{Prompt: Tell me about the night Sam and I were born.}
Act I - Family Practice Residency
In 1994, I turned 30 years old, and I was a young married professional. I was working for the University of South Carolina / Richland Memorial Hospital residency program in Columbia, South Carolina. They offered me a spot to train in their program for the specialty of Family Practice. I accepted because it was in the same city where my mother had been born and raised. However, for me, the city of Columbia and the state of South Carolina were completely new.
Like Raleigh, Columbia is a capital city and a college town, but where we lived on the outskirts of town, we could only enjoy hearing the percussive thuds of the artillery exercises on the army base at Fort Jackson, or the muffled orders and squawking response of the McDonald’s drive-through behind our small, flat backyard.
And the closest park to be enjoyed was Sesquicentennial Park, where scrub pines provided only a smattering of shade in the heat of the Sandhills region. It wasn’t a very rich experience, except for the richness of the medical education on the residency rotations.
It was my third year of marriage and my third year of residency. I had the responsibilities of a senior resident, and I spent many hours in the clinic, on the wards, or on call. I was often on a rotation in one clinic or another, far from home. I probably spent 50 or 60 hours at work each week. I spent more of my waking hours at the hospital than I did at home.
Not only was I immersed in my medical rotations. I was also starting to think like a doctor. I was learning not only to care for my patients, but to appear caring and receptive.
I was learning to listen to a patient’s complaints and concerns with empathy, while also exercising some skepticism about their interpretations and self-diagnoses.
I was learning to split my thinking brain into one side, showing compassion, and another side, generating a differential diagnosis (a list of possible conditions) and a diagnostic algorithm (a set of discriminatory questions and examinations) with which to reach the diagnosis. Basically I was learning to split my personality into the outwardly caring persona (the “good doctor”) and the inwardly analytical logician (the “diagnostician”).
This is the headspace I was in when Dianne dropped in unexpectedly during my morning schedule of patients at the “continuity of care clinic” on campus in November.
“What are you doing here?” I said.
“We’re having our babies!”
“What?” (Is she in labor? It’s five weeks before the due date.)
“We’re having our babies. Today!”
“What?” (She doesn’t look like she’s in labor. She seems a little… manic.)
“I had my ultrasound this morning, and they said that one of them is too much bigger than the other one, and they need to be delivered. Today! They called it twin growth disparity. One of them is taking all the nutrients, and the other one isn’t getting enough. So I’m scheduled for a C-section this afternoon. So get ready to have your babies.”
“Oh… Okay.” (Oh shit. I thought I had more time.) “Okay, I have to talk to some people to get my patients rescheduled. I’ll call you when I’m done.”
So I wrapped up clinic early that day, and I let the attending physicians know that I had an urgent family medical issue, that my wife was scheduled for a C-section. And I don’t really know what happened after that. Next thing I remember we were all in the operating room.
Act II - The Operating Room
A labor and delivery operating room is quite big. It has to be big enough to hold quite a lot of people (and equipment).
At the head of the surgical table, you find the still conscious expectant mother. She is able to witness (or at least hear) the entire proceeding. A partition is draped between her and her belly, and I am allowed to sit on one side of her, and the anesthesiologist is on the other. The partition, which is made of a light blue pleated surgical apron, keeps me and her from looking directly at the business end of the surgical shenanigans. On the other side of her head sits the anesthesiologist, on a surgical stool, with all sorts of monitors, medications, and machinery with which to ensure the health of the most important person in the room, the mother-to-be.
A newborn, mother, and the surgical partition.
In the middle of the action is the Obstetrician, the surgical assistant, the surgical nurse, and another nurse or assistant… or two. They are all standing in the “wings” of the operating theater as the surgical lamps cast a spotlight on the place where the twin starlets will emerge onto center stage.
A surgical team beneath surgical lights.
Off in the distance, below the foot of the table, there are two bassinets, and two or three pediatric specialists waiting to make their neonatal assessment, and if necessary, to perform a neonatal resuscitation. They are quietly talking behind the scenes (in this theatrical metaphor) as the action unfolds.
Everything goes according to plan. At least according to the surgeon’s plan. I wasn’t aware that the babies’ birth order was going to be reversed. The baby that was lower in the birth canal, who would have been the first baby born in a vaginal delivery, was the second to be born in the C-section. The baby that was higher in the uterus — the one that was smaller — had the honor of entering the world first, at 4:32 pm. She became Baby A — Jasmine Allison Gallup. Baby B was pulled out a minute later, at 4:33 pm — Samantha Bailey Gallup.
