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Happy Birthday and Good Luck

 , December 07, 2018

Gretel Whiteman

Another morning, another Caesarean section in operating theatre two. Preparation for this major operation was underway and staff were busy everywhere. In my time as a medical student, I had learned that what looks on first impression like vaguely organised chaos is, of course, incredibly methodical. As surgical instruments are counted and recorded in one corner, a crib is prepared in another; as the registrar enters details into the computer, the consultant speaks to the patient. I had a quick look at the patient’s notes: it was a planned Caesarean due to the patient’s previous baby having been born by emergency Caesarean, and this one was brought forward by her water breaking the evening before. This was baby number eight in the family. Thankfully, the 39-week pregnancy was uneventful despite several missed antenatal appointments, but some notes in the pregnancy record suggested that a number of doctors had found this woman to be a difficult patient, and she’d had referrals for social and psychological help in the past. I left that thought in the back of my mind.

The anaesthetic room received the mother; wheeled in on a theatre bed and wearing her purple hospital gown. She was very uncomfortable with a huge belly bursting at 39 weeks’ gestation and already experiencing contractions: that baby was waiting for no-one.

I introduced myself to the patient as the team’s medical student while her cannula went in. Despite the odd painful contraction and swollen belly, she was not overly distressed and was easy enough to talk to for a five-minute conversation. Looking beyond the bursting abdomen, it was clear that she was incredibly thin – perhaps malnourished. She had at least three missing front teeth. When her heavily tattooed partner arrived soon afterwards, I noticed that he was also missing several teeth.

The operation went smoothly, and a healthy baby boy was born at 8:47am. He was beautiful, if a bloody, mucoid, crying infant is beautiful. He was everything a newborn needed to be, and his APGARs were 9 and 9. The obstetric consultant methodically continued his usual procedure, delivering the placenta and stitching the layers of uterus, fascia and skin one by one. Being not particularly useful in the final stages, my own contribution naturally waned as the incision grew smaller. I was able to “un-scrub” and step back from the operation.

At the back of the operating theatre I got to hold that baby boy then. He was just twenty minutes old. Although undoubtedly special and unique, he could have been any perfect newborn baby. I would have been much the same as him when I was half an hour old. He was so malleable: a completely clean slate that was incredibly open to influence. His future and potential were entirely flexible at this stage.

I felt so strongly for that 20-minute old child that I had to pretend there weren’t tears in my eyes. I rocked him and stared at him, wondering what he was going home to, with seven older siblings in an area well known for socio-economic difficulties, and with parents showing likely signs of a troubled past. It is uncomfortable that a person’s physical appearance and just a small bit of their personal history can spark so many internal queries or assumptions. I don’t know if they have faced difficulties in the past, or what they may be. I don’t know if they have struggled with alcohol, drugs, money or violence. Sometimes we can’t draw any conclusions from the collective number of teeth of a child’s parents and perhaps it was rash to jump to conclusions about this patient.

I hoped that my assumptions were wrong. However, drawing on the relatively small amount of experience I had, I felt that the quick conclusions I had drawn were unfortunately likely to be correct. It is also true that the lifestyle problems like the ones that jumped into my assuming mind are horrendously difficult to shake off from one generation to the next. A vicious cycle tends to ensue. And yet, here in this room, we were about to bring a baby of the next generation into the world. I just wished that there would be someone in his life that would provide that clean slate of his with a strong positive influence.

I held him and reflected that I was lower than the lowest rank in the medical team. I was relatively inexperienced, and I had limited skill to determine whether these patients might need extra help; moreover, being a student, I had very little power to intervene or change a patient’s experiences inside or out of the hospital. Furthermore, the obstetric team at this hospital (of which I was a temporary member) was here to provide a specific service to a mother – that is, a safe Caesarean – and not a holistic lifestyle intervention.

My time in the hospitals so far has taught me that we can’t fix everything. We can try, we can look for the struggling people and organise extra help for the patients who need it, but we can’t fix the world; a very difficult pill to swallow when holding a perfect newborn with a hazy future. We are doctors and we care for patients’ wellbeing, but we are not lifestyle coaches.

The midwives and paediatrician took excellent care of the baby in his first minutes of life. From the mother’s medical notes, I knew that referrals had been made for social and psychological support in the past. It’s quite possible this family will need extra help in the future, and that’s about all we can do. We can’t fix the world. As I put the baby boy back in his cradle, I wished him a happy birthday and good luck. I don’t know to what sort of home he went. He was wheeled out behind his mother and the operating doors closed.

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