Please Take Away the Pain

I'm on call for OB today. This usually entails placing epidurals for laboring pregnant women and providing anesthesia if they need a c-section, whether it be epidural, spinal, or general anesthesia. Most anesthesiologists do not like covering OB. The patients are usually healthy patients who have high expectations for the arrival of their little ones. They, their families, and their nurses are often very demanding. This is in striking contrast to the rest of the patients in the hospital, who are often very sick, or dying, and appreciate the care we are providing. It is emotionally hard to work like h*ll to keep a patient barely alive after a car accident that comes in through the ER, then turn around and place an epidural in a whiny, whimpering, complaining, healthy female in labor. It's not that I don't appreciate what they are going through. I do. In fact I am one of only a few anesthesia providers at this hospital that has had epidurals placed in herself. I remember thinking to myself, "You want me to do WHAT while I am having the worst pain in my life? " when the anesthesiologist asked me to sit still AND curl around my baby like a shrimp. It was difficult. I know, ladies, I know. I have been there. I have felt your pain. Nonetheless, I do have a giant needle in your back, and any movement on your part is bad. I have told my patients that if they want me stop at any time, I will. If they feel that they can't sit still, they can ask me stop. Epidurals are, afterall, an elective procedure. In fact, one of my best friends had all 3 of her children without epidurals. Brave, huh?

Amidst all of my complaining about covering OB, I do like it. I am there for the special occasions of all these families. BabiesBabiesBabies! Little hands and little feet. I get to take part in a truly miraculous event. I am able to reminsice about the births of my own children, and remember how they were the two best days of my life, albeit the most painful days. And my ticket to these special events: I get to take away the pain.

Every so often, we are asked to provide epidurals to patients with a fetal demise; that is, a baby that has died in utero. Labor is difficult as it is, but to have to labor and deliver without the end result being a viable child is heartbreaking. In some ways, these epidurals are easier to place: the women are usually not in their 3rd trimester yet, so they are not big, and anatomically the placement is easier; they are not often in active labor, so the patients are less uncomfortable. But without a doubt, they are truly harder to do. I just placed one today. She was 23 weeks along, and had broken her water several days ago. The pediatricians and OBs had told her and her family today that the baby was not alive. She was induced, and later, she asked for an epidural. They called me, and I placed the epidural without any problem. Several hours later she delivered. I returned to remove the epidural, and I asked her if the epidural worked for her. She said yes. Instead of my usual series of follow-up questions about the delivery and the baby, I just told her how sorry I was for her loss. I wanted to give her a big hug and cry with her, but I didn't. I maintained my composure and gave her a slight smile. She thanked me, and I left.

This hadn't been my first fetal demise, but it was the most powerful one. This patient was truly sad, and the sadness enveloped everyone who walked into the room. Each one of us wished we could do something to help: her husband, mother, each of the nurses, and myself. And while I was able to provide her with a more comfortable labor, I was unable to take away her pain.