Tuesday, May 29, 2007

Punk

The 16 year old mom had been rushed back to the C-section because of a prolonged drop in the baby's heart rate. After laboring in relative boredom for most of the day, things had suddenly gone into high gear,with little time to explain things to the family. The mother was put under general anesthesia, so the father couldn't go back into the C-section room to see his baby born. After some chaotic hurried moments, the baby was born, and as is typical in these situations, the baby's first cries a few seconds after delivery were met with a collective sigh of relief.

I hadn't needed to do much for the baby, and as I was leaving the delivery area a nurse asked me if I could just let the family know how the baby was. Of course, I said, and went to the labor room where the new father, grandmother, and an aunt were waiting.

I walked into the room to see the grandmother and aunt looking expectantly and nervously at me. Next to them was the baby's father, looking a young 16 years old himself. He wore a skewed baseball cap, an oversize T-shirt, and baggy low slung jeans that didn't bifurcate into legs until about the level of the knees. He didn't even bother to look up when I entered the room but just kept staring at the floor. I sighed internally. Another young punk, I thought, not brought up with proper manners and certainly not prepared for fatherhood.

I told them the baby was fine and congratulated them, telling them the usual happy spiel about a normal newborn. The grandmother inquired about the mother, who was still on the C-section table, while the father remained uncommunicative, almost on the verge of seeming impolite. But then I noticed something wet drip off his cheek unto the floor. I looked a little closer and saw that he was crying, and not just crying but weeping profusely. I had taken his lack of eye contact and speech as a sign of impertinence, when in fact he was overwhelmed with emotion by the situation. He was looking at the floor not because he was a jerk, but probably because he was too overcome to do anything else.

Whether his tears and emotion were of concern for his girlfriend and baby, or joy that everything was going to be fine after the minutes of uncertainty, or of a new realization of the responsibility now upon him, I don't know. But I do know that I had judged too quickly. My heart went out to this young man who a few moments before had somewhat disgusted me. It would be a cliche but true to say that it reminded me I shouldn't judge a book by its cover. Maybe the lesson isn't quite so broad but just that, hey, punks have feelings too.

20 Comments:

Blogger Midlife Midwife said...

Lovely story. Thankfully our patients and their families continue to amaze us. And thankfully, we are often brought up hard against our prejudices and it softens us.

11:18 PM  
Blogger ERnursey said...

That's a very nice story. It is essential to once in awhile be reminded that we aren't as smart as we think we are, isn't it. Just discovered your blog, interesting reading even for an ER nurse who has a pathological fear of childbirth and slimy wet newborns :)

12:02 AM  
Blogger purple_kangaroo said...

Thanks for sharing this. Glad to see you posting again.

3:09 AM  
Anonymous Karen in KC said...

You have been missed... :-)

So very glad you are back!

9:51 AM  
Blogger Magpie said...

Sweet. Glad to see you posting again.

10:19 AM  
Blogger abby said...

This was lovely and beautifully written. Again, welcome back, ND!

1:37 PM  
Blogger buddhist mama said...

Welcome back, Neo. Given the shame in expressing emotions in our society, especially for men, no surprise really that this guy was staring at the floor rather than you. Then add in the inherent authority that you as a doc inspire and the age difference (I'm going to guess you are a tad more than 16) and of course the poor guy had no choice but too look at the floor.

But it was nice to know that your little world can be rocked and thanks for rocking ours as readers as well.

2:14 PM  
Anonymous Megan said...

THRILLED that you are back!!

9:44 PM  
Blogger Shannon said...

I am so happy that you are back! Great story..it is so true that you can't always judge a book by its cover. It is so easy to do yet sometimes we are so wrong.

12:30 AM  
Blogger amy said...

For those regular readers of this and other medical blogs, there is a front page article in today (5/31/07)'s Boston Globe about Dr. Flea being unmasked as a blogger. His malpractice case was settled.

The Boston Globe is online if you want to read the article.

9:14 AM  
Blogger Fat Doctor said...

Very nice post. Very, very nice.

2:02 PM  
Blogger Fat Doctor said...

Hey neonataldoc, I have a blog-oriented question for you. Please email me at the.fat.doctor AT gmail DOT com. Thanks!

