Class of 2016
That morning, I woke up bright and early for my first ever labour and delivery shift. I didn’t know what to expect. All I knew for certain was that I would be shuffling awkwardly behind a resident, trying to make myself invisible. First, I saw a baby born by elective Cesarean section. The mother was anxious, but she did not feel pain when the scalpel cut through the wall of her uterus since they had given her enough analgesic. Through a wave of blood, a baby boy was yanked from her abdomen and into the world. He tested out his lungs for the first time and I shed a tear into my surgical mask, surprised at how moved I was by this business-like procedure. As the new dad snapped iPhone photos of his tiny red-faced child, the mother’s tubes were tied – a sign that these parents intended to bring no more life into this world.
Minutes later I was in a room with a different mother. This woman had just been in a car crash; after the accident she had not felt her baby move. Luckily, by the time I was speaking with her, the nurse had found the baby’s heart beat. It sounded to me as if the baby was sending a signal to her mum—it swam about happily, announcing its vitality. “Don’t worry, I’m still here!”
After that, I met a woman in induced labour at 41 weeks. She was swearing, sweating, and moaning. She had been on the ward for over 12 hours but, within half an hour of my entering the room, she had delivered a baby girl. There was only one problem: the amniotic fluid contained meconium, and the team was concerned about aspiration. As soon as the child entered the world, before she was even allowed to cry, she was swiftly taken from her mother, a tube forced into her mouth to suction out the viscous fluid. “Is she OK?” her mother asked fearfully. “Yes,” the doctor replied, “She’s perfect.”
I noticed how quickly the intense emotion in these rooms shifted from joy to tragedy. I began to wonder what it would be like if I were the doctor in these situations, the one who had to make quick decisions and explain to concerned parents that their precious child was not "perfect." The thought made me feel apprehensive and I quickly swept it aside.
When my shift was done, I looked at my phone and saw that I had two missed calls from my partner.
“It’s Gran. She died last night,” he told me when I called him back.
My partner's Gran had been in palliative care for the last week. We all knew she was dying, but the words were still a shock. Of course, we were filled with sadness at the news of her death, but there was also a sense of relief. She had lived a long, comfortable life and died quietly in the night, surrounded, in her last days, by her loving family. Her pain was now eternally over and her family could choose to remember the times when Gran was Gran without lingering on the times when Gran was suffering.
My partner and I had a quiet lunch and then I headed back to the hospital. There, I met a couple of nephrology patients. The first was a cheerful 60-year-old man. He had been on dialysis for years but was subsequently lucky enough to receive a kidney. “Me and a couple of other guys got our kidneys on the same day… I think the accident was pretty bad,” he said, referencing the donors whose deaths meant life for him.
The next patient was a woman around 30 years old. She received dialysis treatment that morning. Since she began dialysis a year or so ago, her life had changed dramatically and she’d had to quit her job; she just didn’t have the energy. Bitterness coloured her story. She looked ahead at her life and saw only doctor’s appointments, treatment adjustments, and endless dialysis. “My only hope is to get a transplant,” she sighed. “Wanna feel my dialysis fistula?” I palpated the vein and artery connected under the skin of her forearm. As I felt her life buzz beneath my fingertips, I felt sadness for a woman who was simultaneously being preserved and assailed by medicine.
When I got home that night I felt exhausted. My partner packed to go back home to his family. When he was gone, I called my mum and told her about my whirlwind experience with life and death. “You—as a doctor—will have to formulate a practical approach to death and dying,” she told me. “Real circle of life stuff. It’s too bad my dad isn’t able to have those conversations with you.”
With that, I couldn’t hold it in, and began to weep. Tears of joy for the babies lucky enough to be born well into loving families; tears of sadness for my mum’s dad, a retired doctor whose health has declined steadily and inevitably since his diagnosis of Parkinson’s a decade ago; tears of relief for Gran, who was finally at peace; and tears for those whom medicine keeps alive but not without a cost to quality of life. I felt overwhelmed by the complexity of illness and dying, overwhelmed by the prospect of packing all that into some sort of pragmatic strategy. I realized that, as a doctor-to-be, I must learn how to be sensible and professional about this circle of life while simultaneously acknowledging and honouring the narratives of its players. I figure that finding this delicate balance must be a lifelong process, involving experience, honest reflection, and resilience without callousness. And I figure, too, that it’s not going to be easy.