A Day in the Life of an Obstetrician: On Gratitude

Monday morning, I turned my cell phone on at 7:45 AM as usual, after having a cup of coffee in my breakfast room and skimming through the newspaper.  One of my partners called, informing how a patient I admitted several days ago for severe fatigue during pregnancy had fallen out of her hospital bed last night, right in front of her husband.  She was a vibrant 45 year-old woman who had an unplanned pregnancy after having her now two teenagers.  She was a diabetic and a caring mother, caring enough that she was reluctant to take her oral medications for fear of harming her baby.  She was doing well until a week before when she had poor appetite, headache and insommia.  The last week before her admission, she stopped eating, drinking, taking her insulin and she barely slept.  She was sent to the hospital from my office when my partner noted she could hardly move. 

My patient was transferred to the ICU after the fall and becoming unresponsive.  A head CT scan shortly afterward showed a massive brain tumor.  Later in the morning, she had emergency surgery and it was confirmed that she most likely had glioblastoma multiforme, an extremely aggressive brain cancer, the one that killed senator Ted Kennedy and, more recently, Vice-president Joe Biden’s son Beau.   

Ironically, I had attended a meditation session with my group of physician friends the afternoon before my patient’s fall.  We discussed the topic of gratitude, about how we should learn to be grateful for our moments and to recognize our joy, often hidden behind our sorrow.  We read out loud to others some items from our “gratitude” journals which we had kept for seven weeks.  We all had cited similar things we were grateful for, a sunrise, family love, good health, friendship…

I drove to work in shock upon hearing the news about how my patient had gone from being a busy working mother, to a very sick pregnant patient with terminal brain cancer. 

I felt grateful simply for the smooth ride to the hospital, surrounded by the lushness of spring with cherry blossoms and wisteria cascading from the young branches awakened after a long winter.  I was grateful for being free of pain or sorrow, of hardship or heartache, for that moment, except for the heartache for my patient and her family.

Later in the evening, I went to the ICU to visit my patient’s family.  She was in DNR or Do Not Resusscitate status.  Her death was imminent, with her life sustained artificially through the ventilator.  Her husband and some relatives were surrounding her bed.  Two nurses from Labor and Delivery Suite entered the room and, together, we held hands and prayed for her health.  I don’t know if the nurses knew how terminal my patient was, how any prayer now was no longer for her survival, but for inner peace for her loved ones.  Soon, seasons will change, if all goes well, her children will grow up, get married, have children of their own and continue their cycle of life.

The day my patient was taken off her life, or to be more precise, her “organ” support, I delivered a beautiful big boy for another patient.  While this patient was in labor, I wandered into the ICU to visit my dying patient and look for her husband.  Together, we walked to a little courtyard outside the hospital cafeteria.  The afternoon was sunny and the air was cool.  There were not any witnesses to our conversation except for the birds on nearby trees.  Spring has settled in this area for a few weeks now, with an on and off spell of cold weather.  Our surroundings were in the shades of pink cherry blossoms and lime green young shoots. 

The patient’s husband talked about his family life, how his wife had lived her life and how she cherished her children.  We talked about her passion of living a full and functional life and how often she expressed this view of living a full life.  We talked about how ironic it was that my family was in his shoes just four years ago with our mother, and how we handled her death.  We defined death, in a cultural and religious sense, and discussed about the technicality of death in grave illnesses.  We talked about her unborn, too young to be saved, so ironic to be conceived at her age while the deadly cancer was sprouting in her brain.  When to take a loved one off life support?  It’s not an easy matter, because emotions can sometimes trump over logic.  To let someone who’s brain dead to carry on is often more for the living than the dead.

That evening, the ventilator was taken off and my patient died immediately.  I chose not to come back to the ICU, as it was a private moment for my patient’s family to mourn for her sudden passing.  I had my quiet moments to reflect on the few turbulent days in my world as a physician.  I was grateful for being a physician, for the privilege to witness the fragility of life.  Physicians often see life and death exchanging their roles without warning signs.  Death is in our face so often, as if it’s a constant reminder of life.  Live this moment, it says, for it might be your last.

Within the chaos of the world, there’s balance and order if we seek for it.  On the same day, many babies are welcomed to the world while many othesr are mourning for their loved ones’ passing.  I brought a baby into the world and I lost my patient in the same evening.