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"A
DOCTORS CHOICE"
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Two years after I came to California, there came to my
office one day a fragile young woman, expecting her first
baby. Her history was not good from an emotional
standpoint, though she came from a fine family. I built
her up as well as I could and found her increasingly
wholesome and interesting as time went on, partly because
of the effort she was making to be calm and patient and to
keep her emotional and nervous reactions under control.
One month before her baby was due, her routine examination
showed that her baby was in a breech position. As a rule,
the baby's head is in the lower part of the uterus for
months before delivery, not because it is heavier and
"sinks" in the surrounding fluid, but simply because it
fits more comfortably in that position.
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There is no routine "turning" of all babies at the seventh
or eighth month, as is so generally supposed, but the
occasional baby found in a breech position in the last
month not infrequently changes to the normal vertex
position with the head down by the time it is ready to be
born, so that only about one baby in 25 is born in the
breech position. This is fortunate, as the death rate of
breech babies is comparatively high because of the
difficulty in delivering the after-coming head, and the
imperative need of delivering it rather quickly after the
body is born. At that moment the cord becomes compressed
between the baby's hard little head and the mother's bony
pelvis. |
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When no oxygen reaches the baby's bloodstream, it
inevitably dies in a few short minutes. Everyone in the
delivery room is tense, except the mother herself, in a
breech delivery, especially if it is a first baby, when
the difficulty is greater. The mother is usually
quietly asleep or almost so.
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The case I was speaking of was a "complete" breech --
the baby's legs and feet being folded under it, tailor
fashion -- in contrast to the "frank" breech, in which
the thighs and legs are folded back on a baby's body
like a jackknife, the little rear end backing its way
into the world first of all.
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The hardest thing for the attending doctor to do with
any breech delivery is to keep his hands away from it
until the natural forces of expulsion have thoroughly
dilated the firm maternal structures that delay its
progress. I waited as patiently as I could, sending
frequent messages to the excited family in the corridor
outside. At last the time had come, and I gently drew
down one little foot, I grasped the other, but for some
reason I could not understand, it would not come
down beside the first one.
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I pulled again, gently enough but with a little force,
with light pressure on the abdomen from above by my
assisting nurse, and the baby's body moved down just
enough for me to see that it was a little girl -- and
then, to my consternation, I saw that the other foot
would never be beside the first one.
The entire thigh from the hip to the knee was missing
and that one foot never could reach below the opposite
knee. And a baby girl was to suffer this, a curious
defect that I had never seen before, nor have I since!
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There followed the hardest struggle I have ever had with
myself.
I knew what a dreadful effect it would have upon the
unstable nervous system of the mother. I felt sure that
the family would almost certainly impoverish itself in
taking the child to every famous orthopedist in the
world whose achievements might offer a ray of hope.
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Most of all, I saw this little girl sitting sadly by
herself while other girls
laughed
and danced and ran and played -- and then I suddenly
realized that there was something that would save every
pain but once, and that one thing was in my power.
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One breech baby in 10 dies in delivery because it is not
delivered rapidly enough, and now -- if only I did not
hurry! If I could slow my hand, if I could make myself
delay those few short moments. It would not be an easy
delivery, anyway. No one in all
this world
would ever know.
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The mother, after the first shock of grief, would
probably be glad she had lost a child so sadly
handicapped. In a year or two she would try again and
this tragic fate would never be repeated.
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"Don't bring this suffering upon them," the small voice
within me said. "This baby has never taken a breath --
don't let her ever take one. You probably can't get it
out in time, anyway. Don't hurry. Don't be a fool and
bring this terrible thing upon them. Suppose your
conscience does hurt a little; can't you stand it
better than they can ?
"Maybe your conscience will hurt worse if you do get it
out in time.
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" I motioned to the nurse for the warm sterile towel
that is always ready for me in a breech delivery to wrap
around the baby's body so that stimulation of the cold
air of the outside world may not induce a sudden
expansion of the baby's chest, causing the aspiration of
fluid or mucus that might bring death. But this time the
towel was only to conceal from the attending nurses that
which my eyes alone had seen. With the touch of that
pitiful little foot in my hand, a pang of sorrow for the
baby's future swept through me, and my decision was
made. I glanced at the clock. Three of the allotted
seven or eight minutes had already gone. Every eye in
the room was upon me and I could feel the tension in
their eagerness to do instantly what I asked, totally
unaware of what I was feeling. I hoped they could not
possibly detect the tension of my own struggle at that
moment.
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These nurses had seen me deliver dozens of breech babies
successfully yes, and they had seen me fail too. Now
they were going to see me fail again. For the first time
in my medical life I was deliberately discarding what I
had been taught was right for something that I felt sure
was better. I slipped my hand beneath the towel to feel
the pulsation's of the baby's cord, a certain index of
its condition. |
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Two or three minutes more would be enough.
So that I might seem to be doing something, I drew the
baby down a little lower to "split out" the arms, the
usual next step, and as I did so the little pink foot
on the good side bobbed out from its protecting towel
and pressed firmly against my slowly moving hand, the
hand into whose keeping the safety of the mother and
the baby had been entrusted. There was a sudden
convulsive movement of the babies body, an actual
feeling of strength and life and vigor. It was too
much. I couldn't do it. I delivered the baby with
her pitiful little leg.
