It's been a hard month on OB.
Obstetrics always involves some degree of unpredictability. Things in labor can go wrong quickly, but there's always something to do (i.e. call the OB/gyn or have a C-section). These aren't the desired outcome of normal labor, but both mom and baby make it through ok.
This month has felt full of outcomes that aren't like that. We've had several patients with severe preclampsia (a blood pressure and kidney problem resulting from problems with the placenta) who ended up delivering early at 27 and 32 weeks to try to preserve the moms' health. We had a 35 week fetal death who came in after her PCP couldn't find the baby's heartbeat in the office. I ended up delivering her just days after her baby shower. We've had a veritable rash of women coming in with their water breaking early (PPROM, for you medical readers) at 31-32 weeks leading to an early delivery and an anticipated minimum two-month NICU stay for their preemature babies. And we've had several people come in with placental abruption, early separation of the placenta from the uterus causing sometimes-dangerous bleeding for both mom and baby - mom for the loss of her blood, baby for the loss of nutrients as the placenta separates. Both of those patients went for stat cesarean sections.
On top of these early deliveries with tiny babies who will probably make it and may or may not have infections or other complications due to their prematurity, we've had a couple of late miscarriages at 15 and 16 weeks. I've been involved in both of them, holding the palm-sized baby after the delivery and trying to comfort the mom while acutely feeling my own helplessness. One today particularly tore me up.
It is the patient's fourth loss. She's been through so much that she can't even keep straight the stories of the other pregnancies and in what years the various losses occurred (between 12-22 weeks) over the past five years. She came in with bleeding, worried about the pregnancy at 16 weeks. "I'm 38," she confided to the intern and me before we ordered the ultrasound that showed a half-completed miscarriage, "and I'm worried that I'm running out of time [to have children]."
I recalled how it felt to walk with a couple in my church a year and a half ago who lost their baby at 20 weeks after years of struggling with infertility and then months on bedrest when they had finally achieved this pregnancy. Then I tried to imagine going through that again. And again. And now - after today - yet again. The anxiety of coming in, the waiting for test results, the despair of yet another loss.
I tried to imagine what it would feel like to watch your body fail you again. The sense of betrayal. How can I not carry another pregnancy? How can my body not do what it was made to do? What is wrong with me? Why is my own body turning against me and failing me in this way?
It is a similar feeling to what I imagine couples struggling with infertility must feel. The unpredictability. The helplessness. The disappointment. The recurrent sense of loss. Loss of hopes. Loss of dreams. Loss of plans.
When I helped deliver the fetal demise (stillbirth) a couple weeks ago, the father turned to me in anguish as he looked at their dead little one after the delivery.
"How can you do this?" he asked me, his face crumpling. "Do all the live babies make up for the dead ones?"
I told him how I felt privileged to be part of their grief, to be the one who walked with them and sorrowed with them in their suffering. I told him how I would rather be there than have their baby be delivered by someone who didn't care. I would rather be there to try to ease the harshness of their grief as its waves crash with a soft touch and gentle words. Those are true things. And yet I still hear his question ringing in my ears, in my heart, especially today.
What makes the pain worth it?
It isn't as simple as the good and joyful things outweighing the bad and sorrowful ones. It's not a simple matter of addition or subtraction and whether you end up with a positive tally. No, the depth of suffering and the sense of how wrong things are requires more than that. It requires a hope for redemption. Not that the bad things will be merely outnumbered by the good but that they themselves can be transformed into good things.
I think again of that sense of betrayal I feel when when I put myself in my patient's place, in that hospital bed hearing the news of another loss. I imagine that sense of helplessness and betrayal. It feels like part of the creation groaning for redemption - part of the echoing knowledge of creation itself that things are not right, that things break down and fail and even our very bodies do not always work the way they're supposed to. Some part of me stands outside the pain of the loss itself and aches and mourns for the fact that losses happen, that things go wrong. And the groaning that mourning represents reminds me of another groaning. Later in Romans 8, Paul reminds us that the Holy Spirit groans our requests and needs and longings before God when we do not even know what to pray for. So somehow my longing and aching and mourning is gathered up in wordless pleas made by God the Spirit to God the Father.
I need some groaning right now. I need some groaning hope of redemption. I need the reminder that hope is what G.K. Chesterton calls an "unreasonable virtue," for "hope means hoping when things are hopeless, or it is no virtue at all." And hope means waiting. And trusting that hope will not disappoint us. And believing that in all things God works for good. Believing this doesn't require some twisted logic by which we make believe that bad things are good. Instead it embraces bad things as they are - as bad - and yet opens up the possibility of redemption and transformation. It opens up the possibility that good really is stronger than evil, that hope can win out over despair, that faith can withstand the darkness.
That gives me hope. For my patients and their suffering. But even more, for me and my shortcomings and sin. Hope that all that I am - strengths and dismal failures alike - can be gathered up into a transforming embrace and made new and good. It gives me hope that He who had the temerity to take on material skin and bones and live through a 1st-century teen pregnancy with all its unpredictability will continue to do the surprising and transforming work of birthing Christ in me and in us.
Even in the midst of loss.
