Volume 35, Number 1


Emily Hartzog

The night shift on obstetrics was Gina’s most dreaded rotation. As a third-year resident, she still couldn’t get used to the three long months of exchanging days for nights and felt exhausted the whole time. And it was much worse when those months fell during the summer because her Depression-era New York City apartment had no air conditioning, and they were always doing construction right outside her window.

The shift lasted for twelve hours from eight o’clock at night until eight the next morning. Sometimes, things were so quiet that the hours dragged by, a 12-hour eternity clicking along on her Timex watch. Other times, there didn’t seem to be nearly enough hours to finish up her work before the team arrived the next morning.

At least she knew a lot more now and had the confidence she lacked during her nerve-wracking internship year. Most of the time, she could make decisions on her own and didn’t have to call the chief resident in the middle of the night to ask questions.

Gina finished the take-out Chinese in its styrofoam container and walked across the street to the hospital. The elevator to the labor and delivery unit on the eighth floor was slow, as always, and she had to search for scrubs in the nooks and crannies because the regular closet was empty. By the time she got to the conference room, the OB doctors who worked the day shifts were already sitting around the table with the paperwork to hand off to the doctors on the night shift.

Scott was the resident in charge of Labor and Delivery. He went over the seven patients currently on the ward with Gina. Three of them were in various stages of active labor with no problems, one was under observation due to decreased fetal movement, and three patients were being monitored and on medication for premature labor.

Gina asked a few questions and sent him home for the night. After that, she introduced herself to each patient and reviewed the plans with the nurses. She came back to the nurse’s station where there was a whiteboard on the wall with the patients’ names and room numbers and a black sharpie on a string dangling beside it. She added the most recent information so she could tell at a glance what was happening with each of them.

By 1 AM, the three patients in labor had delivered, and the ward was fairly quiet. Gina went into an empty patient room and sat on a chair in the dark to rest her eyes from the fluorescent lights for a few minutes. It wasn’t very long before a nurse came in and said there was an admission coming up from the labor room with premature rupture of the membranes at twenty-one weeks.

It was a serious matter when the fluid leaked out from around the baby only halfway through the pregnancy. Gina saw that it was a familiar patient from her internship year and sighed. Esther had lost a baby from premature labor, also during the night shift, two years earlier.

Gina followed the stretcher into the room and helped them transfer Esther over to the bed. In the process, Esther’s head scarf slipped to one side revealing her shaved head. Gina had forgotten how strange it was to see a shaved head on a healthy woman. Esther adjusted her scarf modestly, and Gina sat down beside her.

“Oh Esther, I wish I was seeing you again in happier circumstances. When did this happen?”

Esther said, “You know, Doctor, I’m not sure. I felt more moisture than usual all day yesterday. Around midnight I woke up cramping. There was no doubt about it then because a lot of fluid leaked out.”

“Have you had any fevers? Was the fluid clear when it started leaking?”

“No fevers and the fluid has been as clear as water. The doctor downstairs told me my cervix was still closed, and there was no blood or evidence of infection.”

Gina said, “You’ve been around the block with this stuff so much you could qualify as an obstetric resident by now.”

Esther asked, “Would contractions show up on the monitor this early in the pregnancy? I’ve been looking at my strip and haven’t seen any.”

“We would definitely be able to see them if they were there. As you know, there are various medicines to stop premature contractions, and you’ve experienced most of them” Gina saw a few tears run down Esther’s cheeks and reached over to hand her the box of Kleenex.

Esther said, “I can’t believe this is happening to me again. I was in the hospital for a month last time and still lost the baby.”

“Your water being broken is the big difference this time. We’re going to have to get some steroids on board to help the baby’s lungs and start antibiotics to prevent any infection.”

“Please do anything that has even a small chance of helping. Our whole community is praying for this pregnancy to succeed.”

By the time Gina finished getting Esther admitted, the bloodwork done, the IV started, the orders written and her medications started, another patient had arrived upstairs in active labor. And then another.

Both of the new patients had delivered by the time the daytime team came in with coffee and doughnuts to relieve the night shift. Gina gave them the handoff information and told Scott to be sure to spend some time with Esther because she’d lost a baby only two years before. She felt guilty she hadn’t had more time during her shift. Although Esther was very stoic, Gina knew how upset she must be.

Gina bought a fruit popsicle from the deli on the way home. She showered to cool off and ate the popsicle before going to bed. But her electric fan was no match for the daytime heat and the construction noise. She slept fitfully until it was time for her to get up and shower again to get ready for work. She felt exhausted, but she only had to make it through one more night before the weekend. Then she could get some better sleep at night when it would be cooler and quieter.

Back at Labor & Delivery that evening, it was a relief to see things were quieter than the night before. Thankfully, Esther had remained stable with no contractions or fevers. The one patient who was in labor had an uneventful delivery at 10 PM. The board was almost empty after that. Gina took off her gloves and gown and let the nurses know where to find her. She was going to sit and talk with Esther.

It was 11 PM, but Esther was still wide awake. Gina left the lights low and pulled a metal chair over to the bedside. Esther smiled and reached out to hold her hand.

