This story was told by Dr. Frederic Loomis, an obstetrician, who recalled it from his practice many years ago:
Two years after I came to California, there came to my office one day a fragile young woman who was expecting her first baby. Her history was not good from an emotional standpoint, though she came from fine family.
I built her up as well as I could, and found her increasingly wholesome and interesting as time went on, partly because of the effort she was making to be calm and patient and to keep her emotional and nervous reactions under control.
One month before her baby was due, her routine examination showed that her baby was in a breech position. As a rule, the baby’s head is in the lower part of the uterus for months before delivery, not because it is heavier and sinks in the surrounding fluid, but simply because it fits more comfortably in that position. There is no routine spontaneous “turning” of babies at the seventh or eighth month, as is so generally supposed, but the occasional baby found in a breech position in the last month not infrequently changes to the normal vertex position with the head down by the time it is ready to be born, so that only about one baby in 25 is born in the breech position.
This is fortunate, as the death rate of breech babies is comparatively high because of the difficulty in delivering the after-coming head, and the imperative need of delivering it rather quickly after the body is born. At that moment, the cord becomes compressed between the baby’s hard little head and the mother’s bony pelvis. When no oxygen reaches the baby’s bloodstream, it inevitably dies in a few short minutes. Everyone in the delivery room is tense except the mother herself, during a breech delivery. The mother is usually quietly asleep or almost so.
The case I am remembering was a “complete” breech, with the baby’s legs and feet being folded under it, tailor-fashion, in contrast to the “frank” breech, in which the thighs and legs are folded back on a baby’s body like a jackknife, the little rear end backing its way into the world and appearing first.
The hardest thing for the attending doctor to do with any breech delivery is to keep his hands away from it until the natural forces of expulsion have thoroughly dilated the firm maternal structures that delay its progress. I waited as patiently as I could, sending frequent messages to the excited family in the corridor outside.
At last the time had come, and I gently drew down one little foot. I grasped the other, but for some reason I could not understand, it would not come down beside the first one. I pulled again, gently enough but with a little force and with light pressure on the abdomen from above by my assisting nurse, and the baby’s body moved down just enough for me to see that it was a little girl. But then, to my consternation, I saw that the other foot would never rest beside the first one. The entire thigh from the hip to the knee was missing, and that one foot could never reach below the opposite knee. And a baby girl was going to have to suffer this curious and strange defect, one that I had never seen before, nor have I since!
There followed the hardest struggle I have ever had with myself. I knew what a dreadful effect it would have upon the unstable nervous system of the mother. I felt sure that the family would almost certainly impoverish itself in taking the child to every famous orthopedist in the world whose achievements might offer a ray of hope.
Most of all, I imagined this little sitting sadly by herself while other girls laughed and danced and ran and played…and then I suddenly realized that there was something that would save every pang but one, and that one thing was in my power.
One breech baby in ten dies in delivery because it is not delivered rapidly enough, and now I knew I could control the speed of the delivery. I could slow my hands, I could make myself delay for a few additional short moments. It would not be an easy delivery in any case, and no one in this world would ever know. The mother, after the first shock of grief, would probably be glad she had lost a child so sadly handicapped. In a year or two she would try again, and this tragic fate of birth would never be repeated for her.
“Don’t bring this suffering upon them,” a small voice within me said. “This baby has never taken a breath. Don’t let her ever take one. You probably can’t deliver this baby in time anyway. Don’t hurry. Don’t be foolish and bring this terrible thing upon them. Even if your conscience does hurt a little, you can certainly stand it better than they can. Your conscience would surely hurt worse if you were to deliver this poor handicapped little thing into this family.”
I motioned to the nurse for the warm sterile towel that is always ready for me in a breech delivery to wrap around the baby’s body so the stimulation of the cold air of the outside world might not induce a sudden expansion of the baby’s chest, causing aspiration of fluid or mucus that could bring death.
But this time the towel was only to conceal from the attending nurses that which my eyes alone had thus far seen. With the tiny and pitiful little foot in my hand, and a pang of sorrow for the baby’s future sweeping through me, my decision was made.
I glanced at the clock. Three of the allotted seven or eight minutes had already gone. Every eye in the room was upon me, and I could feel the tension in the nurses’ eagerness to do instantly what I asked, even though they were totally unaware of what I was feeling and thinking. I hoped they could not possibly detect the tension of my own struggle at that moment.
These nurses had seen me deliver dozens of breech babies successfully, but they had seen me fail also. Now they were going to see me fail again. For the first time in my medical life I was going to deliberately discard what I had been taught and always believed was right, for something these circumstances were trying to convince me was a better outcome.
I slipped my hand beneath the towel to feel the pulsations of the baby’s cord, a certain indication of its condition. Two or three minutes more would be enough. To seem like I were doing something, I drew the baby down a little lower to “split out” the arms, the usual next step; as I did so, the little pink foot on the good side bobbed out from the protecting towel and pressed firmly against my slowly moving hand, the hand into whose keeping the safety of the mother and baby had been entrusted. There was a sudden convulsive movement of the baby’s body, an actual feeling of strength and live and vigor.
