She and her husband arrive early evening, in the midst of rush hour, the busiest time of a very busy night in a very busy labour and delivery unit. My patient is close to delivery and as I make my way hurriedly to the desk to call the doctor, I catch her eye as she stands, still, the fear emanating from her.
I make the call and then move over to where she stands and ask if I can help in any way, her husband puts his arm around her protectively and pulls her closer. Her face is pale and pinched looking. 'My baby hasn't moved today' she whispers.
Immediately I'm torn between a patient who is almost ready to deliver, and this couple who look to me to right their world. The choice isn't easy, I don't want to absorb her pain, it would be easy to take her to the triage room and allow someone else to take care of her, but just as her pain pushes me away it pulls me close and I quickly reassign my delivering patient, take her arm gently to a nearby examination room.
As she pulls her orange and brown striped t-shirt up over her tummy, I notice she must be close to term, I ask her questions as I ready the fetal monitoring machine. She is just 3 days away from her due date, her husband sits on the window sill nearby as she climbs onto the bed, she shivers uncontrollably and I pull a warm blanket around her.
I spread the gel over her swollen belly and move the toco across her skin in a steady pattern, the room is silent as we wait to hear the steady gallop of a baby's heart beat. There is nothing. I keep trying, I talk reassuringly I keep moving the toco, I struggle to make eye contact as her eyes never leave my face. Still nothing. I suggest we do an ultrasound. The obstetrician who I had called for the delivery is on the unit now and comes down to see her. He has such a gentle demeanour and I'm so relieved it is he who is here. He puts more gel on her belly and runs the transducer slowly across her skin, he quickly finds what he is looking for, the baby's heart. All 4 chambers clearly evident on the grainy screen, but it is still, there is no tell tale flutter, no steady beat. Just a chilling unnerving quiet, and he doesnt have to say a word, he is sitting on the edge of her bed and as he takes her hand she begins to cry.
Her sobs become a slow wail which start from deep within her and quickly reach a crescendo, until eventually she is screaming with the worst pain any mother can imagine. She climbs off the bed rips off the toco and blood pressure cuff from her body, and vomits, again and again. Her husband, the doctor and I stand helplessly by. We try to touch her, to hold her and shield her and ourselves for the pain, but she shrugs us off, and sinks to the floor. We all cry. Reams of blank tocograph paper spills from the fetal monitor and onto the floor and I'm mesmerized by it.
Over the next few hours her grief changes her, she withdraws and slips into herself and allows us to take care of her physical needs. I start an IV and the induction process is begun, her contractions hit with astounding force. As the sun rises she has her epidural and sinks into an exhausted sleep, family arrive from San Diego. Her sister creeps into bed with her and holds her close allowing her husband to get a few hours of sleep. We are all ragged with emotion but the love in the room is tangible, a sense of peace and the beginning of acceptance settles over us all as her family pour all the love they can into her.
Shiloh is born a little after lunch, a beautiful perfect baby girl. She never draws a breath...