life...

I found out today that the smaller 28-week-old twin who was gasping away with lungs too young for air on Friday died over the weekend. 

I had another intense experience today.  At the end (finally drawing to a close long after we were supposed to be in OPD at 3 p.m.) of an unusually long day in the operating theatre this afternoon, a woman came in at 19-20 weeks pregnant with vaginal bleeding and crampy abdominal pain who had been sent over from OPD.  An exam had been done, finding the cervical os (opening) open, showing she was probably in the process of miscarrying.  She hadn't passed any larger tissue yet, though, but it was decided to take her for a D&C (dilation and currettage to clean out the uterus) since left-in parts can become infected and cause sepsis and even death.

After we got her into the operating room, though, feet up in the stirrups and under anesthesia, she started to pass something more than blood.  I realized it was the fetus and had gloves on and so happened to be the one to catch the baby and then placenta as it came out.  It was a tiny baby boy I could hold in one hand with his little feet dangling off the edge towards my wrist.  He was alive still, heart beating away with the impact of it visible on his chest wall and occasionally giving a visible but inaudible gasping attempt to get oxygen into lungs much too young that contracted his entire rib cage, which is probably still mostly bendable cartilage at that age anyway. 

Early in my third year in medical school on my OB/gyn rotation I heard the story of a late second-trimester abortion that resulted (accidentally) in a live fetus, disturbing everyone involved (and sending me home to cry in anger and helplessness to a friend on the rotation).  I remember wishing I could have been there at the time to hold the baby so that at least it didn't have to die alone as well as unwanted.  The image of that little one set aside somewhere to breathe its last breath completely abandoned was more than I could take.

This baby was not unwanted (that I know of), but his mother was under anesthesia, and his grandmother was not interested in holding or seeing him when I showed him to her, including pointing out the beating heart.  So in an oddly gratifying though tragic closure to my experience at the beginning of my clinical years, I ended up holding this little one, simultaneously delighting in and sorrowing over his perfectly formed ears, fingernails, tendons, visible heartbeat, and even sticky immature skin, wishing he had stayed safe inside his mother for another six or eight weeks even, until I didn't see that heartbeat anymore.

This picture (or one like it) sits on the mantle of my parents' home, and I have been told it reminds them of me when I was born prematurely and very small. 

     from: http://blog.cornerstorkbabygifts.com/wp-content/uploads/2008/10/premature-baby.jpg

As much as I am sorry for the parents' loss of this little one, the whole experience reminds me of Psalm 139:13-16 and God's ultimate control over the days of our lives, as many or few as they may be:
"For you created my inmost being; you knit me together in my mother's womb.
I praise you because I am fearfully and wonderfully made;
your works are wonderful, I know that full well.
My frame was not hidden from you when I was made in the secret place.
When I was woven together in the depths of the earth, your eyes saw my unformed body.
All the days ordained for me were written in your book before one of them came to be."