The Road Less Travelled

I just finished another on-call weekend, the second to the last weekend I will have to be on-call this year.  It turned out to be among the “most brutal” on-call weekends I can remember from recent years.  I worked from 7A.M. on Friday morning to 3P.M. on Sunday when I got to leave the hospital and see the remainder of a sunny but windy day.  The wonderful nurses on Labor and Delivery suite seeing how tired I was, after more than 36 hours working without sleep, “protected” me by allowing me to sleep for six hours on Saturday night into early Sunday morning by not constantly calling me like the night before.  

All my plans for doing errands were trashed.  I have always used my on-call weekends to do mundane errands such as grocery shopping, car washing, going to the pharmacy to get new hand lotion or shampoo etc… I was even a bit annoyed that I was assigned to a weekend where the time changed, and I ended up working one EXTRA hour without compensation.  There is NO justice, I said to myself.  How did I bounce back so quickly in my younger days where I had to work 36 hours without sleep? I was in my twenties back then when I was an ObGyn resident.  Except for an incident when I would have walked into the wrong apartment if I hadn’t heard my mother’s calling, and another incident when I almost fell asleep at the steering wheel on the highway while driving my mother back to Northern Virginia from Baltimore, I did very well.  I can’t stay up without being a little cranky or having a little headache nowadays, showing how the biological clock works.  I can exercise vigorously to slow down my biological clock, but I can’t turn it off!

Despite my extreme fatigue when I reached home on Sunday afternoon, I realized how much I love medicine.  I helped bring ten lives into the world; I witnessed the beginning of ten lives, as magical as watching a sunrise.  I heard the painful screams of the moms before they turned into laughs of joy as their babies emerged into the world.  I saw fathers shedding tears while trying to smile at their newborns.  How many instances in life can make you laugh and cry at the same time?  Not too many, if you think about it.

Every birth, like every sunrise, has its uniqueness.  Not every sunrise is spectacular.  Sometimes, the heavy clouds hide part of the sun, while other times, the sun can’t be seen at all.  Childbirth is very similar.  Not every child comes into the world in perfect shape or form.  Some end their journey prematurely and tragically.  

This weekend’s deliveries reminded me of how the world operates, with us being in the steering wheel but only with a certain degree of control.  When I rushed one of my patients into the operating room for an emergency cesarean section, as her extremely premature baby was showing signs of distress, my heart sank as I saw the desperation in her eyes.  She was an older woman with several serious medical conditions, and this probably will be her last chance of having a child.  I tried to reassure her, before she was put under general anesthesia, how she was going to be “OK.”  I told her how I was going to try my best to deliver her baby safely.  I didn’t reassure her how her baby would be “OK” too.  I felt guilty not saying something in that nature, but I think she was too smart to know the gravity of the situation.  Hope is a wonderful thing a physician should share with patients, but false hope is never a fair thing.

As I delivered the tiny baby, just big enough to cover my two palms, and handed him to the neonatologist, I thought about how, at that very moment, there are so many lives doing so many different things.  It was early Saturday morning, and my bootcamp was underway.  Some of my friends were exercising while others were on trips abroad, and from the talk in the operating room between the nurses, everybody had a place to go and a thing to do.  Outside the hospital, somebody was having breakfast with his family, somebody was running along the C&O canal, somebody was watching his children playing sports… In the operating room, my patient was asleep unexpectedly, while I and the surgical team were desperately trying to save her child.  Life and death have a vague boundary in an operating room, like tears and laughters in a delivery room.

After the delivery, I called home to check on my family.  I reminded David how we were supposed to give “the teenager” more independent time.  We watch over him too much, he complains.  Is there such a thing of parents watching over their young ones too much?  I told David how annoyed I was on and off with “the teenager,” who, like other teenagers, seems to be too “relaxed.”  They need to be more organized, more disciplined, more aware about how grave the world can be if they do not put 100% effort into whatever they are doing. Why can’t teenagers have perfect executive functioning like their brilliant parents?

