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Ankuda: Fourth Year Lessons

04/11/11 5:55PM By Claire Ankuda
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Vital Signs: Vermont Charts A New Course For Health Care

(HOST) This week, VPR presents "Vital Signs", our series on overhauling Vermont's health care system. As lawmakers debate bills, and policy makers crunch numbers, UVM medical student Clair Ankuda reminds us that on the most important level, health care is about relieving suffering.

(ANKUDA)  I started my fourth year of medical school working nights on labor and delivery. Everything about it was exhilarating: biking to work at sunset, helping care for my own set of patients with a pager that wouldn't stop beeping, falling into bed before lunchtime.
 
I soon learned what it meant to be in labor: to understand the sounds of contractions, to feel how the baby was curled, and when it would drop.  I learned to catch babies: to anticipate and guide their smooth heads, to lift their shoulders down and up, to pass them, always so small and so surprising, onto their mothers' chests.  I learned to read heart beat tracings and to find little feet on ultrasound machines, to angle the probe to watch delicate lungs flutter like gills as they practiced breathing.

One night was particularly busy.  The board that lists patients was nearly full of scribbled in-boxes, and not one of them had yet been crossed out to indicate that a baby had been born.  Medical students like to keep track of their numbers: total deliveries, busiest night, and I was hopeful to beat my previous record.
 
The patient for whom I was caring for had been having a difficult labor: she'd spiked a fever, her contractions had been too slow and then too rapid, she was tired.  None of this was unusual, but it was not smooth.

I first realized that something was different because the baby came too quickly, almost before I'd put on my gloves.  I joined the doctor beside her to help deliver the infant, but I was confused: the baby was too small in my hands and too still.
 
The doctor and nurses rushed the baby to the warmer in the corner to start resuscitating, and I was left at the bedside, making sure the mother's bleeding was under control.  I could not make myself look towards the baby as the anesthesiologists and pediatricians rushed in, and alarms beeped in the hallway.
 
As I held the clamped placenta, the mother locked her eyes with mine.  They were wild, but her face was frozen.
 
"Is everything okay?" she asked.  "Is my baby okay?"
 
I looked back at her, as directly as I could.  "Everyone is here to help.  These people are all here to help."
 
That night, I realized how little I understood about pain.  I did not understand the fear, the ache of this woman.  I had no real answer for her.  So much of what I'd been learning was about confidence: knowing how to read monitors, how to do things.  But that night, for the first time, I began to learn what to do when there is no way of knowing, when another person's suffering is as distant a land as I could ever travel to.  I didn't have words.  But I could stand by her, I could fight my own fear and let her eyes hold mine.
 

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