Obstetrics always involves some degree of unpredictability. Things in labor can go wrong quickly, but there's always something to do (i.e. call the OB/gyn or have a C-section). These aren't the desired outcome of normal labor, but both mom and baby make it through ok.
This month has felt full of outcomes that aren't like that. We've had several patients with severe preclampsia (a blood pressure and kidney problem resulting from problems with the placenta) who ended up delivering early at 27 and 32 weeks to try to preserve the moms' health. We had a 35 week fetal death who came in after her PCP couldn't find the baby's heartbeat in the office. I ended up delivering her just days after her baby shower. We've had a veritable rash of women coming in with their water breaking early (PPROM, for you medical readers) at 31-32 weeks leading to an early delivery and an anticipated minimum two-month NICU stay for their preemature babies. And we've had several people come in with placental abruption, early separation of the placenta from the uterus causing sometimes-dangerous bleeding for both mom and baby - mom for the loss of her blood, baby for the loss of nutrients as the placenta separates. Both of those patients went for stat cesarean sections.
On top of these early deliveries with tiny babies who will probably make it and may or may not have infections or other complications due to their prematurity, we've had a couple of late miscarriages at 15 and 16 weeks. I've been involved in both of them, holding the palm-sized baby after the delivery and trying to comfort the mom while acutely feeling my own helplessness. One today particularly tore me up.
It is the patient's fourth loss. She's been through so much that she can't even keep straight the stories of the other pregnancies and in what years the various losses occurred (between 12-22 weeks) over the past five years. She came in with bleeding, worried about the pregnancy at 16 weeks. "I'm 38," she confided to the intern and me before we ordered the ultrasound that showed a half-completed miscarriage, "and I'm worried that I'm running out of time [to have children]."
I recalled how it felt to walk with a couple in my church a year and a half ago who lost their baby at 20 weeks after years of struggling with infertility and then months on bedrest when they had finally achieved this pregnancy. Then I tried to imagine going through that again. And again. And now - after today - yet again. The anxiety of coming in, the waiting for test results, the despair of yet another loss.
I tried to imagine what it would feel like to watch your body fail you again. The sense of betrayal. How can I not carry another pregnancy? How can my body not do what it was made to do? What is wrong with me? Why is my own body turning against me and failing me in this way?
It is a similar feeling to what I imagine couples struggling with infertility must feel. The unpredictability. The helplessness. The disappointment. The recurrent sense of loss. Loss of hopes. Loss of dreams. Loss of plans.
When I helped deliver the fetal demise (stillbirth) a couple weeks ago, the father turned to me in anguish as he looked at their dead little one after the delivery.
"How can you do this?" he asked me, his face crumpling. "Do all the live babies make up for the dead ones?"
I told him how I felt privileged to be part of their grief, to be the one who walked with them and sorrowed with them in their suffering. I told him how I would rather be there than have their baby be delivered by someone who didn't care. I would rather be there to try to ease the harshness of their grief as its waves crash with a soft touch and gentle words. Those are true things. And yet I still hear his question ringing in my ears, in my heart, especially today.
What makes the pain worth it?
It isn't as simple as the good and joyful things outweighing the bad and sorrowful ones. It's not a simple matter of addition or subtraction and whether you end up with a positive tally. No, the depth of suffering and the sense of how wrong things are requires more than that. It requires a hope for redemption. Not that the bad things will be merely outnumbered by the good but that they themselves can be transformed into good things.
I think again of that sense of betrayal I feel when when I put myself in my patient's place, in that hospital bed hearing the news of another loss. I imagine that sense of helplessness and betrayal. It feels like part of the creation groaning for redemption - part of the echoing knowledge of creation itself that things are not right, that things break down and fail and even our very bodies do not always work the way they're supposed to. Some part of me stands outside the pain of the loss itself and aches and mourns for the fact that losses happen, that things go wrong. And the groaning that mourning represents reminds me of another groaning. Later in Romans 8, Paul reminds us that the Holy Spirit groans our requests and needs and longings before God when we do not even know what to pray for. So somehow my longing and aching and mourning is gathered up in wordless pleas made by God the Spirit to God the Father.
I need some groaning right now. I need some groaning hope of redemption. I need the reminder that hope is what G.K. Chesterton calls an "unreasonable virtue," for "hope means hoping when things are hopeless, or it is no virtue at all." And hope means waiting. And trusting that hope will not disappoint us. And believing that in all things God works for good. Believing this doesn't require some twisted logic by which we make believe that bad things are good. Instead it embraces bad things as they are - as bad - and yet opens up the possibility of redemption and transformation. It opens up the possibility that good really is stronger than evil, that hope can win out over despair, that faith can withstand the darkness.
That gives me hope. For my patients and their suffering. But even more, for me and my shortcomings and sin. Hope that all that I am - strengths and dismal failures alike - can be gathered up into a transforming embrace and made new and good. It gives me hope that He who had the temerity to take on material skin and bones and live through a 1st-century teen pregnancy with all its unpredictability will continue to do the surprising and transforming work of birthing Christ in me and in us.
Even in the midst of loss.
Feeling in need of some parental redemption right now - so thank you for your encouraging words, a reminder that God is a God of redemption and wholeness.
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