This is from the twenty-seventh chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends and family to join us.
A SURPRISING GIFT
We arrived at Memorial Mission Hospital in Asheville in a driving snowstorm. I dropped Barb at the emergency room entrance and parked the car. By the time I arrived in the ER, Barb had been whisked up to the obstetrics unit and was already being evaluated by the admitting nurse, who had spoken by phone with the admitting physician—Sedrick Porter, M.D.
Our admitting nurse, Marie, had been a labor and delivery nurse for her entire career—all of which had been at this hospital. “I am so glad you’re here,” she said warmly. “It’s been unusually quiet. We haven’t had a delivery since yesterday, and you all are our only guests—at least for now.”
Admission labs were drawn and a detailed history taken, and then Dr. Porter showed up. He struck us as a quiet and gentle man whom we instantly liked and trusted. What I liked the most was his simple explanation of the options we could consider. I was used to physicians telling us what to do, not doctors willing to empower us to make our own decisions. Whether he did this because I was a physician or whether he did this routinely with all his patients, I don’t know. I do know, though, that I was forever influenced by his example. I would go on trying to emulate Dr. Porter’s approach throughout my career.
“Walt and Barb, there are a couple of options open to you. One, we can wait and watch. You can walk around a bit, Barb, and if labor gets going, hey, that’s great. The advantage of this choice is that we won’t need to start an IV or use Pitocin. The disadvantage of waiting is that, since your membranes are ruptured, the longer we wait the greater the chance of you or Erin getting an infection—which would prolong your hospitalization and increase your costs. Fortunately, the real risk for this doesn’t start increasing until the membranes have been ruptured for eighteen to twenty-four hours.
“The second option would be to begin Pitocin now. The advantage is that your baby almost certainly would be born sooner. The disadvantage is that Pitocin-induced labors are more difficult than natural labors. But it is indeed an option.
“Does this information make sense? Does it raise any questions in your minds?”
We looked at each other. I could see Barb visibly relax. This wise physician was both reassuring and empowering.
After a moment he continued. “How about this? I need to see a couple of other folks. How about I go see them? You two can discuss the options, and then I’ll drop on by and we can talk some more. OK?”
We nodded in agreement. He smiled at us both, patted Barb on the leg, and then reached over to give my shoulder a squeeze. “One other thing. I’ll be here as much as you need me throughout the rest of the night, and we’re going to provide you the very best care we can.”
He turned to leave as I continued to take mental notes on the lessons this experienced physician was teaching me by his example. Barb spoke first. “Honey, I think I’d like to walk around a bit. If labor doesn’t start in the next few hours, then let’s go with the Pitocin. What do you think?”
“That sounds OK to me.”
When Dr. Porter returned, he seemed pleased with our decision. “Barb, I’ve never been pregnant or had to face this decision myself. But if I did, I think I’d choose what you all are choosing.”
Then his forehead furrowed. “There’s just one thing I need to tell you. I will only be available to you until about 6:00 A.M., and then my partner, Phil Davis, will take over. Barb, I want to tell you about Dr. Davis. He’s been with our group for a number of years. My wife says that if she were young enough to have more children, she’d choose Dr. Davis to be her doctor. If you haven’t delivered by 6:00 in the morning, then I’ll be telling him all about you guys so he’ll be up to speed.”
He paused for a moment. “Any questions or concerns?”
We shook our heads no. He smiled and turned to leave. “Marie,” he said to our OB nurse, “I want you to take great care of our new friends.” I’m sure he must have said this to her about every patient he saw, but it sure made us feel special and important.
After dinner we were up and about—talking, walking, and then sitting. Barb continued to leak amniotic fluid but felt no cramps or signs of labor. During this time Marie came to find me. “Dr. Larimore, there’s a phone call for you.”
I left Barb to go to the nurses’ station. I thought sure it would be Rick, calling to check on us. Instead, it was Barbara Morris. Barbara had been my intern when I was a second-year resident, and we had continued to work together when I was a senior resident. She was one of the most intelligent and fun-loving physicians I knew. She, Barb, and I had become close, and “Aunt Barb,” as Kate called her, had become a dear family friend. Not only that, but during our last year in Durham she had been our personal physician. She had diagnosed our pregnancy and provided Barb’s prenatal care until we left for Bryson City.
