She came in weeks ago, blissfully oblivious to how her world was literally about to turn upside-down. We'll call her Suzie. She was at her routine 20 week ultrasound and they found that she was 4cm dilated. That's bad news. A diagnosis of cervical insufficiency, meaning your cervix just doesn't stay closed if any pressure is put on it. Previously, its been called cervical incompetency, somehow implying a deficiency on the mother's part, that she was incompetent in carrying a baby. An active high school teacher, Suzie was now given the choice of a 'rescue' stitch in her cervix and complete bed rest until delivery (with a fairly low success rate), or to just let labour happen and put in a prophylactic stitch early in her next pregnancy. Suzie and her hubby chose the procedure and bed rest. They desperately wanted this pregnancy, having already experienced two miscarriages. It would be at least 4 weeks until baby would even be a candidate for resuscitation at 24 weeks. As days went by, and turned into weeks, Suzie bled a bit, sometimes she cramped. Then we wouldn't even let her up to the bathroom and we but her in 'Trendelenburg' position, so she lay every day, all day, with her head far below her feet. Scared even to have a bowel movement.
At 23 weeks, babies born are not resuscitated, the cut-off for viability is 24 weeks, even then, only 50% actually survive and 85-90% will be blind, deaf, or have mental or physical disabilities. But parents can request resus at 24 weeks. After 25 weeks, resuscitation happens most of the time, regardless of parental choice. A strange set of rules, built like a fence around the ethical principles of trying to do more good than harm.
We were updated each day, until she hit 23 weeks and 5 days. Suzie's water broke, she went into labour and we had to take her to the operating room to remove the stitches so they wouldn't completely tear through her cervix and permanently damage it for any future attempts at pregnancy.
Some images will forever be burned into my mind, and this is one of them. A small, tight, shiny membrane slowly proceeding from the vagina, feet first. Tiny feet in a glass globe coming out towards us, each only 2 or 3 cm long with five delicate, miniature toes on each foot. Imprinting their footprints forever onto my heart as they came.
We swam in the sorrow and intensity of the moment. The air felt like viscous liquid around me. Their grief making waves that hit each person in the room. Completely enveloping me in the heart-wrenching, soul-destroying pain of the present moment. A father's tears dripping freely onto the face of his tiny tiny son, swaddled in towels, eyelids still fused. Time stood still. Masked faces in sterile gowns blurred in the periphery of the operating room and the only thing real was a husband and wife, a sister gazing and embracing this tiny being, silently yelling out in agony, guilt, and anger. Raw. Abject. The physical pain and emotional intensity of this delivery not followed by pure joy and sheer bewilderment at the miracle of a new living, breathing, crying being that most deliveries have.
I've watched dozens of partners, mothers, and friends watch their loved one go through the exquisitely miserable pain of labour. Some are so uncomfortable they have to leave often, to get ice chips, a blanket, anything, to feel like they are doing something. I remember one husband unable to coach or encourage, but could only hold his wife's head close to his, looking straight into her eyes, never moving for over an hour, being fully present in her reality with unspoken intensity. Its near impossible to watch someone go through such agonizing suffering and not be able to alleviate it or share their burden. Being a religious person, pain and suffering are central to my understanding of our place in the world and really, a huge part of what life is all about. Sharing in the messiness and aching of humanity, crying out in unison at all the injustice that life may bring.
This past week, a dear dear friend of mine had to have labour induced after her baby was found to no longer have a heartbeat. It wasn't unexpected, and we had discussed all sort of options and decisions they may have had to make in the future. But the all-consuming brokenness and grief that comes with the loss of a child, with all the hopes for their future is devastating. It gave my experiences at work a whole new meaning. Dimensions that I never imagined were clear to me, as I saw my friend's story in each of my patients. Her fears and her dreams, and now her brokenness. There are no neat answers to explain the pain. No glib words of comfort or encouragement. This all-consuming pain must be experienced completely and without filters.
Pain is a personal thing. You can witness it, you may even share in it and feel like you're drowning in it, but it must always be owned. You can't take it away from someone else to free them from it. Somehow, unexplainably, I find hope in the midst of these messy emotions. A hope found in the knowledge that this pain is at the center of what it means to be truly human.
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