musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Regret-me-nots


Sometimes if I awaken during the black of a cloudy moonless night, I am gripped by an uncomfortable feeling I can’t identify, a feeling whose source is almost within reach, yet blurred and formless like a ghost. And then, as silently as it approached, it disappears again into the night leaving only shards like broken glass I must take care to avoid if I am tempted to follow. There is no reason to do so, though: regret is an ephemeron I could not hope to catch -or, for that matter, subdue if I ever did.

It is not like that when both you and it are still young and as yet undefined; regret -and Age- require Time, as a tree requires a stem to mark its passage for good or ill from the ground. It is only in retrospect that either can wish it had opted for another branch along the way.

The etymology of the word regret is freighted with a rich cargo, most of which incorporate the sense of lament or weeping for a loss: someone’s death, for example, or something which, once lost, can never be regained. The only thing worse than regret, perhaps, is suggested by the sign the poet Dante imagines he sees in his famous poem about his trip to the underworld (The Divine Comedy): written on a sign over the gates of Hell are the words ‘Abandon all Hope’.

But, with regret, there can be hope sometimes: through reassessment of the loss or even by rationalizing subsequent positive feelings or actions as being the fortunate result of the loss. I am reminded of one of my favourite poems by Robert Frost, ‘The Road Not Taken’,the last stanza of which is: ‘I shall be telling this with a sigh somewhere ages and ages hence: two roads diverged in a wood, and I— I took the one less traveled by, and that has made all the difference’.

I’d like to think that for me, regret’s power is only flexed in the dark of Night, when, much like what Shakespeare has Banquo say when he is talking to Macbeth about what the witches have told him: ‘And oftentimes, to win us to our harm, the instruments of darkness tell us truths, win us with honest trifles, to betray us in deepest consequence’.

Still, is recovery from regret, or even avoidance of it in the first place, merely a rationalization? Is that what Frost was doing to justify his choice? Was Banquo merely trying to explain away the witches’ prophesy so it would not affect Macbeth? Do we escape regret because with hindsight the thing we’ve lost, the route we didn’t take, the advice we chose to ignore, was really not that important to us -or at least we’ve managed to convince ourselves it wasn’t? I wonder about these things.

A common question that is often asked of elders -usually by the young, seeking wisdom- is ‘If you had the chance to live your life again, would you make the same decisions?’ The question, it seems to me, is meaningless: had a different path been chosen, it would have been a different person answering, and then, no doubt, there would be a different answer given; we are who we are in large part because of the decisions we have taken. For good or ill, we are, in fact, the answers we sought.

I remember one time, in what seems a different life now that I’m retired, when I was asked that very question. It was 3 A.M. or some such ungodly hour, and as the only obstetrician/gynaecologist on call in a frantic downtown hospital, I was busy in the Delivery Suite dealing with various complications of pregnancy. Some required frequent assessments; some babies on the brink of delivery were in distress and required urgent and timely intervention; others were happy with the process but their labour progressed rapidly and demanded some form of attendance at the very least.

I was never alone, to be sure: there were incredibly competent and experienced midwives, and I had two younger resident doctors on call with me, one of whom was early in her specialist training and the other had almost completed her residency. The two doctors and I were sitting at the nursing station completing some charts, when there was a phone call asking me to come to the Emergency Department right away: they had just seen a patient who was in shock from blood loss from what the Emergency doctors thought might be a ruptured tubal pregnancy.

I was about to run down the stairs to Emerg, when one of the nurses grabbed me. A baby was in distress as it was being born; it was, apparently, an undiagnosed occiput posterior whose head was stuck in the birth canal (babies normally are facing down as they are being born -they seem to travel more easily along the vagina like that; this one was facing up). The heart rate was plummeting and despite frantic pushing on the part of the mother, things were not improving.

Time for allocating resources: I sent the senior resident down to Emerg to assess the bleeding and arrange for the OR, and I ran into the delivery room where the head was stuck. There is a distinct ridge on a neonate’s head where the bones meet on the top of its skull -a handy lever for turning the head if coupled with moving its shoulders in the same direction through the mother’s abdominal wall. Sometimes it works, sometimes not -but in this case I doubt whether we could have got the mother to the OR for a Caesarian Section in time to save the baby. But I had been in this kind of situation before and I was able to turn the head; with resumed maternal effort it then presented itself on the perineum. There seemed to be very little injury to the birth canal or the baby fortunately, so I asked the junior resident if she minded helping the midwife to put in a few stitches if they were required. Then I raced down to the Emergency Department just in time to see the bleeding patient with the ruptured tubal pregnancy being wheeled onto the elevator on the way to the operating theatre.

When our shifts were over the two resident doctors and I met together for breakfast in the cafeteria after the operation and the delivery of several other babies. That was when the junior asked me if I ever regretted my decision to specialize in obstetrics.

I had a sip of my coffee and thought about it. “What did we see last night on our shift?” I asked.

She had a bite of her strawberry jam-covered toast. “Well, an occiput posterior delivery, an ectopic pregnancy, a woman we had to induce for worsening hypertension near term, a drug overdose in a pregnant woman… oh, yes, and about a thousand normal deliveries,” she added, smiling through the jam she’d managed to drop on her chin.

I chuckled at the jam. “And what was your question, again?”

She rolled her eyes and shrugged. “Do you ever regret your decision to specialize in obstetrics…?”

“Do you?” I said and smiled back at her.

She shook her head, obviously still excited about her experiences last night.

“Then there’s your answer Emily,” I said, carefully spreading peanut butter on my bagel and sitting back on my chair with a tired and contented sigh. “There’s your answer…”

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gozzter

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