3/4/05

Newborn medical students
And other miraculous beginnings.

My new Medicine Mensch article, written between deliveries.

And here it is in full:

MEDICINE MENSCH: Bringing Up Baby — and Doctor
March 4, 2005

Even God needs help when making miracles. He sent a wind to split the Red Sea rather than doing it directly; Moses took intensive elocution lessons before he could shout the Ten Commandments down to the Israelites, and the walls of Jericho could well have been jerry-built by history's first unscrupulous contractors. Add to this list the Miracle of Birth, which requires a number of gadgets that whir, beep and gargle to help doctors coax new life into the world. As I begin my rotation in obstetrics and gynecology (OB/GYN), I know to treat these machines with wary respect, stepping aside as the all-powerful nurses set them up, then copying down their flickering readings with equal parts diligence and ignorance. One new mother attached to a monitor wanted to know whether her blood pressure readings were good or bad. "They went up, and now they're coming down," I answered lamely, to her silent dissatisfaction.

A few days ago, for instance, I participated in the delivery of an ultra-Orthodox woman's baby. Most such women, though young, already have a number of kids, and respond to my questions either in blasé fashion or with outright impatience, aware that they know their own physiology better than I ever will — after all, it's served them for the past four or five children. Their next birth will be fine, God willing, and, in any case, they've got an experienced obstetrician waiting in the wings to help make sure the miracle proceeds as planned.

When I say "participated in the delivery," I mean that at first I stood in the corner, paralyzed with fear, hoping that if I were asked to catch the baby, it wouldn't slip out of my hands like a wet trout. (Newborn babies should come with grippable surfaces, as do basketballs or pistols.) As it turned out, I did leave the corner, when invited by the attending physician to help support the mother's body and the baby's emerging head in a way that made me think I was helping. (This is an essential part of teaching: making the student think he or she can be of service even when it's not the case.) I put three fingers on that warm, black-haired dome and, together with the doctor, gave a gentle pull. The newborn flopped out purply with a healthy cry, caught by the doctor, or — more important to my terrified self — someone other than me. I didn't drop anything! The baby was transferred carefully, but with great speed, to a couple of waiting pediatricians.

This is the point when the father swung into action with his own piece of equipment. As the pediatricians hovered around and above the child (I thought doctors and father were going to butt heads, but, by another miracle, they did not), Dad held his cell phone up to the squalling bundle, broadcasting its cries to a grandmother in Brooklyn. The father returned the phone to his ear, said "Mazel tov" and burst into tears. (He had been in the room the whole time, learning Torah, carefully training his eyes on the monitor or out the window when the mother-to-be, his wife, was convulsed in another epic round of pushing.) His wife asked him, in Yiddish, "Host yeder gekolt?" ("Did you call everyone?")

Off in the corner where I stood, another birth was taking place, helped by nature and by medical school, if not quite by God. A new medical student — me — was coming into the world. Sure, this is my second rotation, but the first, though fascinating, was the decidedly nonstrenuous 9-to-5 Psychiatry rotation. The first couple weeks of OB/GYN has you working from 4 in the morning till 7 in the evening. The unit in which I'm stationed delivers around a hundred babies a week. Here, what's miraculous is the transformation of the act of birth from the breathtaking to the manageable. "This is not normal," one new mother said, smiling through tears, trying to describe her feelings as she watched her baby being cleaned and monitored by the pediatricians. "Every delivery is different," the doctor responded, friendly but underwhelmed, as he sewed up an incision.

A miracle becomes everyday through systematization. The people were stunned by their first exposure to the divine voice, and refused to listen to God after his first words, but Moses had done it a thousand times; for him, it was already routine. When I see a pregnant woman, as ripe as a watermelon, warily approaching the secretary to say that she's here to give birth, I realize that this might be the first time she's ever said those words, while it's maybe the millionth time they've been uttered on this floor. Miraculous acts are not available to the medical student, but a short interview and physical exam, performed in the service of routine medical evaluation, can make sure that the abnormal and the wonderful give rise only to results that can be treated and managed. At least in the medical realm. As for raising the children themselves, that's an even more slippery fish to catch.

Zackary Sholem Berger received his doctorate in epidemiology in January from New York University. Now he's becoming that mythical figure, the Jewish Doctor. His OB/GYN rotation lasts until Purim, when he will not deliver any babies while drunk — or sober, for that matter. Questions and comments can be sent to doctor@forward.com; no medical advice given.

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