Milena Forte is a family physician at Sinai Health and an Assistant Professor in the University of Toronto Department of Family & Community Medicine
Weekends have lost some of their meaning during the COVID-19 pandemic. The structure of the week is one casualty of the pandemic. One Saturday evening, I received a text that one of my patients had come into the hospital in early labour*. She had been into triage a few days earlier but at that time, she had not been in labour so we sent her home. She said was not equipped to cope with pain. Understandable perhaps, given that she was a single mom with an unwanted pregnancy from a partner she considered less than desirable and on whom she had a restraining order. I’ve been her doctor since I delivered her daughter sixteen years ago. She’s funny and resilient and, over the time I had known her, I had gained her trust enough to have seen her smile on occasion.
The night progressed and so did her labour. By dawn she was 7cm dilated with bulging membranes. She was visibly grateful when I arrived, despite my masked appearance. She held my hand tightly (a breach of the social boundaries in the outside world) and asked me not to leave. The resident that had followed her pregnancy with me had also come in to the hospital, partly because she realized, as I did, that this patient had almost no one else she could rely on. When we asked her how she would be getting home the next day, she responded that a friend had agreed to call her an uber.
When it came time to push, she was despondent. When her nurse tried to soothe her, she responded with a stinging reminder to us: “You don’t understand, I didn’t want this.” But we did understand; her social circumstances being the main focus of our care for her over the past several months. Despite her epidural she was in tremendous discomfort. She writhed in the bed and blew away her contractions despite the overwhelming urge to push. Eventually, she found the strength to bear down long enough to push baby’s head out but the shoulders did not follow. I moved onto the bed to gain some leverage to resolve the shoulder dystocia. What seemed like an eternity later, sweaty and exhausted under my PPE, I pulled her baby out and handed him over to the resuscitation team. After a few minutes, he started to breathe on his own. I breathed as well. A heavy breath, exaggerated under my mask. It was a tough delivery, and would not be an easy postpartum course, but he was here, and in her arms. And they shared a birthday. I drove home and wondered what life would now be like for them.
A few hours later, I received a text indicating that another of my patients was in labour. Her first labour had been fairly rapid. She had gone unmedicated then and was likely to do the same again. She had a supportive partner, an excellent understanding of the birthing process and an unflinchingly positive attitude. She did not need me there, but I wanted to be there so I kissed my kids and headed back to the hospital.
Soft call is a funny thing. The longer you do it, the harder it is to stop. I have been practicing soft call obstetrics for twenty years. Some days I wonder how much longer I can do it for. And then there are days where I am struck by the incredible privilege of participating in this most intimate moment in someone’s life.
I arrive at dusk to find my second patient progressing beautifully, seemingly unbothered by her very active contractions. When it’s time to push, she shows the slightest signs of discomfort and her husband takes her hand. Within minutes her baby is born and she is unscathed. We place him immediately onto her chest and watch her instantly bond. I am inspired and touched, but cannot help feeling a twinge of injustice for my patient a floor above, alone on her birthday with a newborn son she will no doubt love but did not plan on having. I have learned it is not my place to judge or even feel sympathy for situations I cannot fully understand let alone control. I can empathize. But that day I was acutely aware of how different these two births were, and of how different the lives of the babies born were likely to be. It was hard not to be affected by it. Some births stay with you long after you leave the hospital. I am grateful to have been a part of these two women’s stories.
*Patient consent to publication obtained.
Very impactful patient stories and well written.
Thanks for sharing this thoughtful blog, Milena. I don’t know when you get time to write, given your multiple competing priorities, which includes the thoughtful and compassionate care that your patients receive. I particularly appreciate the gratitude you shared in your blog, and the silver linings found amidst the pandemic we are going through!
Rita Vander Kant
Milena u r a great doctor and your patients do matter to u they should all be thankful to have you by their side!