in the stars to hold our destiny but in ourselves. I saw the world in her face at that moment: a bridge to where we all must travel. And her smile became my smile… and the little baby’s that managed to say goodbye.

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