To survive in medicine, compartmentalize your patients

“Breathe in slowly, deeply, giving fresh energy to your body.

Breathe out, releasing any tension from your day.

In … 1 … 2 … 3 … 4 …

Out … 4 … 3 … 2 … 1 …”

I try to follow the yoga instructor, but in my post-call fog, I struggle to let go of the last 24 hours. We begin by sitting poses to stretch our necks. But my neck is so tight, I can barely bend it to the side.

Box 1. The lid tips open from my pager beeping. “First baby, water broken.” Her name looks Chinese, and I can’t pronounce it. Doesn’t matter, the husband answers the phone and with a heavy accent says “We are going to hospital now.” The lid slides back for the moment, what is in the box is still a mystery.

“Concentrate on your breath. If your mind wanders, return to your breath.” How do I stop the wandering? I can’t seem to control it.

Box 2. The lid has a small window that I can barely see into — “induction, she is overdue, her first pregnancy, slow progress,” is the sign-out message I receive from the previous OB on call. Inside, her box is as dark as her smooth skin. Lying on her side, bundled in blankets and facing away from me, all I see are her long braids splayed across the pillow, overflowing onto the blanket. Is she sleeping? I touch her shoulder — she is not startled as if just awoken, but rather rolls her head towards me in slow motion, weighed down from the long night in labor. Her mother approaches me, her clothes untucked and wrinkled, her hair sticking out every which way. She is so short, I am looking down on her, an unusual stance for my short stature. “When is she going to have this baby?” “I don’t know,” I answer. “I need a little time to assess her first.” This box is filled with fatigue and defeat.

“Let the past go. Be present with your breath.” My breath out becomes a long sigh as I struggle to maintain plank position.

Box 3. I don’t know enough about this box, I shouldn’t walk in yet, but I do. I see an empty bed, a curtain drawn beyond the bed and a man peeking around the curtain. As I introduce myself, he comes around the curtain wearing a suit, a yarmulke on his head. “My wife is in the bathroom.” As I turn to leave, I see through the crack in the door; she is sitting on the toilet with the nurse at her side. I wait outside until she is back in bed. When I approach her, I see her eyes are puffy and red, the tears continuously falling. I hesitantly start, “I’m sorry. I know I have no words to help you at the moment. But I also need to take care of you. Can I look at your incision?” Just a few hours ago, she delivered a baby that looked like an alien, so disfigured with an unusually large forehead that ballooned out the entire head, shallow set eyes, fused fingers, and toes — all unknown until the delivery. She has refused to see the baby. Shock and deep heartache hang heavy in this box.

“You have no control of the future. You have control of now.”

Box 2. When I return, it is still dark. The patient doesn’t speak, only her mother does. I feel like I don’t know her at all, I can’t seem to connect with her. When I check the patient, I can tell the baby’s head is facing the wrong way and has not even entered her pelvis. Despite hours upon hours of strong contractions, despite the day turning to night turning to day, she has not progressed in her labor. I talk to her and her mother about needing a cesarean section. “She was a big baby,” her mother says as she cocks her head towards her daughter, “and I needed a C-section with her.” Finally, the light is turned on, and I see my patient’s young face clearly – she looks like a teenager. After poking and prodding from the anesthesiologist to see if her epidural will work for a C-section, it appears it won’t — she can feel the pinpricks on her belly, and she must be given general anesthesia. Another chance to interact with my patient dashed, she will be asleep for her C-section. No one to shout out to “it’s a boy!” at the delivery. It’s just quiet in the OR, and we go about our business of delivering the baby. This box feels empty and detached.

“Listen to your body.” My body wants rest, not downward dog.

Box 1. Time to unlock this box completely. As I walk in, I notice a rice cooker precariously perched on the counter near the trash and dirty linen bins. I look at it closely, wondering if I’m seeing things. Maybe it is some sort of new gadget in labor and delivery … no, it is really a rice cooker. The husband is excitedly bouncing around the room as if the floor is covered in hot stones. In contrast, his wife is sleeping, comfortable with her epidural. “You should get some rest and something to eat. Your baby won’t be here for a while yet.” He looks at me somewhat confused, thinking the baby will be here any minute. He eventually takes my advice, gets some dinner while I monitor his wife. Later he tells me the rice cooker has special soup for his wife after she delivers. They have no family here, and no family members were able to obtain a visa to come to the states “because of Trump,” but his wife has good friends who sent the soup. Many hours later, when she is finally ready to push, it takes time to teach her how to because of the language barrier. But giving birth is universal, and she eventually succumbs to her primal urges. As we start to see the top of the baby’s head, she tells her husband “I’m done, I want a C-section.” I reassure her it is not necessary, her baby will be here any moment. Her husband tells me “she has little confidence.” I show him the baby’s head when she pushes. With a big grin and urgency in his voice, he excitedly yells at her something in Chinese, which I imagine is “I see the baby, she is almost here, keep pushing!” And with a few more big pushes, the baby is out, and they are both shouting happily. This box is full of joy and love and tradition.

“This pose can be difficult. Use blankets or whatever you need to help you.” I butterfly my legs and lean forward. I’m awkward and stiff and needing lots of props to maintain the pose. The instructor walks around to help others. I see her helping my daughter first. Eventually, she reaches me. Just a gentle touch on my shoulders and I realize how tense they are. Another touch to my back and I let out a small cry, but I really want to open the floodgates. If she touches me one more time … but she moves on.

And I’m back to struggling to find the present and my breath.

I’m struggling to box up my patients and set them aside. But I can’t. I want to know how the soup tasted, if the shocked mother found courage to hold her baby, if the young mother is ready to mother.

Finally, the instructor dims the lights, the music is soft, the room comfortably warm and we lie down for our final pose, Savasana. With my eyes closed, my breathing slows, and my body melts into the mat. Although they stay close to me, I close the boxes and let them be.

Namaste.

Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN

Image credit: Shutterstock.com

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