Medical Error

The Delivery … of a Medical Mistake

July, the month interns start their training. That’s true every year.

Before residency work-hour restrictions were instituted, interns stayed in the hospital until the work was done. There was no “signing out” and going home. That’s how I entered and grew in the medical field.

My longest workweek was 128 hours. So, of the 178 hours in a week I spent 40 of those outside the hospital.

Then this …

“Push”

Enough already I think.

“Push!”

Come on, let’s get this over with.

“Push!!”

Come on now, don’t you want to deliver?

“Puuuuuuuush!” I command.

The parturient in lithotomy position before me begins to focus. Bearing down, she complies with a vigorous push.

The nurses flanking her and supporting her legs encourage as well (and far more cheerfully than I). “Push, dear. Push and hoooold it. You can do it. Push this little baby out into the world.”

We labor together. We’re a team, but the mother, as always, does most of the work. The nurses, my “assistants” know way more than I do. I’m strictly a bench warmer. The ragtag team member.

As the intern on his OB/Gyn rotation, lent to that service from the emergency department — where I belong — I feel like I’ve attended a billion deliveries during my month there.

I could do this in my sleep I think to myself.

And that’s a damn good thing because I am practically comatose. My stupor, the result of far too many hours at work, in the days well before medical trainee work-hour restrictions.

I’m bobbing and weaving, micro-sleeping like a tortured prisoner, while my patient pants and blows.

The baby’s head emerges, finally. I suction the tiny mouth and minuscule nostrils. It’s a textbook delivery, a “spont,” medical shorthand for a spontaneous vaginal delivery.

Nuchal cord my moribund brain warns. Check for a cord around the neck.

I do; it’s not there.

Now I’m entering the home stretch, on autopilot. The obstetrics resident, my supervisor, my superior, has left the room.

After this one’s done I can lie down for a few minutes.

I want the bed so much I can taste it.

Another gentle push with minimal downward pressure by me and the anterior shoulder delivers. The slightest upward pressure next, and there’s the posterior one too. The rest of the baby’s body glides out.

Gently I grasp the flexed wet infant. I haven’t dropped one yet; and I’m not going to start now.

Quickly drying and wrapping my slippery new charge I begin to stand and step away from the delivery table. I’m ready to present the earth’s newest to her proud mother.

But halfway through my first pace, the mother begins to follow me.

What’s this?, I wonder in a fog. Why is mom trailing me?”

The mother slides subtly toward me and emits a low moan. Even the normally cool, calm, and collected nurses seem concerned.

Then in an instant, it hits, like an electric jolt. I’ve committed a “minor” oversight in my well-rehearsed delivery sequence.

How does it go again? The baby connects to the umbilical cord and that connects to the placenta and that, in turn, connects to mom, at least for now.

With my brain on standstill, I almost walked away with a baby still attached to its mother!

After voluminous, crimson-faced apologies and much propping up from the ever-supportive nurses, and the completion of ALL stages of labor, I exited, feeling slightly lower than a worm with poor posture.

Thankfully the thoroughly-overworked new mother graciously understood and was quickly distracted by more pressing concerns.

I slunk off to bed. There, despite crushing fatigue, I stayed awake for about a nanosecond berating myself before sinking beneath the waves of a soothing reprieve from shame.

No harm was done, although my then-fragile psyche took a clubbing. I’ve never forgotten the incident. Paralyzing fatigue conspired with a brief attention deficit and disaster nearly resulted.

Thankfully though, the only outcome was a dose of embarrassment sufficient to last me a lifetime.

In 2004 a similarly self-flagellating but more-sophomoric version of this tale appeared, outlined in red, in the British Medical Journal.