A Christmas memory

Around the holidays, I sometimes think about one of my most memorable patient encounters that occurred on Christmas Eve, 1977. This memory reminds me of the bittersweet quality of the work that I once did and that most of you still do.

I was doing my obstetrical rotation at the University of California, Davis Medical Center (then Sacramento Medical Center). I could hear the patient screaming about five minutes before she arrived to the obstetrical floor, her cervix fully dilated. She had not received any prenatal care. Although the patient’s screams were attention grabbing, what straightened my spine was the 300-pound linebacker-esque male companion who accompanied her with a long lead pipe (remember, this is pre-9/11 security). The man with the lead pipe asked in a threatening voice, “Who’s gonna deliver my honey? I wanna speak to him now!”

My second-year resident told me that he was leaving for dinner now. He would be back some time in the distant future, and he had full confidence in my ability to do this precipitous delivery. I thanked him for his generous support and turned to meet this gorilla of a man who towered over me and spoke in a low, growling voice. “You the doc who’s gonna deliver her?” he asked as he methodically pounded the lead pipe across his other hand. I told him that I was and that it was a pleasure to meet him.

He told me that I could deliver his “honey” as long as I didn’t cut her or lay a hand on her. I told him that I couldn’t guarantee that; it all depended on how the delivery went. In reply, he said softly, “You cut her, and I’ll kill you,” and quietly sat down next to the delivery table.

At that point, I considered the benefits of a career in mechanical engineering or architecture and promptly put “Honey” onto the delivery table in stirrups while she screamed at the top of her lungs. Her bodyguard sat quietly, glaring at me, and tapping away with his lead pipe.

You have probably already predicted this, but the baby’s heart rate dropped to 90 beats per minute as it crowned, indicating fetal distress that was probably due to a problem with the umbilical cord. I told macho man that I had to do an episiotomy to get the baby out quickly so that it would survive. He stood up, walked over to me, and said very quietly, “You do that, and I will kill you, so help me God.”

I looked at him, looked at the lead pipe, looked at the baby, looked at the lead pipe, looked at him, took a deep breath, and performed the episiotomy. I untwisted the umbilical cord from around the baby’s neck, pulled the baby out, auto-transfused the baby through the umbilical cord, suctioned and dried the baby amidst a roar of amniotic fluid and blood. Macho man became very pale, and he promptly passed out on the floor. Honey and her baby both did remarkably well.

Twenty minutes later, my friend with the lead pipe woke up (I certainly didn’t call a code!) and asked me in a meek and embarrassed voice if I was going to tell anyone that he passed out. I looked him in the eye and asked, “Are you going to kill me?” He said, “No” in a barely audible whisper. I told him that this entire episode would be between the two of us alone. He got up quietly, left his lead pipe on the floor, and retreated unobtrusively from the obstetrical ward.

Like magic, my second-year resident returned at that moment and asked, “How did it go?”  I looked at him with dry wonderment. “Merry Christmas,” I replied.

Wishing you all the best this holiday season,

Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, senior consultant with The Greeley Company, a division of HCPro, Inc. in Danvers, MA.