2:18 PM  
Blogger Aidan's mom said...

I have always wondered why the father cannot be present if the mother is put under general anesthesia for a c-section. Is this always the case ND? Or is this a doc or anesthesiologist call?

3:22 PM  
Blogger neonataldoc said...

Aidan's mom: Good question. I think it's because the anesthesiologists don't want it.

9:40 PM  
Anonymous Anonymous said...

Regarding emergent cesareans and dads being in the room:

I'm an experienced L&D nurse with 14 yrs exp in several different states & hospital types. In our industry traditionally fathers or significant others are asked to wait outside during emergent surgeries--where they typically are left to panic and imagine all the worst possible things in the loneliest manner possible.

In a routine cesarean the mother is conscious and most of us want her to participate emotionally in the delivery of her baby. So we invite dad or grandma to come along too. Typically they're seated at mom's head behind a surgical drape that hides most gore if they're not inclined to watch. In my experience surgeons and anesthesiologists and nurses welcome that presence and share the goings-on as much as possible. If dad actually wants to see the surgery that's usually not questioned. They do have to wear surgical garb and they do have to agree to follow rules (ie don't touch the blue stuff).

But in an emergency everything changes. The anesthetist has to intubate mom and for multiple excuses we think it's not good for loved ones to witness that. Same for baby: parents are usually asked to step outside when we're intubating or doing something invasive.

I can't speak for the NICU environment...but for the emergent cesarean I think it's just a bunch of excuses.

"won't be safe" --assign somebody to keep them safe.

"too traumatic" --not being there makes it worse! assign that safety person with the intent that they can narrate events. In codes we use chaplains for this purpose....

"mom's not awake anyway--not needed for support"--yeah--because she won't have questions for years later about how it happened, what happened, how it felt, etc, etc. (being sarcastic here). Having somebody there actually feels supportive even when they're not "awake"

"makes me shaky"--well...frankly I want the provider to be confident and un-distracted, so this is as good an excuse as I can accept.

The American Heart Association has been telling us for years now that families do better if they're allowed to observe code situations. I believe we should extend the same courtesy to families experiencing emergency cesareans.

Thanks,
Olga, RN
Perinatal nurse

PS: SO glad you're back ND!

11:43 AM  
Anonymous Anonymous said...

I had also wondered why Dad's were not allowed to be present during general anesthesia C-sections.

I had a horrible experience with an epidural when my daughter was born and I'm currently 7 months pregnant. Lately, I have experienced a lot of anxiety should the need for a C-section arise. I'm absolutely terrified of another epidural to the point where I feel that I would require general anesthesia.

At the same time, I feel terribly guilty that I would be depriving my husband of being present for our daughter's birth.

I appreciate the insight and information regarding this.

Julie

1:11 PM  
Blogger Aidan's mom said...

The reason I wondered was that it was what happened in my situation. I developed HELLP and they did an emergency C. My DH was not in the room and was left to do exactly what was referenced in an above post...wonder if he was going to see either his wife or his baby alive.

I understand the idea that there are not enough people present to have somebody there to comfort a nervous father in an emergent C section. But is it really any better to leave a husband in the hallway wondering about whether or not his wife and child are going to die?

On another note...when I think about it I feel a twinge of sadness that neither my husband or I were really there to "greet" our son. He was met with nothing but strangers.

Gratefully as soon as they wheeled our son out of the delivery room and to the NICU, my husband followed him and was with him every step.

Lori

5:09 PM  
Blogger 23wktwins'mommy said...

I like this post.
It reminds me a lot of what people probably thought of my fiance and father of my 23 week twins. At only 21 years old, English as his second language, and extremely shy, I bet a lot of the medical team thought he was just some punk.
Nevertheless, everyone was always nice; and after 122 days in the NICU, they got to know who he really is...an incrediblely sensitive, devoted, loving father, who just may be the next 165 pound Olympic boxing gold medalist. Some punk.
Glad your back ND!

7:40 PM  
Blogger Erica said...

OK, so I am pregnant, but that post moved me to tears. Thank you.

6:33 PM  
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1:34 AM  

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