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Medical Humanities

Meeting Halfway at 6 | 80 | 0

Jason Han

April 3, 2018

“Go meet room 9. She’s going to be next.” 

I was pointed to the oversized white board on the wall. Densely filled with coordinates of new life, it towered over us, as if to project a sense of control over the twenty or so women in labor. In the row labeled room 9, it read, “6 | 80 | 0.” Six centimeters dilated, 80% effaced at 0 station. I looked up and nodded as if I understood what any of it meant.

Filled with trepidation and excitement, I walked down the narrow hallway, the security of the call room fading beyond an ear’s reach. Being on my first week of labor and delivery rotation, I wondered if Room 9 would perhaps offer the chance to deliver my first baby. After a few polite knocks, I opened the door and eagerly introduced myself. 

The room, while spacious, felt small, the light struggling to illuminate through the humid air. She welcomed me as I neared. Sitting at the bedside was her mother, who, having emigrated from North Africa, knew very little English. She nevertheless received me with that universal gesture—a smile. 

Despite having been in labor for the past twelve hours, she appeared remarkably graceful. Her deep, controlled breaths and eyes firmly closed with each contraction conveyed the presence of pain but not frustration. I held her hand as she squeezed mine through the pain, sharing with me brief windows of her humanity. 

We told stories to pass the hours. Then an unexpected question broke the silence— “Rice?” When I looked over, I saw her mother gesturing toward the table where she had unpacked their dinner. The sweet scent of Algerian cuisine filled the room. And in that moment, if only for a few seconds, I could smell and almost taste my own mother’s homemade cooking. I left the room that evening, wishing her good luck in the likely case she would deliver overnight. 

It puzzled the resident that Room 9 had made little to no progress that day. Far from being “next”, she had now come to a worrisome halt. When I arrived the next morning, I saw her numbers unchanged on the whiteboard. But this time, those numbers were palpable. Beyond the ink, I could imagine her suffering through the innumerable hours, her body against the waves, borne back ceaselessly to that unrelenting position, 6 | 80 | 0.    

The confidence with which we embark on the algorithm dwindles quickly as we approach its desperate end. None of our interventions succeeded in hastening her delivery. Her pain level only continued to grow. I rushed to her room after the huddle ended. When I squeezed her hand, she smiled faintly through her now dry, pale lips. She and her mother looked at me nervously, expectantly. I told them as reassuringly as I could that everything will be alright, but deep inside I was hoping for someone else to tell me the same. I stayed by their side for the ensuing hours until a resident came to find me. The mother next-door was about to deliver, and I should be there to observe. Reluctantly, I tore myself away with the promise to return. 

But in that brief hour, the team rushed into Room 9 to respond to an alarm. The tenuous fetal heart tones now demanded urgent action. Using a metal clamp, the attending quickly delivered the baby only to discover the cause for the distress: the baby had an undiagnosed congenital leg deformity. This finding came as a shock not only to the team but also to the mother. But that wasn’t our only concern now. During the chaos, the mom also suffered from a severe laceration and needed to be treated quickly in operating room. 

When I learned about the series of terrible outcomes that befell her on my way to the OR, my heart sank. Where were our god-like medical interventions now? Couldn’t we have done anything to prevent her suffering? I felt powerless. Absent from the room, I couldn’t even provide what little I knew how to do—to hold her hand in times of pain. Filled with shame, I opened the OR door. 

What I witnessed helped me realize that we were not, in fact, failing after all. 

The nurses were spreading warm blankets over her shivering body. The neonatologists were vigilant in their trips to the OR to reassure her that her newborn was going to be okay. I quickly put on a pair of gloves and helped load the needle driver in my trembling hands for the resident who was in charge of repairing her wound. For the next three hours, long past all of our shifts, we brought together the vulnerable edges of her body all the while assuaging her soul with all the compassion we could muster. She, too, endured through the long procedure, motivated by love for the child she would soon be able to hold in her arms. Through the long evening ahead, we were there for each other.

Throughout our careers, we will be humbled by countless moments where modern medicine falls short. Even Mother Nature will disappoint. But it is precisely when the foundations we rely on falter that the threads of humanism offer us hope, which unite us in this brief window of existence we share. I was looking for certainties in medicine when they could only be found elsewhere. Humanism healed us both, the mother and me, when science could not.  

A month later, I was typing at a computer station when I heard my name. I looked up and found the patient wearing a lively pink sweater and a brimming smile, standing at the doorway. She gave me a warm hug and told me that she could not be any happier. While not a surgical candidate, the baby was receiving excellent follow-up care. She had recovered fully, too, and was grateful to the team for their compassion.     

“Who was that?” my attending asked me. “Why did she thank you?”

“A former patient, a friend. It’s a long story…” 

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Jason Han is currently a first year integrated cardiothoracic surgery resident at the Hospital of the University of Pennsylvania. His interests include narrative medicine, bioethics, especially in the application of social psychology principles. He is a contributor to the Philadelphia Inquirer's healthcare section and the AAMC Aspiring Doctor Series.