The reason I love medicine, I realize, is how it “readjusts” my perspectives on the important things in life.  When I held that tiny baby in my hands, before passing him on to the neonatologist, I realized how lucky I was, as much as how lucky my teenager was.  At least, he got to see his teen years.  It could have all ended when he was three, with his deadly cancer in the last stage.  He survived it to be a teenager who’s trying to reason with his parents on how his world should operate.  I was not so sure this tiny baby will see his teen years.  It will be a very rough journey for him in the next few months with many potentially damaging consequences.  Will he live to be a teenager?   With his life being totally dependent on his doctors and all the modern medical equipment in the NICU; will he someday have the chance to ask for his independence?

Several weekends ago, when the fall leaves reached their peak, David and I asked Sandy to hike the Billy Goat Trail on the C&O canal with us.  He reminded us he didn’t like hiking as much as playing basketball, especially when he had to hike “alone” without any friends.   As many parents have warned us years ago, teenagers don’t often want to do things with their parents.  After much futile effort trying to persuade him to go with us, we left him home.  The views on the Billy Goat Trail were spectacular as we stood on some cliffs looking out to the Potomac River.  I was bothered at first by not having Sandy seeing the same views with us, until I saw a big tree leaning over one of the paths on the hiking trails.  The roots of the tree were so visible on the ground, like a school of snakes running to different directions.  It was a teaching moment when I realized as parents, we can’t keep all our children together forever.  Some will want to be artists, others businessmen, or healers.  Some will move to the West Coast, others abroad. They all start from a big tree, then head to different directions on the trail.  The tree can only hope its roots will reach the fertile soil and water, but it can’t direct where they will go next.  

I never like to watch spectator sports, or play tennis, like my son and husband, and they never get annoyed at me for not doing so.  Why was I bothered when Sandy wanted to play basketball on a beautiful fall day instead of hiking on the C&O canal?  Doesn’t he have his own mind, and don’t I want him to be an independent thinker?  As we called Sandy from the car to let him know we were on our way home, we could hear the bouncing ball on the ground.  He informed us he was playing basketball by himself.  I was impressed at his multitasking, holding the phone with one hand while bouncing the basketball with the other.

Maybe my husband was right.  Someday, Sandy should learn to be more flexible and go for a hike on a beautiful fall day, as I should be more flexible and sit down to watch a Duke basketball game with them during some Final Four events.  I never understood why they screamed and yelled at the TV during these games, just as Sandy probably never understood why we had to hike so high up just to see the fall leaves, as he can see them everywhere in Potomac.  Maybe he is too much like me.  We both have our own passions and individuality.  That’s how the world operates, with everybody doing different things and having different goals.  To see the tiny baby being born last Saturday, I should be glad that Sandy can play basketball.  I wish for this tiny baby to grow up and play basketball.  He doesn’t need to hike with his parents, just grow up and play basketball.  

I made rounds on my patient Sunday morning.  She was pale and tired.  Her baby was doing quite well in the NICU, for his gestational age and his weight.  He probably is a fighter like his mom.  I am sure many people, unlike me, would wonder why she had to try so hard to be pregnant with him.  Why not adopting a child?  Why not enjoy life the way it was instead of playing against nature?  She could have run along the C&O canal on this beautiful fall day.  She could have breakfast somewhere with her husband.  Instead, she was alone in the operating room, frozen in fear for her life and her own baby’s life.  Which way would have been better?

Truthfully, she did what was best for her.  She was one of the roots of this giant tree of life.   She knew what her heart was yearning for, what would make her happy and what would make her life meaningful.  She understood the risks and the trade offs.  Happiness carries a certain price and she was willing to take the chance for it.  It was appropriate that I felt sorry for her and for the long struggle her tiny baby will face.  I, however, should not feel that she had made a mistake.  Everybody follows her own path and her own desire.  That’s how the world is in balance.  That’s how the world should operate.