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I told the family the next day, and with a catch in my
voice, I told the mother. Every foreboding came true.
The mother was in a hospital for months. I saw her
once or twice and she looked like a wraith of her
former self. I heard of them indirectly from time to
time. They had been to Rochester, Minn. They had been
to Chicago and to Boston. Finally I lost track of them
altogether. As the years went on, I blamed myself
bitterly for not having had the strength to yield to
my temptation.
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Through the many years that I have been there, there
has developed in our hospital a custom of staging an
elaborate Christmas party each year for the employees,
the nurses and the doctors of the staff. There is
always a beautifully decorated tree on the stage of
our little auditorium. The girls spend weeks in
preparation. We have so many difficult things to do
during the year, so much discipline and so many of the
stern realities of life, that we have set aside this
one day to touch upon the emotional and spiritual
side. It is almost like going to an impressive
church service, as each year we dedicate ourselves a
new to the year ahead. This past year the arrangement
was somewhat changed. The tree, on one side of the
stage, had been sprayed with sliver paint and was
hung with scores of gleaming silver and tinsel
ornaments, without a trace of color anywhere and with
no lights hung upon the tree itself. It shone but
faintly in the dimly lighted auditorium.
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Every doctor of the staff who could possibly be there
was in his seat. The first rows were reserved for the
nurses and the moment the procession entered, each
girl in uniform, each one crowned by her nurse's cap,
her badge of office. Around their shoulders were their
blue Red Cross capes, one end tossed back to show the
deep red lining. We rose as one man to do them honor,
and as the last one reached her seat, and we settled
in our places again, the organ began the opening
notes of one of the oldest of our carols. Slowly down
the middle aisle, marching from the back of the
auditorium, came 20 other girls singing softly, our
own nurses, in full uniform, each holding high a
lighted candle, while through the auditorium floated
the familiar strains of
"Silent Night."
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We were on our feet again instantly. If someone spoke
to me then, I couldn't have answered, and by the time
they reached their seats I couldn't see. And then a
great blue floodlight at the back was turned on very
slowly, gradually covering the tree with increasing
splendor: brighter and brighter, until every ornament
was almost a flame.
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On the opposite side of the stage a curtain was slowly
drawn, and we saw three lovely young musicians, all in
shimmering white evening gowns. They played very softly
in unison with the organ -- a harp, a cello and a
violin. |
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I am quite sure I was not the only old sissy there
whose eyes were filled with tears. I have always liked
the harp, and I love to watch the grace of a skillful
player. I was especially fascinated by this young
harpist. She played extraordinarily well, as if she
loved it. Her slender fingers flickered across the
strings, and as the nurses sang, her face, made
beautiful by a mass of auburn hair, was upturned as if
the world that moment were a wonderful and holy place.
I waited, when the short program was over, to
congratulate the chief nurse on the unusual effects
she had arranged.
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And as I sat alone, there came running down the aisle
a woman whom I did not know. She came to me with arms
outstretched.
"Oh, you saw her," she cried. "You must have
recognized your baby. That was my daughter who played
the harp and I saw you watching her. Don't you
remember the little girl who was born with only one
good leg 17 years ago?
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We tried everything else first, but now she has a
whole artificial leg on that side -- but you would
never know it, would you? She can walk, she can swim,
and she can almost dance. But, best of all, through
all those years when she couldn't do those things,
she learned to use her hands so wonderfully. She is
going to be one of the world's great harpists. She is
my whole life, and now she is so happy And here
she is!" As we spoke, this sweet young girl had
quietly approached us, her eyes glowing, and now she
stood beside me.
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"This is your first doctor, my dear - our doctor," her
mother said.
Her voice trembled. I could see her literally swept
back, as I was, through all the years of heartache to
the day when I told her what she had to face. "He was
the first one to tell me about you. He brought you to
me." Impulsively I took the child in my arms. Across
her warm young shoulder I saw the creeping clock of
the delivery room 17 years before. I lived again
those awful moments when her life was in my hand, when
I had decided on deliberate infanticide. I held her
away from me and looked at her.
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"You never will know, my dear," I said, "you never
will know, nor will anyone else in all the world, just
what tonight has meant to me.
Go back to your harp for a moment, please -- and play
"Silent Night" for me alone. I have a load on my
shoulders that no one has ever seen, a load that only
you can take away."
Her mother sat beside me and quietly took my hand as
her daughter played.
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Perhaps she knew what was in my mind. And as the last
strains of "Silent Night, Holy Night" faded again, I
think I found the answer, and the comfort, I had
waited for so long.
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THIS
WAS REPORTEDLY PUBLISHED IN THE MEDICAL JOURNAL IN
CALIFORNIA |
THIS
DOCTOR IS UNKNOWN TO ME...I RECEIVED IT FROM THE
INTERNET. |
THANKS JAN...IT IS SO BEAUTIFUL |
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