And everything in between

Some might say that this is not strictly an obstetrical story. And truthfully, it is not. It is rooted in a birthing event. Yet, it is more than that. It is a story that has resonated with me throughout my career—one that I have repeatedly shared with colleagues and especially with family practice residents during their obstetrical rotations.I was much younger then. In addition to running a busy practice, I delivered dozens of babies each year and did two or three emergency room hospital shifts each week.I remember that evening vividly. I was sitting in the nursing station, waiting for my patient to deliver. The labour was progressing beautifully.Suddenly, a nurse stuck her head out of one of the other rooms, calling for help. I ran in to see if I could be of any assistance. On the bed was a patient unknown to me who was in the final stages of delivery. Apparently, until this point, everything had been going well. Suddenly, she was unresponsive. I checked for a pulse. There was none. A code blue was called. I began CPR.The anesthesiologist rushed in. The obstetrician on the floor grabbed a vacuum. By the time the resuscitation team arrived, the baby was delivered, the patient was intubated, and a pulse was detected. No longer needed, I left the room and, shortly thereafter, delivered my own patient’s baby. Mom and baby were fine. When I came home, I called to see how the other patient was doing. I was told that she had been stabilized and transferred to the intensive care unit. Her baby was doing well.Two weeks later, an elderly patient of mine, Rose, came into the office complaining of lower back pain. Over the last while, life had not been easy for her. Years earlier she had been diagnosed with breast cancer. She was a survivor, but she was frail. Her husband, a former family physician, was in the later stages of dementia, and she was his primary caregiver.I examined her. I felt she was suffering from soft tissue mechanical back pain. But I wrote in my note that considering her previous history of breast cancer, X-rays of the lumbar spine were warranted. I gave her the requisition.She never went for the X-rays. A few days later, I received a message that she was in tremendous pain. Before I had a chance to call her back, I learned she had been admitted to my hospital. Imaging showed that her body was riddled with cancer. Her prognosis was poor.After finishing my day in the office, I went to see Rose in the hospital. When I walked into the room, I could tell from her eyes that she knew the end was near and that she would likely not leave the hospitalSuddenly, she smiled. She told me that she understood. And then she motioned to me to come closer as she wanted to tell me something quietly. I thought that maybe she did not want the patient in the bed next to her to hear. She gently whispered: “But you know, the woman in the other bed is going home tomorrow. She almost died in childbirth.”I carefully pulled away part of the curtain that separated Rose from the person next to her. The woman was sleeping. Beside her was a baby in a bassinet. This was the woman who I had helped to resuscitate. She had survived. She and her baby were well.It was a profound moment. In this room was a microcosm of everything that I get to do as a family physician. It was all there. Birth and death. Beginnings and endings. Successes and failures. And everything in between.

And everything in between

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