I locked the screen at the best possible visual that she could get of her baby and moved back for her to see. “Your lab reports show your MSAFP levels to be high. The scan was negative for a clearly defined skull or brain matter. Your baby is anencephalic. It is a very rare type of neural tube defect.”
I remember the first time when I, as an undergraduate student, witnessed my senior take a delivery at the hospital. Everything was a first for me then. My first obstetrics posting, my first delivery visual, my first vision of myself as a practicing obstetrician for I fell in love with the subject, the very first time. And as I stood there, my heart frozen with a mix of feelings of palpable excitement and immature fear, my senior pulled the baby’s head out of it’s cage and slapped free air into it’s lungs. A moment too emotional for my brain to process. And so it decided to shut down. I opened my eyes lying on the baby’s bed with a row of neatly packed babies fresh from the other world. The one lying right next to me was the only one in blue. A boy. The strangely comforting peace on his face as he slept seemed to bear absolutely no mark of the little warrior’s struggle with his voyage into our world just a few moments ago. In the time that I took to come back to consciousness, the mother had delivered the placenta, been cleaned and put to sleep.
“First time, is it? You don’t like obstetrics too much do you?,” said my senior’s voice from behind. “A first yes. But I do like the subject. I like it a lot.”
“Aah. Don’t worry. It gets better as you witness more and more you know. Call it immunisation or anaesthesia. It stops getting to us after a while.”
And so I believed. Our profession leaves us numb. We learn to get over our fears and our own pain, to relieve the pain around us. And every time that I begin to think that I have had too many firsts to ever shut down again, I have yet another waiting.
Her watch clocked at 5:45pm. She was just in time for her appointment scheduled at six. She didn’t have to wait too long, the Femina magazine with one of the reigning Bollywood actress’ baby paunch on it’s cover looked inviting. How many weeks did that look like? She looked at her own belly bulge and dated it to about 20 weeks. The tunic hid most of the actress’ bulk, while she had a proud paunch stick out from her thin frame. She looked away. This was no time for fashion magazines. Fifteen minutes wasn’t much, but she had waited 16 years. The needles of her watch inched to a six in the evening.
I was to see my last patient for the day. Mrs. Gayatri, 37yr old female, G9P1L0A9, 18 weeks pregnant, here for her follow up antenatal visit – read the white paper pad my secretary had scribbled on. Mrs Gayatri had conceived a number of times in her marriage of 16 years but never really made it to the delivery bed. Childless, she had had a history of recurrent abortions, with the unexpected drop even before her belly could swell with the weight of another life. At times, an unexpected episode of bleeding well before her otherwise regular cycles would mark yet another opportunity at motherhood for her lost. In 16 years, this was probably the first time she felt the weight of another being inside of her, kicking her in her sleep or as she cooked her meals.
“Hello Mrs. Gayatri. How are you?”
“Scared almost always. But the good scared you know. This is exciting,” she gleamed as she handed over her lab reports to me. “My maid thinks it’s a girl. She says she can see it in my eyes. It doesn’t kick as often though. Is that unusual? I don’t have to go pee as much and…”
“Mrs. Gayatri,” I interrupted her, oblivious to her maid’s eye reading skills. “I will have to ask you to lie down on the bed for me. Just a quick ultrasound scan.”
“Oh okay. Is everything alright doctor?”
I couldn’t answer her question with complete certainty and I looked away pretending to be busy setting up the ultrasound machine for her. Jelly spread on tummy, ultrasound monitor lit to life, the probe sliding on the naked belly.
“Oh my God,” my lips let escape.
“What..what is it doctor? Is the baby fine?”
“So what does that mean for my baby? I mean I can still have the baby right? It’s alive and it kicks me everyday,” she pleaded, her voice cracking.
“Yes Mrs Gayatri. Your baby is alive. We aren’t sure for how long though. Anencephalic babies have no skull or brain matter. Their face looks normal and they might be able to breathe or respond to touch, but they are often unconscious, blind and deaf. Most babies are stillborn or die soon after birth.” I paused for Mrs Gayatri to say something but she didn’t move, her eyes fixed at the black and white mosaic of her baby. She didn’t seem to be listening to anything I said but understood it all better than I had thought. “Is there still a way for us to hold the baby, for once maybe?,” she asked turning away from the screen for the first time. Looking at her expressionless face, what felt like my brain shutting down was me witnessing a perplexing unopposed yet graceful acceptance by Mrs Gayatri of her loss, that I found difficult to accept. As I resumed back to a more professional self, Mrs Gayatri looked at me for an honest answer.
“We can inject you with prostaglandins that cause the uterus to contract and simulate a delivery for you. The baby is delivered just as in a normal delivery. Analgesics will be adequately administered so it is a completely painless procedure for you.”
“Okay,” she said as she wiped the jelly off herself and picked up her purse to leave. “I waited for 16 years to be a mother and now I don’t have to wait at all, not even for 4 months. I had never thought after a history of unexpected abortions, I would ever want to have it by choice. It’s funny how this abortion is my shot at being a mother even if for a delivery maybe.”
I saw her thin frame leave my office, her hair hanging loosely in a bun behind her, stopping only for a second to stare at the magazine stand.