It was too much. I couldn’t do it. I delivered the baby with her pitiful little leg. I told the family the next day, and with a catch in my voice, I told the mother.
Every fear and foreboding came true. The mother was in a hospital for several months. I saw her once or twice and she looked like a wraith, a shadow of her former self. I heard of the family indirectly from time to time. They had been to Rochester, Minnesota. They had been to Chicago and to Boston. Finally with the passing of time I lost track of the family altogether.
As the years went on, I blamed myself bitterly for not having had the strength to yield to my unethical temptation.
Through the many years that I have been here, our hospital has developed a lovely custom of staging an elaborate Christmas party each year for employees, nurses, and doctors of the staff.
There is always a beautifully decorated tree on the stage of our little auditorium. The staff spends weeks in preparation. We have many difficult things to do during the year, so much discipline, and so many of the stern realities of life, that we have set aside this one day to focus upon the spiritual and emotional side of life. It is truly like going to a small but impressive church service, as each year we dedicate ourselves anew to the year ahead.
This past year the arrangement was changed somewhat. The tree on one side of the stage had been sprayed with silver paint and was hung with scores of gleaming silver and tinsel ornaments, without a trace of color anywhere, and with no lights hung upon the tree itself. The silver tree was barely visible in the dimly lit auditorium.
Every doctor on the staff who could possibly be there was in his seat. The first rows were reserved for the nurses. In a moment the procession entered, each nurse in uniform and each one crowned by her nurse’s cap, her badge of office. Around their shoulders were their Red Cross capes, one end tossed back to show the deep red lining. We doctors rose as one man to show them honor, and as the last one reached her seat and we settled in our places again, the organ began the opening notes of one of the oldest and most revered of our carols.
Slowly down the middle aisle, marching from the back of the auditorium, came twenty more nurses each holding high a lighted candle while they softly sang the familiar words to “Silent Night.” We were on our feet again instantly. I’m glad no one spoke to me then, because I could not have answered, and by the time the procession of nurses reached their seats, I could hardly see either.
Right then a large blue floodlight at the back was turned on slowly, gradually covering the silver tree with more and more splendor, brighter and brighter, till every silver ornament was almost a flame. On the opposite side of the stage a curtain was slowly drawn open and we saw three lovely young musicians, all in shimmering white evening gowns. They played very softly in unison with the organ — a harp, a cello, and a violin. I am very sure I was not the only old sissy there whose eyes were filled with tears.
I have always had a special reverence for the harp, and I love to watch the grace of a skillful harp player. I was especially fascinated by this young harpist. She played amazingly well, and as if she really adored the sound she was creating. Her slender fingers flicked across the strings, and as the nurses sang, her face — made beautiful by a mass of auburn hair — was upturned as if the world at that moment was a wonderful and holy place.
When the short program was over, I waited to congratulate the chief nurse on the really superlative effects she had put together for us. As I sat alone waiting, a woman came running down the aisle toward me, someone whom I did not recognize at all. She approached me with arms outstretched.
“Oh, you SAW her,” she cried, “you must have recognized your baby! That was my daughter who played the harp — and I saw you watching her. Don’t you remember the baby girl born here with only one good leg seventeen years ago? We tried everything else at first, but now she has a complete artificial leg on that side — but you would never know it, would you? She can walk, she can swim, and she can almost dance!
“Best of all, through all those years when she couldn’t do any of those things, she learned to use her hands so wonderfully. She is going to be one of the world’s great harpists! She enters the university this year at seventeen, and she is so happy…and here she is!” As we spoke, this sweet young girl had quietly approached us, her eyes glowing, and now she stood radiantly beside me.
“This is your first doctor, my dear. Our doctor.” The mother’s voice trembled. I could see her literally taken back, as I was, through all the years of heartache to the day when I told her what she would have to face. “He was the one to tell me about you, to bring you to me!”
Impulsively I took the child in my arms and gave her a long hug. Across her warm young shoulder I saw in my mind the clock on the wall of the delivery room seventeen years earlier. I lived again those awful moments when her life was quite literally in my hands, when I had almost decided to give up on that life.
I held the young harpist at arm’s length and looked into her eyes. “You will never know, my dear,” I said, “you will never know, nor will anyone else in this world, just what tonight has meant to me. Please, go back to your harp for just a moment and play ‘Silent Night” again just as you did a little while ago. I have a load on my shoulders that no one knows about, a load that only you and your harp can take away.”
Her mother sat beside me and quietly took my hand as her daughter played. Perhaps she knew what had gone through my mind in first meeting her precious daughter. As the last notes of “Silent Night, Holy Night” faded away, I at last found the answer, and the comfort, that I had waited for so long.
[From an article republished by FamilyTalk.org in December of 2011]
As always, posted for your edification and enlightenment by
NORM ‘n’ AL, Minneapolis