Labor and Delivery, in the Backseat of a 1992 Crown Victoria and Under a Red Sky

It was the middle of the night and I was working on Labor and Delivery at a busy county hospital in Atlanta. After finishing my cervical exams for that hour to the tune of a memorized script of “relax your knees out to the side,” “keep breathing,” “lots of pressure,” I slowly made my way back to our call room to resume my post of staring at the fetal monitors for the next hour and charting notes.

Because the hospital was in a constant state of renovation, our work room had been temporarily relocated to the once misused janitor’s closet. What once looked like a unkempt flea market-tent of IV poles, broken wheelchairs, and busted speculum lights was now a long narrow room stocked with plastic picnic benches overflowing with computer monitors. A mini fridge hummed cheerfully in the corner next to a fax machine that had mysteriously appeared a few days earlier and was too heavy to drag back into the hall. I didn’t particularly mind this room because it had windows. It was nice to be reminded that the sun still rose and set while we worked. A glimmer of dawn at the end of the shift meant your night was almost over.

Tonight, the sky was thick with humidity. The giant Coca-Cola billboard outside our window cast its eerie red light over the freeway like a huge capitalist night light. "The Great Gatsby" had his Dr. T. J. Eckleburg. We have our fountain soda.

Washed in this familiar red glow, I wrote my notes for the night, my elbows rubbing with the chief resident next to me as I worked. During residency we’d rotate on night shift for six weeks at a time. Twice. So, for a total of three months of the year, we disappeared from the lives of our families and friends, and turned into zombies during the few hours they’d ever see us awake. For six solid weeks we’d be stuck in this tiny red room in the corner of Labor and Delivery, our interactions with humanity reduced to awkward late-night pelvic exams, sign-outs with our co-residents, and moments of terror mixed with the fluids of childbirth. As my elbow bumped my chief resident again, I felt her physically recoil in disgust. The Coca-Cola sign burned the back of my head. My eyes burned from lack of sleep.

“I’m going to get a soda,” I said. The interns grunted in response, their eyes still glued to the squiggly lines of the fetal monitors. I crawled over the fax machine.

In the elevator I stared at the ceiling and tried to breathe. When was the last time I peed? When was the last time I ate a vegetable?

By the time I got to the vending machine, I realized that all I had in my pockets was lube, surgical gloves, and an eye shield. (Trust me, it's important. I had made my interns google “ocular chlamydia” on their first day of the rotation.)

Dejected, I turned back to the unit when an overhead page rang out: Obstetric emergency in the hospital lobby. Great. On my way there, a dozen different scenarios bounced around in my head: placental abruption, hemorrhage, breech, getting drenched in amniotic fluid.

My thought process was disrupted by a 6-foot-5-inch surgeon in an intimidating TRAUMA TEAM jacket. “Are you obstetrics?” he asked. I thought, How did they make scrubs long enough for this guy?

“Uh, yeah,” I answered.

“Great. Come this way.” He looked nervous. Never a good sign when the trauma surgeon is nervous.

He led me out of the front doors of the hospital where a 1992 Crown Victoria was parked precariously on the front steps of the hospital. A team of ER doctors, nurses, and techs stood around it in a semi-circle, an empty stretcher waiting to receive its patient.

A guttural scream emitted from the back seat of the car. No one moved. Several male residents awkwardly wrung their hands. Without thinking, I climbed into the back seat.

I found myself facing a young woman in active labor. She had pressed herself as far back into her seat as she could. Every muscle in her legs was working as she braced herself against the passenger’s seat, one leg even kicking against the ceiling of the car. Her fingernails dug into the headrests and ripped the vinyl seats. The driver had thoughtfully laid down a few beach towels with cartoon characters on them.

“HELP ME!” Sweat dripped down the woman’s chin. Her eyes were wild with pain.

I pulled on the mask and gloves from my back pocket and checked her cervix after quickly taking a history. Fully dilated. Left Occiput Anterior presentation. +3 station. Hair.

Another contraction took hold and she kicked the seat with all of her strength, screaming in pain.

This time I shouted back: “Look at me!” Reluctantly her animal eyes locked with mine. “You’re going to be OK!” Panting, she nodded. “Next contraction you’re going to push and we’re going to have a baby!” I showed her how to hold her knees back to create room for the baby and taught her how to hold her breath during the push.

With the next contraction I put my entire weight into her foot with my shoulder as she pushed. The baby’s head delivered as I gently swept away the cord from around its neck. “One more,” I told her. Our eyes locked again. She was in pain, but remained focused. This time, I delivered the baby. I placed the little girl on her mother’s chest while drying her sticky body with a cartoon beach towel. A whimpering noise like a puppy emerged from under the towel. The woman slumped in relief, tears streaming down her face.

Applause erupted from the crowd of stunned clinicians behind us.

Armpits wet, my heart rate finally slowing down, I crawled back out of the car, and back into the Coca-Cola-red night sky.

Dr. Sawyer is a Pelvic Surgery Fellow at Emory University and will be starting a FPMRS fellowship this July at UTSW in Dallas, Texas.

Illustration by Jennifer Bogartz

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