Barbara greeted me warmly. “Walt, I just called your office to wish you all a Merry Christmas and talked to Rick. He told me what had happened and where you were. How are you all doing? How’s Barb?”
I updated Barbara on our situation. “Walt,” Barbara responded, “if you all and Dr. Porter don’t mind, I’d like to drive out and be with Barb for the labor and delivery.”
“Barbara, that’s nuts. One, it’s snowing. Two, it’s a four- to five-hour drive. Three, it’s Christmas Eve!”
“Walt, one, I grew up in New York and I know how to drive in the snow. Two, Barb was my patient and I want to be with her during Erin’s delivery. Three, there’s no way Barb is going to deliver in the next few hours. So I’m coming!”
I knew I couldn’t dissuade her. “Well, Barbara, let me check with Dr. Porter to see if it’s OK with him, and I’ll let you know.” As I suspected, the doctor, ever gracious, responded, “Walt, I’d be delighted if Dr. Morris would come and join us. It would be a treat.” I called back to let Barbara know and heard the non-surprising news that she was already on her way.
Late in the evening Dr. Porter returned. Barb was still leaking amniotic fluid and had not had a single contraction. In addition, her cervical dilation had not changed. We elected to begin Pitocin.
Barbara Morris arrived about 9:00 P.M. and stayed with us through the night. Barb’s labor intensified throughout the evening as a result of the Pitocin. At 11:00 P.M. Marie said goodbye, as her shift was over, and another nurse began to care for us. At midnight we all wished each other a Merry Christmas and were now convinced that little Erin’s birthday would be the same as the Christ child’s.
By 1:00 A.M. I had been up for nearly thirty-six hours and could barely keep my eyes open. Barb was in a strong and uncomfortable labor pattern and had dilated to about seven centimeters. Dr. Morris had already settled down to sleep in the doctors’ lounge. “Barb,” I pleaded hesitantly, “would you mind too terribly much if I took a little nap?”
The hospital did not have private labor rooms—all rooms were double occupancy. Since we were still the only patients in the labor unit, I laid down in the bed next to Barb. I didn’t wake up until the nurse shift changed at 7:00 A.M. Shortly thereafter two doctors showed up—Barbara Morris and Phil Davis. Phil, as had been predicted by Dr. Porter, was as gentle and kind as we could have expected. His examination of Barb revealed that her cervix was now completely dilated but that Erin’s head position wasn’t optimal.
Instead of being what we doctors call OA (for occiput anterior—meaning that when the mom is on her back, the baby’s nose is pointing down, which is the position that is easiest for the mom, the baby, and the birth attendant), Erin was OP (for occiput posterior, or “nose up,” a much more difficult position for the baby, the mother, and the birth attendant). This was not only increasing Barb’s discomfort but prolonging her labor as well.
“Barb,” counseled Dr. Davis, “there are some studies showing that if we get you off your back, then the baby is more likely to turn on her own. The baby is doing fine and there’s no sign of any sort of trouble. So I’d like to suggest that you try some different positions. You can lie on your side to push. If you want to try some knee-chest pushing, that may be helpful. Also, if you’d like to walk, I’d be OK with that. Either way, I’m not planning to go home and open Christmas presents until little Erin is in your arms.”
He smiled at us. His reassuring manner filled the room and gave us comfort.
So Barb tried different positions, but nothing caused Erin to turn. Barb pushed and worked and pushed and worked. Dr. Davis checked her on a number of occasions. “Barb, I think you are making progress. Are you OK? Can you keep going?”
Barb, ever the trooper, decided to continue. By 9:30 A.M. she had been pushing for over three hours. She was beginning to feel exhausted (and, not that it mattered, so was I).
“Barb and Walt,” confided Dr. Davis, “I think it’s time to go to the delivery room. If we can push the baby out, great. If not, I can use a little vacuum cup or forceps to help her deliver. Does that sound OK?”
