The baby’s head is crowning. I’m standing next to the attending physician who says to
me, “What are you doing? Help her.” I look at him in awe for a moment. You see, as a medical
student I have a specific set of duties. I count sponges. I hold retractors. However, this physician
is not a typical attending. Today my tasks include guiding this baby into the world.
Flashback five years and I’m sitting in “Medical Humanities,” an undergraduate literature
course at the University of California, Santa Cruz. Our first reading is Atul Guwande’s
Complications: A Surgeon’s Notes on an Imperfect Science. We discuss the paradox of medicine,
where patients expect the best care possible at all times. Each patient wants “perfection without
practice.”
     

     Fast forward to the present, and baby is progressing. I feel the slick bundle of tangled hair
in my gloves. I know I must rotate the head so it can glide forward safely. I try to hold on tight,
which only makes my gloves slip more. My attending sees this. He puts his hands over mine.
The rest of the head comes all at once. Then two shoulders and a body. I feel a rush of relief, and
resolve that I will do better next time. I have to.

     In class we also read Joan Didion’s The Year of Magical Thinking, an account of her grief
during the year following her husband’s death. She spoke of a “vortex”—an emotional response
to tragedy where one becomes lost in nostalgia. We question whether this experience may be
common in medicine.

     The baby is a girl. I pass her to mommy, my hands now steady. Mommy beams. Daddy
cuts the cord. For a moment, the parents enjoy their new baby.

No one is ever prepared for what comes next.

     As we are delivering the placenta and suturing mommy closed, I see the neonatologist
return from his assessment. He says the baby has several congenital malformations. She will be
affected by these for life, and must be transferred to another hospital with more specialists. Her
Dad can go, but mom must stay here. Baby is taken, and the room is now silent aside from
heartbroken sobs.

     Hours later, when I am done with my shift, I go back to see her. I ask if she would like
some company. She is still crying. I imagine the “vortex” she must be in, desperate and alone. I
think of my gloved hands, shaky and white and then later bloodied and confident. I wonder if
practice makes you somehow better at this, and if so—how can that be? And then she starts to
speak.

     The night rolled in, as sad and heavy as ever. And though powerless to fix the baby’s
condition, I stayed. I listened. In that moment, I realized it took all my experiences leading up to
this moment (not just those in which I learned the science of medicine) that allowed me to truly
practice the art of it.

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