A letter for you

Christine Motheron

It was a hot July night. My last shift of the week. I had been busy all day, as I always am in obstetrics. I was back home for a few hours of well-deserved sleep when I was told that a woman in labour had arrived.

Your mother hadn’t been my patient for very long. She had just moved into the city. Within two visits, I had heard her story. Your parents had been trying to have a baby for many years. Naturally, at first. Then with the use of the available modern medical procedures. An exhausting course of treatment with a possibility of a pregnancy that grew less and less likely. Hope gave way to bitterness and finally to disappointment. Over the years, your mother and father came to accept that they would probably never have a child. They had thought of adoption, but now what they mostly needed was time.

They hadn’t counted on you! Now, against all odds, three months after having stopped hormonal supplements and insemination, and having undergone two cycles of in vitro fertilization, your mother did not have her period as usual. Nature had “outsmarted” science!

Back to me, en route to the hospital, this time to attend your birth.

When I arrived, your mother was smiling and enduring the pain of contractions very bravely. The labour was long, as it often is with a first pregnancy, but was progressing well. Your parents told me again, between contractions, that this pregnancy had been a miracle for them and had gone marvelously. Their happiness was obvious and contagious. Your mother pushed hard as she felt you descending and approaching birth. It would not be long before they would be able to see your little face. What an event!

But suddenly, something serious happened. In just a few minutes, everything came tumbling down. Your mother began to bleed. A lot. Your little heartbeat was too slow. Much too slow. It would not resume beating normally. We quite literally ran to the operating room to perform a cesarean.

Time stood still ….

It was an interminable wait ….

The diagnosis came as soon as the surgeon opened your mother’s abdomen. A massive separation of the placenta. One of the most dreaded complications; one that you usually only read about in the chronicles of experienced doctors. The cocoon that had protected you for months was letting you down. On the resuscitation table: I waited with a team of anesthetists and nurses for you to arrive. I kept my cool in spite of the concern that gripped me inside.

You were not moving when you arrived, your arms limp, your eyes opened, your skin pale. We tried everything to restart your heart and get your lungs working.

Finally, we had to transfer you to neonatal intensive care to watch you closely. You had a very long way to go ...

Later that day, I went to your mother’s room to try to explain the unexplainable. I saw your mother on her bed, still groggy from the medications, and my professional demeanour disappeared. A tiny baby blanket was spread on the little bed where you should have been …

At that moment, I was no longer a doctor. I was a mother facing another mother in distress. We didn’t know if you would pull through, and I couldn’t make any promises. We would have to see how the next few hours would unfold. I felt helpless and sad.

My shift was over; I was numb. I needed to go home to my children ….

I cried often during the next few days, unable to break away from the human drama I had witnessed. And worst, which had taken place in my care. How could the most beautiful day in your parents’ lives become, in just a few minutes, their worst nightmare?

You don’t learn how to deal with such emotions until they become brutally apparent. You feel like an acrobat without a lifeline. None of the difficult pregnancies of the past ever prepares us for such a shock.

As obstetricians, we are most often rewarded as professionals with immense joy: that of having the privilege of being on the front line, of helping to bring new life into the world, of sharing exceptional moments in the lives of parents, of having the satisfaction of accompanying and helping with such an important event. In spite of the medical and technical aspects of birth, the emotional aspect fills me every time I see little babies, so wanted, their parents bursting with pride and happiness. It’s one of the reasons I chose to practise family medicine obstetrics. The medical challenge is always there. But the human element, the rewarding feeling of participating in the most exceptional moments of the lives of people, is a large part of my obstetrics practice.

After 24 hours, you continued to rely on life support and medications to stay alive. Your prognosis was pessimistic. Your parents decided to let you sleep peacefully. Forever. Painfully, they let go of their dream of having a child.

Then there was the funeral home. A funeral for a baby. How do you cope? The idea alone is untenable. But I had to go, if only to let your parents know that I was not indifferent to their pain. Far from it. My life and my career had not followed a straight line. Your life was not just another case in my day-to-day work. But most of all out of respect for you. To honour the courage that you showed throughout your dramatic birth and short life. You were so beautiful in your little wicker coffin. So small …

I think of you often. And of the fragility of existence. The memory of that summer night is always alive. But deep inside, I know that your short passage through my life has allowed me to become a better human being and a better doctor. And, I hope, a better mother.

Christine Motheron MD CCFP

Winner, AMS–Mimi Divinsky Award for History and Narrative in Family Medicine for a Story Written in French.

Dr Motheron is a family physician and a professor of clinical family medicine at the UMF Maizerets and of obstetrics at the CHUQ-Pavillon St-François d’Assise, which is affiliated with Laval University in Quebec city, Que.