Two years after I came to California, there came to my office one day a
fragile young woman, expecting her first baby. Her history was not
good from an emotional standpoint, though she came from a 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 "turning" of all babies
at the seventh or eighth month, as is so generally supposed. 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.
The case I was speaking of was a "complete" breech -- 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 first of
all. 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, 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 -- and then, to my
consternation, I saw that the other foot would never be beside the first
one. The entire thigh from the hip to the knee was missing and that one
foot never could reach below the opposite knee. And a baby girl was to
suffer this, a curious defect 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 saw this little girl
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 once, and that one thing was in my power. One breech
baby in 10 dies in delivery because it is not delivered rapidly enough, and
now -- if only I did not hurry! If I could slow my hand, if I could make
myself delay those few short moments. No one in all 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 would never be repeated. "Don't bring this suffering upon
them," the small voice within me said. "This baby has never taken a breath
-- don't let her ever take one. You probably can't get it out in time,
anyway. Don't hurry. Don't be a fool and bring this terrible thing upon
them. Maybe your conscience will hurt worse if you do get it out in time."
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 that stimulation
of the cold air of the outside world may not induce a sudden expansion of
the baby's chest, causing the aspiration of fluid or mucus that might bring
death. But this time the towel was only to conceal from the attending
nurses that which my eyes alone had seen. With the touch of that pitiful
little foot in my hand, a pang of sorrow for the baby's future swept
through me, and 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 their eagerness to do instantly
what I asked, totally unaware of what I was feeling. I hoped they could not
possibly detect the tension of my own struggle at that moment. For the
first time in my medical life I was deliberately discarding what I had been
taught was right for something that I felt sure was better. I slipped my
hand beneath the towel to feel the pulsation's of the baby's cord, a
certain index of its condition. Two or three minutes more would be enough.
So that I might seem to be doing something, I drew the baby down a little
lower to "split out" the arms, the usual next step, and as I did so the
little pink foot on the good side bobbed out from its protecting towel and
pressed firmly against my slowly moving hand, the hand into whose keeping
the safety of the mother and the baby had been entrusted. There was a
sudden convulsive movement of the baby's body, an actual feeling of
strength and life 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 foreboding came true. The mother was in a hospital for
months. I saw her once or twice and she looked like a wraith of her former
self. I heard of them indirectly from time to time. Finally I lost track of
them altogether.
As the years went on, I blamed myself bitterly for not having had the
strength to yield to my temptation. Through the many years that I have been
there, there has developed in our hospital a
pretty custom of staging an elaborate Christmas party each year for the
employees, the nurses and the doctors of the staff. There is always a
beautifully decorated tree on the stage of our little auditorium. The girls
spend weeks in preparation. We have set aside this one day to touch upon
the emotional and spiritual side. It is almost like going to an impressive
church service, as each year we dedicate ourselves anew to the year ahead.
This past year the arrangement was somewhat changed. The tree, on one side
of the stage, had been sprayed with sliver 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. It shone but faintly in the
dimly lighted auditorium. The first rows were reserved for the nurses and
the moment the procession entered, each girl in uniform, each one crowned
by her nurse's cap, her badge of office. We rose as one man to do 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 of our
carols.
Slowly down the middle aisle, marching from the back of the auditorium,
came 20 other girls singing softly, our own nurses, in full uniform, each
holding high a lighted candle, while through the auditorium floated the
familiar strains of "Silent Night." On the opposite side of the stage a
curtain was slowly drawn, 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 quite sure I was not the only
old sissy there whose eyes were filled with tears. I have always like the
harp, and I love to watch the grace of a skillful player. I was especially
fascinated by this young harpist. She played extraordinarily well, as if
she loved it. Her slender fingers flickered across the strings, and as the
nurses sang, her face, made beautiful by a mass of auburn hair, was
upturned as if the world that moment were a wonderful and holy place.
When the short program was over, I sat alone, there came running down the
aisle a woman whom I did not know. She came to 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 little girl who was born with only one good leg 17 years ago?
We tried everything else first, but now she has a whole artificial leg on
that side but you would never know it, would you? She can walk, she can
swim, and she can almost dance. But, best of all, through all those years
when she couldn't do those things, she learned to use her hands so
wonderfully. She is going to be one of the world's great harpists. She is
my whole life, and now she is so happy."
As we spoke, this sweet young girl had quietly approached us, her eyes
glowing, and now she stood beside me. "This is your first doctor, my dear,
our doctor," her mother said. Her voice trembled. I could see her literally
swept back, as I was, through all the years of heartache to the day when I
told her what she had to face. "He was the first one to tell me about you.
He brought you to me."
Impulsively I took the child in my arms. Across her warm young shoulder I
saw the creeping clock of the delivery room 17 years before. I lived again
those awful moments when her life was in my hand, when I had decided on
deliberate infanticide. "You never will know, my dear," I said, "you never
will know, nor will anyone else in all the world, just what tonight has
meant to me. Go back to your harp for a moment, please -- and play "Silent
Night" for me alone. I have a load on my shoulders that no one has ever
seen, a load that only you can take away."
Perhaps her mother knew what was in my mind. And as the last strains of
"Silent Night, Holy Night" faded again, I think I found the answer, and the
comfort, I had waited for so long.
