Thanks to a white-out snowstorm, it was a dream night for a general surgery resident on call. The ED was empty, and the harsh weather ensured it would stay that way. Tonight was my lucky night to enjoy some much-needed rest. I smiled at all the snow through the window, then pulled the blinds down and my blanket up.
Two hours later, my pager interrupted my plan for the evening. I was confused by the number I saw there. I had been a resident in this hospital for four years, and I could not recall having seen this number before. I had just about convinced myself it must be a mistake when I decided I had better find out.
A woman answered the phone with, “Hello, OB.” That was when I knew this had to be a mistake.
“Hello, this is Dr. Black, did someone page me?”
"Oh, thank goodness," she breathed. "We have a mother here fully dilated and ready to push."
“We need you to come and deliver her.”
Oh, what a relief; this call wasn't for me, and I could go back to sleep.
"I'm sorry, you must have paged the wrong number. I'm the general surgery resident," and I moved to hang up the phone.
"No mistake," she said. "We need someone to deliver this baby and Dr. K can't get here because of the weather."
I was annoyed that this call spoiled my planned night of rest, so I tried to think my way out. "Did you try the ER doctor?” I asked, knowing they couldn't be busy. I was only a resident, and surely they needed an attending.
“Yes,” she replied, “but they are not allowed to leave the department.”
My mind was spinning, trying to think up a way to get out of this, when she added, "We checked, and you are the most senior doctor in the hospital. We really need your help."
A cold chill ran through me as I realized she was right. I had deliberately shopped around for a surgical residency that did not offer training for other surgical specialties. I wanted to get as much hands-on experience in as many fields as possible. Now that decision was coming back to haunt me. With no ob/gyn residents, it looked like I would have to deliver a baby.
"Um… yeah, OK. Just one thing," I said. "Can you remind me how to get to labor and delivery?”
We all have areas of medicine we find "less appealing.” Delivering babies is one of mine (eye surgery is the other one). I had been present for the delivery of many infants in medical school. Yet, I had somehow missed witnessing the "miracle of birth" every time. Probably because my face shield was splattered with blood, amnionic fluid, and worse. As a general surgeon, I believe not much can gross me out. I've cared for perforated viscera, burns, wounds infested with maggots, and one woman who had both legs traumatically amputated by a city bus. But something about a baby's head popping out makes my stomach turn every time.
As I walked to the elevator, I got nervous trying to remember the steps to delivering an infant. Which shoulder comes out first? What do I do if the labor arrests? I don't know how to use forceps; besides, I have heard they are dangerous. Before my mind spiraled totally out of control, I decided to consult my trusted Surgery On Call pocket reference book. It had gotten me through many midnight problems, from no urine output to chest tube dysfunction to ICU sepsis; certainly, it wouldn't fail me now. However, the authors had failed to anticipate the need to deliver an infant during a raging blizzard.
As I walked into labor and delivery, my anxiety increased. The baby delivery unit has a different look and feel from the other hospital wards. Although the homey decor was designed to make new parents feel more comfortable, it had the opposite effect on me: It made it clear I was somewhere I didn't belong.
"Are you Dr. Black?" a woman in scrubs asked as I entered. "Thank you so much for coming."
She led me into a room where a woman was more than ready to deliver. Her legs were draped up in stirrups next to a table of gleaming instruments. Everyone besides me was prepared for this to happen.
As I entered the room, a nurse said, “Dr. Black is here.”
"Welcome Dr. Black," came a warm and reassuring voice from the speaker phone. "This is Dr. K, so nice of you to join us." He said it like he was welcoming me to the country club. Dr. K came from an older generation of gentleman physicians. The kind of doctor who attends the hospital at 2 a.m. in a sports coat. He coached the patient and me through the delivery of a baby boy. Fortunately, this wasn't the mother's first time delivering, and she even encouraged me as we went along. The baby delivered himself, and all I had to do was not drop the slippery little guy when he shot out. I got the impression this would have all been over sooner if they hadn't waited for me.
This story has renewed relevance for me in the last year. After 20 years in private practice, I hungered for new challenges. I no longer felt I was learning and growing. I wanted to see new horizons, literally and figuratively, and I have. I am now working on the West Coast of the South Island of New Zealand. Thanks to COVID-19 and other unpredictable factors, I frequently find myself the only surgeon operating on the West Coast. We do have OB coverage, so I don’t have to deliver babies, but I find myself asked to do things from all other areas of surgery. Things I have not done since residency, like testicular torsion, peritonsillar abscess drainage, catheterizing difficult patients, pediatrics, and just yesterday placing a supra-pubic catheter. It’s not that I can’t do these things; I just have not seen or done them in a long time, which makes me uncomfortable. But I have learned to accept being uncomfortable and even to welcome the sensation. That's because I have learned that if we're not uncomfortable, we aren't growing, and if we aren't growing, then we are not achieving our full potential.
Narrowing our field of focus is a danger we all face when we go into practice. I trained with one surgeon who did nothing but laparoscopic inguinal hernia repairs. He did that operation well, but you wouldn't want him to be on call if you came in with another problem. That is an extreme example, but we all tend to gravitate to our comfort zone. It's natural to want to stick to those few things you do well and feel most comfortable doing, whether that is a list of surgical procedures or patients with a particular disease. The problem is, when you stop being uncomfortable, you stop learning.
Working in rural New Zealand has given me the opportunity to do things I hadn't seen since residency. That can be intimidating, but it doesn't have to be. I got through the wintery delivery of a baby by talking to someone on the phone. I do that more often now than I did in my previous practice. I call up specialists at the main hospital in Christchurch to ask questions. For the most part, they confirm what I am already thinking, but it is good to have the reassurance — especially before I amputated the testicle of a teenager. We also have resources I could not have dreamed of when I was a resident. I'm not too proud to admit that I recently watched a YouTube video on how to do a procedure. I hadn't done the procedure in years and wanted to refresh my memory and orient myself to the updated procedure kit. I don't know if I learned anything new from that video, but I felt more comfortable after watching it.
When I got called to deliver the blizzard baby, I was not looking for a new challenge. I would have rather stayed in bed. It certainly would have been easier, but then again, I wouldn't have this story to tell or the knowledge that I could deliver a baby on my own if I needed to. That wasn't a comfortable experience, but I know it made me a better person and physician. So when that midnight call comes from whatever your personal OB happens to be, don't decline the summons. Recognize that you are capable of more than you think and step up to the challenge. It will be uncomfortable in the moment, but you will be a better person and physician for having done so.
When did you last do something that you consider your "personal OB"?
Charles Black is a general surgeon, father, landscape photographer, writer, outdoorsman, and fireside philosopher. Catch up with him at ChuckBPhilosophy.com where he writes about life, the universe and everything. You can also view his photos on ChuckBlackPhotography.com. Dr. Black was a 2019–2020 Doximity Op-Med Fellow, a 2020–2021 Doximity Op-Med Fellow, and is currently a 2021–2022 Doximity Op-Med Fellow.
Illustration by April Brust