Posted by TerryS (24.24.79.72) on December 21, 2001 at 17:20:00:
THE TINY FOOT
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. 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. 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. 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.
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. 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!
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.
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 pang but once,
and
that one thing was in my power.
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. 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. "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." 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. 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. 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. 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. 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.
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." 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. 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. 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. 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? 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. "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.
"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. 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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