Samantha (left) & Jasmine (right.)
From my training, I knew that APGAR scores would be taken at one minute after birth and at five minutes after birth, and these scores would be strongly indicative of the health of the infants and their prospects for an uncomplicated hospital stay.
I don’t remember the exact scores, but I remember a bit of relief as the scores were announced. It wasn’t long before the babies were brought, one by one, from the foot of the bed to a place above the partition where Dianne and I could see Jasmine and Samantha up close for the very first time. The OR, and the world, just got a little more crowded.
A Measure of Viability
Act III – The Nursery
After the surgery is completed, Dianne is taken to post-op for cleaning and observation, and then to a room at the quiet end of the maternity ward for some much-needed sleep. I am invited to join the RN in the nursery for a little orientation to fatherhood.
The nursery is everything that the operating room is not. The operating room is like the definition of ‘chiaroscuro,’ — a combination of light and shadow, as the surgical lamps cast bright beams on the pregnant belly, and all else is in relative darkness.
The nursery is completely bathed in warm incandescent light, and if the overhead lighting isn’t enough, additional light can be found emanating from the neonatal incubators, which gently warm the fragile infants until their bodies can thermoregulate themselves.
While the surgical suite was filled with unfamiliar people and seemed crowded, the intake room of the nursery is empty, except for me and two babies, and the nurse, whom I know from a previous rotation.
The nurse is calm and capable — sweet and sympathetic. She goes through the “head to toe assessment” step by step, explaining each step to me as she goes along. She is explaining the process as if I am the newborn’s father… not as if I am an emotionally detached medical resident. This makes me feel like a father for the very first time.
I’ve actually done the Head to Toe assessment myself on other people’s babies. I’m familiar with all of the measures, reflexes, and areas of focus.
But first the babies must have a sponge bath. They are carefully cleaned in all their nooks and crannies. Their hair is combed and their bangs are swept to one side. They are given a new hoodie and a soft, warm baby blanket.
After they are given some loving attention, the focus is on their size and development. Head, chest, and waist circumference are taken. Weight and length are measured. Measures of physical and neuromuscular maturity are taken. Their arms and legs are pulled and stretched like a neonatal yoga class, to determine their level of actual maturity (as opposed to their predicted maturity based on the mother’s last menses and the calculated expected date of conception).
(A chart I probably used during my pediatric rotation.)
Each child in turn is examined for jaundice, birthmarks, hematomas, and other skin findings.
Each skull is palpated for the anterior fontanelle — the soft spot.
All four eyes are examined for a proper red reflex, to rule out a detached retina or other problem with vision.
Each mouth is examined for cleft palate and for a normal sucking reflex.
Each heart is auscultated for a murmur to rule out valvular heart defects.
Each abdomen is palpated for the liver and spleen.
Each umbilical cord is examined above and below the clamp.
The arms are examined for brachial palsy. The legs are examined for hip dysplasia.
The fingers and toes are counted and examined: 10 fingers and 10 toes for each baby.
The spine is examined for spina bifida and for scoliosis.
The genitals are examined for any sexual anomaly.
The neurological exam is performed, including a check of the rooting reflex and palmar grasp—so necessary for nursing.
I’ve done these examinations before. I understand the medical basis for the head to toe exam, but this time I am a quiet… a reverent observer.
Somehow the process and the checklist are a comfort, and a recovery… for me from all of the excitement and stress of the events of the day.
At the end of the exam, only one thing remains. A heel stick must be performed on each infant to collect a blood sample to send off to screen for hereditary conditions. Each baby in turn screams in protest as the heel stick is performed. Then each baby in turn is comforted — swaddled and settled into a nursery crib for their own recovery. I, too, am escorted out of the nursery.
My quiet time with my babies is over, and I return to watch over Dianne until she awakes.
She has precedence in the babies’ care now… in their nursing, their sleeping, and their comfort. I will help… by swaddling the infants and changing their diapers, supplementing their feedings with sugar water, wrapping them in ‘biliblankets’, and burping them.
But Dianne is doing the breastfeeding — balancing both infants on a horseshoe-shaped nursing pillow until they latch on. Now it’s her turn to examine them from head to toe.
Our birth announcement
I think that the “mom” in this inscription (probably to my brother) is my Mom, who came down to Columbia to help out.
Epilogue
The specialty of family practice prides itself on seeing patients across the entire lifespan, from cradle to grave. The knowledge and ability to evaluate and treat neonates, preschoolers, children, and teens separates family physicians from Medical Internists and General Practitioners, who only treat adults.
Cover of the American Family Physician
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