1 - Shame in Medicine: Hello, Shame
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This episode of The Nocturnist is sponsored by First Responders First, an initiative of Harvard T.H. Chan School of Public Health, Thrive Global, and Creative Artist Agency that takes a whole human approach to first responder and healthcare workforce well-being. Learn more at first-responders-first.org. Support for The Nocturnist comes from the California Medical Association.
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I'm in the early part of my second year of family medicine residency training, and I'm sitting in the labor and delivery workroom, watching the clock go by to get to the end of my long 24-hour shift. It's always a little eerie or unsettling for it to be too quiet on a labor and delivery unit. Almost like you're just waiting for the other shoe to drop and all hell to break loose. And it did. I hear a lot of commotion on the other end of the hallway and I stick my head out the door and see a woman clearly in a lot of distress being quickly shuffled into a room. And a minute later, the obstetrician sticks her head out the door and calls for me to come to the room to get involved in her care. And I enter a room that is tense.
There are multiple nurses, there's an obstetrician, there's a pediatrics team, and clearly there's something major going on. And despite the chaos, it seems like everyone knows what they're doing. Except for me, I'm feeling insecure as I had the entire rotation. I'm feeling a little panicked at being involved in this situation without a lot of skills. The obstetrician pulls me over to the patient and tells me that she's having a placental abruption, which is where the patient's blood supply to the baby has been disrupted and the baby is in distress. the urgency in the room was to deliver it as quickly as possible. And so we did that using a vacuum assist device, which is where you attach a small cup to the baby's head and the person delivering her gently, but deliberately pulls the baby out of the mother's body.
Almost in a daze, as if I was watching myself from across the room, I found myself at the foot of the bed, pulling the baby out of the mom's body and praying silently that everything would go okay. And it didn't. I delivered the baby successfully, thank God. But in the process, I caused an injury to the mother. One of those events that you live in fear of as a resident, as a physician, where you and everyone around you, and there were a lot of people in the room, know that something has just gone terribly wrong. And it's almost like time stops. And I can feel my heartbeat in my ears. I can feel my guts fall out on the floor. I can feel my temperature rising. I feel incredibly uncomfortable. and incredibly exposed.
Like I was standing under a bank of those hot, bright operating room lights. And the rest of the room around me is dark. And there I am panicking. And what I see are the eyes of the people standing around me. That's all I see. And I feel the judgment. And the only thing I know to do in that moment, some sort of subconscious primitive impulse is to leave the room.
What is the resident’s emergency birth story that sparks the shame discussion?
And I do that, which is not something I would usually do or have ever done. But I left, I handed the baby off. I handed the vacuum device off and I literally left the room in the middle of the situation. And when I get out in the hall, I'm disoriented and I just start walking. And the only thing guiding where I go next is the desire to get as far away from that room, that mom, that baby, the nurses and the obstetrician as possible. And after walking through, it feels like a maze of hallways in the hospital. I find myself on the complete other end of the hospital and of all places, a meditation room. by myself in the corner, back against the wall, slumped down on the floor, head and hands behind a chair, literally hiding.
And as bad as that emotional experience was, I was not prepared for the shame that was coming.
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