April 28, 2005

Medical Mistakes Worth Making

It was March 2001 and I was still a medical clerk. It was my birthday and my first day on duty at the delivery room of a government hospital most referred to as a “baby factory” because it handled close to 200 deliveries per day. Needless to say, I was apprehensive at having to handle the birth of a human being and upset that I was on 24-hour duty on my birthday. There were 8 deliver tables in the room, all of which I could view if I looked up.

The obstetric resident on duty showed us how to perform a normal spontaneous delivery, reviewed with us how to do an episiotomy (an incision to widen the opening where the baby will go out) and suture it up. We were then assigned to delivery tables with the resident supervising our moves. My first delivery was a piece of cake. It was her eighth child so the mother pretty knew what she had to do. All I had to do encourage her and “catch” the infant. Then, the obstetric resident approached me with a weeping mother in her late twenties. It was apparently her second baby. Unfortunately, she hadn’t felt the baby move for the past one week. Ultrasound did not detect any fetal heart activity. It was enough to break my heart. Then the resident told me I should be able to deliver the dead infant quickly and did not need to perform an episiotomy because its skull bones would have been very soft by now. It could easily pass the birth canal. It was apparently going to be another piece of cake.

I opened the kit for deliveries and laid out the instruments I would need. Upon reaching the suction tip, I hesitated. The infant was dead anyway. There was no need for it. So I left it unopened in its pack.

Fast forward to 45 minutes later. I still hadn’t been able to deliver the baby. The amniotic fluid flowing out was brown colored and smelled like a dead rat. I couldn’t talk to the mother much. She was crying over losing the baby who birth she and her husband were excitedly looking forward to. What does one say in situations like that, after all? It certainly wasn’t lectured to us in medical school. With each contraction, I could see the hair on the tip of its head. It was frustrating with a capital “F”. The obstetric consultant approached me and I explained my dilemma. I told her I felt I needed to do an episiotomy so I could deliver the infant. She gave her assent.

I did the episiotomy and delivered a gray-colored infant. I laid the infant on the sterile cloth I had prepared and proceeded to suture the episiotomy I did. Later I heard a soft cough. I looked around, curious about who had a successful delivery. There was no one else. All the other clerks were sitting around. I was the only one with a patient on a delivery table. I heard another cough, a little bit louder this time and my attention was drawn to the baby I had just delivered. He was coughing.

I immediately opened the suction tip I had set aside and heard myself exclaiming “Mommy, buhay ang baby mo!” (Mommy, your baby is alive!) as I suctioned the infant. I then heard a loud lusty cry that echoed in the delivery room from the baby everyone had thought was dead. The mother cried even harder thanking me for giving life to her baby.

It was an experience that made me realize that there are some mistakes I wouldn’t mind making as a doctor. I wouldn’t mind being proven wrong when a patient lives longer than my prognosis or when I deliver a living baby everyone thinks is dead. There are truly some medical mistakes worth making.