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The Mechanics of Saving Two Lives Is About Numbers and Protocols

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It was her third request for ice, and she was in labor. I apologized to the woman 15 years my senior and as different as I could imagine from the mostly white, middle-class, rural-American friends and neighbors I had grown up with. This was the university hospital in the heart of Chicago’s gritty West Side, and my first clinical rotation in medical school. The chief resident was waiting for me to present the case — I didn’t dare leave to get ice, so I pressed on with my questions. 

Down the hall I could still hear the yells of the youngest patient on the labor and delivery unit— a 16-year-old without any family present. About 20 minutes earlier she had yelled at me, “I can’t breathe!” Our exhausted group of medical students and residents had noted out of earshot that she could not possibly be in any respiratory distress if she could yell.

I had started medical training certain I would go into ob/gyn, but nothing in this rotation was what I had expected. I had just come from a surgery where my main duty was to prod the resident doctor if I saw his eyes start to close. This was an important surgery for meeting his procedural requirements for graduation, but it had been a brutal on-call night and none of us had slept. 

The older patient told me it was her seventh pregnancy and her fourth delivery. I located the permission form for post-delivery tubal ligation and confirmed that she had signed it more than 30 days in advance. When I asked about prenatal care, my patient stated she had not received any and wasn’t sure of the date she may have become pregnant.

I launched into the rote questions all of us newly-minted third year students had committed to memory. Past medical history: lupus. Complications: chronic renal insufficiency, chronic pain, heart failure, previous strokes (a contraindication for hormonal contraceptives). Her last two pregnancies had ended in miscarriage, and she had thought she could get a tubal ligation then but hadn’t known about the waiting period. She’d signed the permission form, and kept trying to schedule the surgery, “but my doctors would never give the OK due to my lupus.” When she got pregnant this time, she looked at her options: Medicaid doesn’t pay for abortions. Her lupus had caused two other miscarriages. She couldn’t take care of another baby. Without intervention this pregnancy would likely not be viable. But here she was, on the labor and delivery floor, asking me another time for ice.

I excused myself and headed to find the chief resident. I went through my presentation, but as I spoke, I was reliving a different scene: the crisis pregnancy center 10 years earlier where an impassive middle-aged administrator had made me watch a videotape about fetal development as I awaited my test results. I’d cried and left the center alone to call my mother. 

The scold of the chief resident’s voice brought me back to the present. “Ms. Jones, I understand you didn’t get any prenatal care. We have to move quickly now to save this baby. Whether you wanted to keep this baby or not, it’s not okay not to take care of it and make sure it’s healthy.” 

I recoiled at his tone; she hadn’t had any choices. But in that moment, he was right. The mechanics of saving two lives is about numbers and protocols. It’s irrelevant whether a person’s choices have been legitimate, whether there are gaps are in the system, whether society and medicine should provide better options. The room sprang to action, with fetal monitors and blood draws, and a call to warn the neonatologists.

I was nearing the end of my 36 hours on call. It would be a few more rotations before I found a specialty that needs to hear stories. As I left the labor and delivery floor to drive home, I didn’t even notice that I had again passed the ice machine. 

Gillian Friedman, MD, has been practicing since 2002 in the fields of psychiatry and addiction medicine. She is currently the medical director at San Jose Behavioral Health Hospital in San Jose, CA.

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