A Resident’s Grief

In his last post, Elorm shared his first experience of confronting his emotions as a physician-in-training. In this post, Elorm shares an experience of watching more senior physicians grapple with loss.

Author’s Note:  No patient names or identifying characteristics were included in this story.

Almost every ward in the hospital exists to confront disease and death. The labor and delivery unit—L&D, as it’s called—is the lone exception. With babies being born in every room, L&D is a daily celebration of new life. I’ve often said that it’s is the happiest place in the hospital. In my third year of medical school, I was assigned to a rotation there.

As a medical student, I had little medical expertise to offer my patients. I was mostly a spectator. This was true on most hospital wards, but it was especially true on L&D. The work was so fast-paced and so delicate that no one was willing to trust me with much. I was a glorified observer, but I didn’t mind. Each day, I had the privilege of experiencing that magical moment when a living, breathing human emerges from within another, when dreams of parenthood are finally realized, when little boys and girls are called “big brother” or “big sister” for the first time, when “Mom” and “Dad” join the esteemed ranks of “Nana” and “Pop”, when a family is transformed forever.

As had been my routine, I was assigned a patient one morning and went to go see her. She was a first-time mother-to-be accompanied by her husband. They had been married almost a year prior and had immediately set about to become pregnant. His excitement could be plainly heard in the way he spoke: eagerly, a little too loudly, a little too quickly. When she wasn’t grimacing with pain from increasingly frequent contractions, she lay on her back with her eyes closed, breathing slow, deliberate breaths and smiling as her husband offered words of encouragement. Though less expressive than her husband, she was excited too. I was excited for them. We were all awaiting the transformation.

The obstetrics team attached a fetal heart monitor to the woman’s belly throughout her labor in order to keep track of the baby’s wellbeing. Hour after hour, through her many contractions and as she tossed and turned in search of a comfortable position, the heart monitor showed a normal reading. The senior resident monitoring her progress finally decided that it was time for her to push the baby out. Shortly after that assessment, as we assembled the disposable gowns, gloves, and protective visors that we’d need for the delivery, the heart monitor signaled an abnormality. The baby’s heart rate began to rise unexpectedly.

More doctors and nurses were called to the room. Where the air had been light with anticipation, it was now thick with concern. The neonatal intensive care doctors were summoned in case the baby would need to be resuscitated. The pregnant woman was preoccupied with the task of delivery, seemingly unaware of all that was happening around her, but her husband could tell that something had changed. While rubbing his wife’s forehead tenderly and bending over to whisper gentle reassurances, he looked around the room at the mob of medical staff as if asking us to give him updates with our eyes.

When the newborn finally emerged, he was gray and listless. I waited for the newborn’s cry, the universal sign of a successful transition to the outside world. But he didn’t. The obstetrics doctors handed him to the intensive care doctors, who began resuscitation efforts. They vigorously rubbed his chest and the soles of his feet, hoping to irritate him enough to make him cry. He wasn’t breathing on his own, so they placed a breathing tube into his throat to help deliver oxygen to his brain. They administered multiple medications according to their resuscitation protocols. Despite all their interventions, the doctors couldn’t find a heartbeat. They ultimately placed the baby in an incubator and whisked him away to the intensive care unit for further treatment. Though I didn’t know it at the time, all of the doctors and nurses understood that the baby likely wouldn’t survive the night.

In the aftermath, the attending obstetrician gathered all the residents and nurses in a huddle outside the patient’s room. I noticed the senior obstetrics resident. She had been the woman’s primary obstetrician throughout her pregnancy and had directed her care in the hospital that day. Standing to the side of the huddle, she stared into the distance, shaking her head slowly.

Our attending acknowledged the gravity of what we’d all just witnessed and attempted to frame it so that we could digest it. “It’s a tragedy when this happens,” she said, “but it’s a miracle that it doesn’t happen more often.” She was right, of course. Childbirth has historically been a deadly experience for mothers and babies alike. That a tragic birth outcome is a surprise rather than an expectation is a testament to the advances of modern medicine. I steeled myself with those words, and with the lessons I’d learned throughout my rotations. Life happens. Death happens. I had seen behind the curtain.

I left the team huddle and headed to the break room, unsure of where else to go. I opened the door to find the senior resident sitting alone with her face in her hands. She picked her head up suddenly as if to see who’d invaded her privacy. She was weeping. Silently. Violently. Tears streamed down both sides of her face. She didn’t wipe them away. Her eyes were reddened and already swelling. She stared at me for a moment, the kind of blank stare I understood to mean that there was nothing to be said. I quickly turned my gaze to the floor as if to pretend that I hadn’t seen her, strangely feeling that doing so would preserve her dignity. Without speaking a word, I walked backwards out of the room and closed the door.

I walked away from the break room and leaned against a hallway wall to try and process what I’d seen. I felt guilty for having seen my senior resident undone. More than that, I was confused. I couldn’t quite understand why she was so distraught. I’d only been in the hospital for a few months by then and I had already learned that death happens—hadn’t she? She was years further in her training than me and had seen many more patients than I had. Surely, she’d lost many more patients as well. Why, then, was she so upset by the loss of this patient?

We’d all just been through a horrific experience, and perhaps she’d just been overcome. Looking back, I see the arrogance in this thought. (Regrettably, I also see that it was sexist.) I’d only been a spectator to the whole episode and didn’t yet have any idea what it meant to be responsible for someone’s care, and yet I assumed that I wouldn’t cry over patients by the time I reached her stage. I never settled on a conclusion as to why she’d wept that day, and though I worked with her for weeks afterwards, I never had the courage to ask.