celebrate, a riot of handshakes and hugs. I was a prophet returning from the mountaintop with news of a joyous new covenant! All the messiness of the birth disappeared; here I had just been holding the newest member of this family, this man’s niece, this girl’s cousin.
Returning to the ward, ebullient, I ran into Melissa.
“Hey, do you know how last night’s twins are doing?” I asked.
She darkened. Baby A died yesterday afternoon; Baby B managed to live not quite twenty-four hours, then passed away around the time I was delivering the new baby. In that moment, I could only think of Samuel Beckett, the metaphors that, in those twins, reached their terminal limit: “One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.” I had stood next to “the grave digger” with his “forceps.” What had these lives amounted to?
“You think that’s bad?” she continued. “Most mothers with stillborns still have to go through labor and deliver. Can you imagine? At least these guys had a chance.”
A match flickers but does not light. The mother’s wailing in room 543, the searing red rims of the father’s lower eyelids, tears silently streaking his face: this flip side of joy, the unbearable, unjust, unexpected presence of death…What possible sense could be made, what words were there for comfort?
“Was it the right choice, to do an emergency C-section?” I asked.
“No question,” she said. “It was the only shot they had.”
“What happens if you don’t?”
“Probably, they die. Abnormal fetal heart tracings show when the fetal blood is turning acidemic; the cord is compromised somehow, or something else seriously bad is happening.”
“But how do you know when the tracing looks bad enough? Which is worse, being born too early or waiting too long to deliver?”
“Judgment call.”
What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? How could I ever learn to make, and live with, such judgment calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too. After all, when I had walked into the hospital just one day before, birth and death had been merely abstract concepts. Now I had seen them both up close. Maybe Beckett’s Pozzo is right. Maybe life is merely an “instant,” too brief to consider. But my focus would have to be on my imminent role, intimately involved with the when and how of death—the grave digger with the forceps.
Not long after, my ob-gyn rotation ended, and it was immediately on to surgical oncology. Mari, a fellow med student, and I would rotate together. A few weeks in, after a sleepless night, she was assigned to assist in a Whipple, a complex operation that involves rearranging most abdominal organs in an attempt to resect pancreatic cancer, an operation in which a medical student typically stands still—or, at best, retracts—for up to nine hours straight. It’s considered the plum operation to be selected to help with, because of its extreme complexity—only chief residents are allowed to actively participate. But it is grueling, the ultimate test of a general surgeon’s skill. Fifteen minutes after the operation started, I saw Mari in the hallway, crying. The surgeon always begins a Whipple by inserting a small camera through a tiny incision to look for metastases, as widespread cancer renders the operation useless and causes its cancellation. Standing there, waiting in the OR with a nine-hour surgery stretching out before her, Mari had a whisper of a thought: I’m so tired—please God, let there be mets . There were. The patient was sewn back up, the procedure called off.
Returning to the ward, ebullient, I ran into Melissa.
“Hey, do you know how last night’s twins are doing?” I asked.
She darkened. Baby A died yesterday afternoon; Baby B managed to live not quite twenty-four hours, then passed away around the time I was delivering the new baby. In that moment, I could only think of Samuel Beckett, the metaphors that, in those twins, reached their terminal limit: “One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.” I had stood next to “the grave digger” with his “forceps.” What had these lives amounted to?
“You think that’s bad?” she continued. “Most mothers with stillborns still have to go through labor and deliver. Can you imagine? At least these guys had a chance.”
A match flickers but does not light. The mother’s wailing in room 543, the searing red rims of the father’s lower eyelids, tears silently streaking his face: this flip side of joy, the unbearable, unjust, unexpected presence of death…What possible sense could be made, what words were there for comfort?
“Was it the right choice, to do an emergency C-section?” I asked.
“No question,” she said. “It was the only shot they had.”
“What happens if you don’t?”
“Probably, they die. Abnormal fetal heart tracings show when the fetal blood is turning acidemic; the cord is compromised somehow, or something else seriously bad is happening.”
“But how do you know when the tracing looks bad enough? Which is worse, being born too early or waiting too long to deliver?”
“Judgment call.”
What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? How could I ever learn to make, and live with, such judgment calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too. After all, when I had walked into the hospital just one day before, birth and death had been merely abstract concepts. Now I had seen them both up close. Maybe Beckett’s Pozzo is right. Maybe life is merely an “instant,” too brief to consider. But my focus would have to be on my imminent role, intimately involved with the when and how of death—the grave digger with the forceps.
Not long after, my ob-gyn rotation ended, and it was immediately on to surgical oncology. Mari, a fellow med student, and I would rotate together. A few weeks in, after a sleepless night, she was assigned to assist in a Whipple, a complex operation that involves rearranging most abdominal organs in an attempt to resect pancreatic cancer, an operation in which a medical student typically stands still—or, at best, retracts—for up to nine hours straight. It’s considered the plum operation to be selected to help with, because of its extreme complexity—only chief residents are allowed to actively participate. But it is grueling, the ultimate test of a general surgeon’s skill. Fifteen minutes after the operation started, I saw Mari in the hallway, crying. The surgeon always begins a Whipple by inserting a small camera through a tiny incision to look for metastases, as widespread cancer renders the operation useless and causes its cancellation. Standing there, waiting in the OR with a nine-hour surgery stretching out before her, Mari had a whisper of a thought: I’m so tired—please God, let there be mets . There were. The patient was sewn back up, the procedure called off.
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