Decisions

I know this scene feels cribbed from a movie, and not a good one, but it happened, exactly this way.

The Labor & Delivery room was quiet except for the whimpers and harsh breathing of the mother and the more cheerful ping of the anesthetic pump. One of the obstetrical nurses had just clocked in. She murmured to the medical student, “What time did Mom go into labor?” Nurses on the L&D floor don’t like to use the word “patient” for a pregnant woman, or for a baby. There are moms and there are kids.

“4 o’clock,” the medical student said.

The young nurse checked the watch pinned to her lapel. “Jeez, eleven hours.”

“Twenty three,” the student corrected grimly.

There were nine people in the crowded little room: the mother, the father, the obstetrician, the anesthesiologist, the obstetrical resident, two obstetrical nurses, the medical student, and, in the totemic hope that she would soon be needed, a pediatrician. Eight of them were dressed identically, green scrubs, green caps, green masks. The mother was in a white cotton shift, flimsy and now reduced almost to rags. She was a small woman, usually pretty and vivacious but weary now, her eyes red from effort and her hair stringy with sweat.

As with everyone but the mother, the obstetrician’s face was only visible from the bridge of the nose to the forehead, but you could know him from just that, a serious-minded Chinese man in his 50s, with six thousand successful deliveries to his credit. He was conflicted, the labor had been going on too long. There were no signs of fetal distress, but the mother was nearing exhaustion. A man in another line of work would have scratched his head contemplatively, but doctors don’t touch anything but the patient if they can avoid it. Keep your hands clean.

He would have talked it over with the mother ahead of time, but she wasn’t his regular patient. Her own ob/gyn was on vacation and, in any case, her first delivery had gone off smoothly; there had been no reason to expect trouble. The nurses, who were good at such predictions, guessed this baby would be more than nine pounds, closer to ten. A ten-pound baby out of a 105-pound woman, no wonder she was exhausted.

He glanced up at the mother’s face. She was clearly in no shape to make a decision, so he spoke to the father. “I think we should use OB forceps. We need your consent.”

The father’s condition was only a little better than his wife’s. A day and a night without sleep, doctors and nurses were used to it, but the father had a desk job, home by seven, asleep by eleven. He wasn’t used to it and it showed. The nurses were letting him sneak O2 whenever his wife wasn’t using the mask, but he still looked ragged.

Ragged, and not responding to the question. “We need you to say we can use the forceps,” the obstetrician explained again.

The father stared at the ring of masked faces around the bed, at his wife’s face. He looked like an escaped criminal, finally run down and cornered, desperate. The pump pinged. Everyone waited. Even the mother seemed to be holding her breath.

And he burst into laughter, loud peals of genuine laughter. “Are you fucking with me?” he asked.

In the defense of that father – to be more specific, in my own defense, because I was that father – the idea that this was some elaborate and ill-timed prank was silly, but only slightly less silly than the truth. I was the least qualified of the nine people in the room to make any health-care decision but at that moment, the decision fell to me.

What the hell did I know? I thought that forceps were like tweezers, little pinchy things. Was he planning to pull the baby out like you would pull a splinter out of your thumb?

I tried to think clearly. “Would you do it if it were your wife, your daughter?” The obstetrician instantly said he would, not a moment’s hesitation. That the man agreed with his own recommendation wasn’t surprising or helpful, but his unwavering certainty reassured me. Then again, doctors think they are God, no wonder he had no doubts.

I looked over at the most experienced nurse in the room, a woman my mother’s age, but realized I could not ask her explicitly. If I had said anything aloud, she would have had to back the doctor up. Of course. He was the doctor, the authority figure. She wasn’t going to contradict him. But she knew, she knew the right thing to do. The physician had delivered six thousand babies, but she had assisted with the delivery of ten thousand, twenty thousand. She could populate a small town with the children, many now grown, that she had helped usher into the world. She knew, but just as the least qualified person was making the decision, the most qualified was forbidden to give advice.

The important decisions of life are not just difficult in themselves and not just difficult because the stakes are so high. Like canny predators, decisions set upon us when we are at our weakest, when we have the least energy, the least time, the least patience.

You are behind the wheel after a day’s drive, snapping your head to try to keep awake. You drive a dark road along the lip of a hill. An oncoming car veers into your lane. Do you steer right, hoping there is enough verge between the road and cliff edge to come to a halt? Or do you go left, and hope the other driver doesn’t attempt to correct his error at the last second? Left or right? Decide now.

Your child, a teenager, comes home late. His eyes are red and he smells of smoke. People at the party were smoking, it irritated his eyes, that’s why they are red, that’s why he came home early. Do you push it, do you teach him his word isn’t trusted, or to you let a potential problem fester? You are half-awake in your bathrobe, standing in the chilly hallway. Decide now.

The company, your employer, is failing, and your boss tells you the new plan. It might work. It isn’t legal, but it might work. Your bank account is at low ebb, the job market sucks, you have been putting in 60-hour weeks since the beginning of the year. Now you are in the stuffy conference room, and your boss lays it out, in euphemism of course, but even the VP of marketing is looking out the window, trying to pretend he isn’t there. The credit-card is past due, so is the mortgage.
Go along, resign, or try to stop him? Decide now.

I looked at the nurse and tried urgently to telegraph the question, tried to access that telepathy that sometimes exists among strangers in crisis. She gave a tiny confirmatory nod.

Incidentally, obstetrical forceps are not tweezers. Imagine delivering a baby by hooking two 9-irons in the woman’s vagina and spreading it wide open. I know, I know: too much information.

Eventually, the baby, my younger daughter, slid out in a laughably horrid fountain of amniotic fluid and feces. The pediatrician scored her 9/10 on the Apgar scale, near-perfect health. Nine pounds, 10 ounces, just as the nurses predicted.

Author Michael Lorton lives in San Francisco, California. He considers himself a computer programmer, in “…the way that Wallace Stevens was an insurance salesman.” He has traveled the globe and his first novel, The Missionaries will be out in August.

Businessman Choosing the Right Door image courtesy of Shutterstock

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