While every career contains firsts, few firsts are as powerful as those in medicine. First you decide to be a doctor. Then the first time you interact with a patient. Leading to the first time you must perform a procedure. The shock of the visceral and fragile quality of the human body, the enormity of the patients’ humanity, and the weight of the responsibility involved in maintaining these combine in the first encounters as a physician. Each is powerful. Still, some firsts produce larger shocks and more lasting lessons than others: so it was with my first day of clerkship.
My first rotation was Ob/Gyn. I spent most of the day in class, then waited at the nurse’s station with the team for sign out. Suddenly, we heard screaming, but not of a woman in labor. This screaming cut through all other noise, conveying unexpected pain. I became aware of the now empty station, as if the residents had been transported by sound alone. Next, nurses sprinting, clutching their stethoscopes to prevent them from soaring off. And the screaming didn’t stop. The crash cart followed with ominous clatter, along with attendings flying past, coats flapping like white wings behind them.
The noise increased. The thin, wet cry of a newborn added to the cacophony. And a patient was being raced down the hall, her screaming made louder by proximity, accompanied by the stampede of staff. As they disappeared into the OR, a nurse told me to join. I scrubbed in, part of a team for the first time. I remember the medicinal scent of the soap and the heat and damp of my own breath enclosed under the mask. I remember the white tile, glaringly clean in contrast to the muddy tan of the surgical gloves encasing my hands. All of this against a soundtrack of relentless screaming, which still contained a measure of anguish but came in shorter bursts as the patient tired. The anesthesiologist pushed the sedative, the screaming stopped, and the patient slid into drugged sleep. The silence was startling.
The attending explained that the patient, Ms. X, had an uneventful vaginal birth. During the third stage of labor, usually the wind-down, she started screaming and blood started pouring. Upon examination, a tear had been found in the posterior vaginal canal. Our task was to determine the extent of the tear and staunch the bleeding.
The blood flowed onto the table and spilled onto the floor, even though Ms. X had been packed with gauze. As the incision was made, more blood welled — too much, even to my untrained eye. It was a steady swell, then abrupt pour from the abdominal cavity, like an overfilled cup. When the attending commented on the extent of blood and ordered more, the gravity of the situation began to penetrate for me. Ms. X was hemorrhaging.
The resident and nurses mopped the blood with more gauze, dropping the soaked wads on the growing mound of red waste. The heat of the OR intensified the scent, so all I could smell was salty, metallic, gamey, sweet blood. I was asked to help, and I then I had my hands inside another human for the first time. The heat was surprisingly intense.
I had a clear view as the attending and resident found the tear and traced the origin to the neck of the uterus. They folded the uterus down, and we saw. The tear had rent through the vaginal canal, the cervix, up through the uterus, over the top and down the other side. The attending blurted he had never seen something like this before. And the blood kept coming.
Reality and textbook learning coalesced when the attending announced the patient was in disseminated intravascular coagulation. The team mopped blood and knitted torn tissue together, while the blood seeped thinner and faster. Blood was everywhere. More transfusions were ordered. The attending told the team our focus needed to be on ensuring the patient survived.
There was so much blood and the smell so strong, I felt I was tasting it. I stumbled, dizzy from this thought.
The attending suggested I might want to leave, but I didn’t. I thought about Ms. X and I thought about the blood. And I thought about the baby. We were there not only to fix a tear and stop the bleeding, we there to make sure a mother didn’t die. And that “we” included me.
In that moment the link between the alien internal flesh and the humanity of Ms. X crystallized. And I first realized what it meant to be a doctor. Even though I was only a medical student, this was still the responsibility I had sought — to buffer between sickness and health, between life and death, between joy and sadness, between a child growing up with a mother or without.
I remained. The patient received an unprecedented number of transfusions. The team emerged covered in blood, but the patient emerged with her uterus, one ovary, and her life intact. The next morning, when we entered Ms. X’s room, she was awake, with her hand draped over the edge of the bassinet resting on her baby’s head.
I made it through my first day, colored with blood and viscera. I remember my fright at being accountable, in whatever small part, for Ms. X’s mortality. I remember the beauty of her hand on her baby’s head. But what I remember best from this first day is knowing why I wanted to be a doctor. The patient is never just the physical symptom or the procedure, but a human, with all the complex history and social connections that accompany that state. To be a doctor means to treat humans, to support them and enable them to continue their own stories. Our stories, including my firsts, are just a small part of theirs.
Dr. Elisabeth Gordon is an integrative psychiatrist, sex therapist, and passionate proponent of education and discussion. She has a private practice in New York City and is a faculty member with the NYU School of Medicine Program for Human Sexuality. She can be found at her website www.psychandsexmd.com