Indeed it did. I hated for him to have to use an operative delivery, but if it ensured our daughter’s safety, we were all for it. Dr. Davis offered to Dr. Morris the opportunity to scrub in and assist with the birth, but Barbara declined. “It was just real important for me to be here with Barb and Walt. I’ll just be the assistant and the photographer, if that’s OK.”
Once we were in the delivery room, Dr. Davis scrubbed and got into position. Then Barb began pushing. As Erin’s head began to show, I would alternate moving from up next to Barb’s head— as her coach and supporter—down to her perineum watching my little girl’s head begin to crown. The experience was surrealistic. It was almost as though I passed through a time warp at Barb’s belly button. Above the belly button I was Walt—Barb’s husband and best friend, her ally and helper. But below the belly button my medical eyes and ears kicked me into my doctor mode.
Finally, at 10:35 A.M., out popped Erin’s head, nose up. She was beautiful. Dr. Davis suctioned out her mouth and nose, and she grimaced. Then, with a little push from Barb and pull from Dr. Davis, with Barbara Morris poised to capture the miraculous event on film, out came our daughter, followed by a large gush of previously dammed-up amniotic fluid. Dr. Davis began to vigorously dry Erin off—and then I noticed it!
My worst fears suddenly gripped my chest. I saw the deformity. Although the rest of her body appeared beautiful, perfect, spotless, and flawless, there was a deformity in Erin’s perineum. For a moment my doctor mind went through its instinctual differential diagnosis—macroclitorus, macrolabia majorum, genital tumors of various sorts, ambiguous genitalia . . .
I looked at Barb, who was sitting up on a special birth pillow, with an angelic look on her face—that postbirth look of accomplishment and satisfaction, a look that no man will ever experience, much less reflect. She showed no concern, but only contentment.
I looked back. She must not see the deformity. What is it? What is wrong? My mind was reeling and boggled. I gasped, almost to myself, “What’s that between her legs?”
The nurse and Dr. Davis at first looked shocked. Then they giggled at each other. It took Dr. Morris to bring me into reality. “Well, Dr. Larimore, I guess you’re going to have to go back and retake your anatomy course. That’s a perfectly normal appearing penis and scrotum between his legs.”
While I was feeling more boggled than ever, Dr. Davis, who had clamped and cut the cord, handed the precious newborn, our son, up to Barb, placing the baby on her chest. “Congratulations, Barb and Walt. You have a little boy.”
The nurse covered him up with a fresh and warm baby blanket. “Merry Christmas,” she said.
“Merry Christmas,” crooned Barb as she pulled our newest family member to her breast. “Merry Christmas,” I whispered to her, to him, and to myself. “What a gift! What a miracle!”
When we were alone, Barb asked, “Walt, would you be willing to say a little prayer—a prayer of thanks?”
For just a moment I was taken aback. What a wonderful request! I thought. After all, could there be a more natural time to pray—and to express thanksgiving—than after a safe birth? Why hadn’t I thought of this before? Especially with my own patients?
“Of course, Barb. Of course.” So we had a brief prayer together—my wife, our newborn son, and I. This, I thought, should become a tradition at each delivery I attend.
Later, in the recovery room, both Dr. Davis and Dr. Morris dropped by to share some special thoughts. Dr. Morris said good-bye and left to drive back to Durham. We were so appreciative of her being there with us.
Then Barb and I finally had some time together with our son. He had been dressed in a gown that looked like a Christmas stocking and a head cap that looked like a Santa cap. The volunteer who brought it in was so proud. This was the hospital’s first Christmas baby of the year! Barb and I were both in shock. We had expected Erin Elizabeth. At least three ultrasounds had shown that he was going to be a she. Instead, she was a he, and for three days he went unnamed. He could easily have been— maybe should have been—Aaron. Instead, he was named Scott Bonham—the latter a family name, the former the only name that freshly boggled parents could come to consensus about.
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
© Copyright Walter L. Larimore, M.D. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.