Free Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER by Pamela Grim Page B

You brace yourself against the end of the gurney and lean forward. Her bent legs are on either side of you. You insert two fingers of your right hand through the lips of the vagina. They slide in a couple of centimeters and then you meet an obstruction. The baby's head…is it a head? Yes, it's a head. With your two fingers you explore the vaginal vault. You are feeling for the cervix, an anatomic landmark whose present condition can give you a clue as to just when this baby is going to pop out.
    Ordinarily the cervix is about three centimeters long; it protrudes like a little short nose into the vaginal vault. During a delivery, as the baby is pushed out of the uterus, the cervix flattens, and the cervix's central opening dilates. This is what you are feeling for as you try to figure out how close that baby is to the real world and the rest of its life.
    You sit on a stool next to her, grope around for a bit and finally peg this lady at about eight centimeters. She is going to deliver soon. No chance to get her to another hospital.
    As you grope around inside the patient, she is moving all over the gurney. “Stop it,” she keeps telling you. She rises somewhat to slap at your arm. “You're hurting me.”
    “
I'm
not hurting you,” you say. “
You're
having a baby. That's what's hurting you.”
    “I know,” she says, still wiggling all over. “But you don't have to be so rough.”
    “
Lie still!
” Helen thunders and for a moment again the patient lies still.
    Helen has taken over the Doppler and is moving it across the woman's abdomen, still looking for fetal heart tones. “I'm not getting anything here,” she says.
    Carol bangs through the doors with a blue cart, the pediatric crash cart.
    “She's eight centimeters dilated,” you tell them. “Not quite there.” You turn back to the patient. “When is your due date?”
    “I don't know,” she says, and she begins thrashing around again.
    “What do you mean you don't?”
    She looks you square in the face and spits out the words. “I mean I don't know because, you asshole, I don't know.”
    This stops you. The chaos is overwhelming. She doesn't know her own due date, you think to yourself. You stand there for a moment, a gloved hand buried deep inside this woman, baffled as to what to do next. Weird words and phrases fling themselves into your consciousness from some deeper place. They are words that dazzled you in medical school:
platypelloid pelvis, deflexed vertex, synclitic, anaclitic.
You must have known what they meant once, though now they seem incomprehensible. But as you try to remember, raising your free hand up to your forehead, there is a stab of bright light in your forehead. Déjà vu.
    You dreamt this before, or maybe lived it. About a case of appendicitis. You were a first-year medical student, and you were standing in an OR suite with the dean of the medical school. He was ordering you to perform an appendectomy on a young boy laid out before you both on an operating table. You had instruments in your hand, but you were doubting yourself, saying, “But if I do surgery on him, I know I will kill him.” The dean seemed to loom larger and larger before you until he towered over you. He was bellowing the whole time, “I don't care if you kill him or not, just do it.” You remember now, if not the whole dream, at least the feeling it evoked, the terror. You remember then that feeling that you could hurt someone; they could be trustingly asleep and you would destroy them.
    That feeling is here now, though it's not so overwhelming or paralyzing as it was in the dream. You look down at the patient and she seems very far away. You look around and that's when you see that everyone is moving very slowly—there is time, you think, there is time to think. You reposition your hand as the Woman starts grunting, going through another contraction.
    “You get anything?” you ask Helen, who is still trying to get fetal heart tones with the