Esther said, “You should get some rest, Doctor. You don’t have to keep me company.”

Gina said, “I want to keep you company. I know you told me not to worry because you’re used to being up here, but I think it must feel lonely at night.”

Esther said, “I guess it does feel lonely. It’s hard to sleep with everything that’s on my mind. My husband looked so lost when he came in today. Hospitals make him nervous, and he doesn’t understand much about women’s troubles.”

Gina said, “I could come in to talk to him if you’d like. I’ve got all weekend off and live right across the street from the hospital.”

Esther said, “I hope you won’t take offense at this, but it would be better if a male doctor could speak with him. In our Hasidic community, the men are in charge of most of the business outside the home, so I think he’d trust a man more.”

Gina thought Esther might be wearing a different wig than she had two years ago. She remembered what Esther had told her about how Hasidic brides are required to have their heads shaved on their wedding day. She couldn’t imagine how strange that would feel.

Gina said, “No offense taken—I understand you have a lot of rules to follow. I’ll ask Scott, the doctor covering OB this weekend, to talk your husband through the situation.”

Esther squeezed Gina’s hand and said, “Thank you, Doctor. Our rules fill our lives with meaning, but they can create difficulties sometimes. A man is obliged to divorce his wife if they’ve been married for ten years without having children. Avram and I have been married for seven years. If I lose this pregnancy, I won’t have much time left.”

Gina said, “I have to say it’s pretty risky when the water breaks early like this. There’s a potential for infection in the sac from being open and exposed to all the bacteria down below. The baby also needs to have a good amount of amniotic fluid around him to develop his lungs normally. I wish I could tell you everything’s going to be okay. Everything is okay right now, but we’re going to have to take it day by day.”

Esther said, “At least I can count on you to always tell me the truth.”

Gina said, “I promise you that.”

She stayed in the room until Esther dozed off then padded quietly out and went to the empty room by the nurses’ station to close her own eyes. The rest of the night was quiet enough for her to get a couple of hours of sleep.

It was a hot Saturday morning, but Gina wanted to go out and be active so she could get back on a normal schedule for the weekend and sleep during the night. She took a walk to the boat pond in Central Park and had breakfast at the Greek diner in her neighborhood. Afterwards, she went home and put her feet up.

There was an exhibition at the Met she wanted to see, but after her morning walk, Gina wasn’t sure she would make it that day. Wearing street clothes, or anything heavier than scrubs, made her feel sweaty, and her feet were sore from work and the hot pavement. Instead, she stayed in the apartment that afternoon and watched a movie on TV.

Sunday was much the same.

When Gina went back to work on Monday night, Scott told her that Esther had developed a fever, despite the antibiotics. She had also started contracting and was on medication to buy more time.

He said, “We did another ultrasound over the weekend and there’s hardly any fluid around the baby, so the chances look bad for normal lung development. Also, the fever tells me she could become septic soon.”

Gina asked, “What does the attending say? I’m sure you’ve made a few calls to Dr. Driscoll by now.”

“Dr. Driscoll thinks it may be too risky to continue much longer. It seems almost certain she’s going to lose the baby and we don’t want to lose her, too. We added another antibiotic this morning, so she’s on four of them at this point. He said if her white blood count continues to climb tonight, we need to get her delivered. The blood was sent to the lab just before you arrived.”

Gina asked, “Did you talk to Esther and her husband about this?”

Scott replied, “Yes, I explained everything to them. Her husband wants us to do whatever we can to save the baby. I think he understands all the risks, but he hasn’t asked many questions so I’m not sure. Esther seemed pretty upset and didn’t say much.”

Gina said, “I was afraid this was going to happen. Okay, thanks. I’ll be sure to keep Dr. Driscoll and the chief resident in the loop. Go home and get some rest.”

Gina introduced herself to the new patients on the ward and saved Esther for last. When she entered the room, she could see that Esther’s eyes were swollen from crying. Gina took a deep breath when she sat down beside her and said, “I’m so sorry about what’s happening, Esther.”

Esther said, “It’s not hopeless yet, is it? Does the baby still have a chance?”

“It doesn’t look good at this point. We’re fairly sure you have an infection in the amniotic sac. We’ve used all the antibiotics we have available, and they aren’t controlling it. The last blood draw was to check your white blood cell count which goes up when you have an infection that’s progressing. Scott told me that your count went up over the weekend. If it goes up any further, we can’t continue to risk your life for the baby.”

Esther said, “I need this baby. Without it, Avram will divorce me, and no one else will marry me after that. My women friends will be busy with their children, and I have no parents to go back to—may their memory be a blessing. I’ll be isolated and alone.”

Gina said, “I’m afraid this pregnancy has so many things going against it that it might not be the one that works for you. There’s an infection that’s not responding to the antibiotics. Your uterus has started contracting and we may not be able to stop it forever. Also, the baby still doesn’t have enough fluid in the sac to have a good chance of developing normal lungs. You have three more years left to try again, and they’re developing a new medication to stop preterm labor that looks pretty promising.”

Esther shook her head and said, “I’m tired of trying. Counting my early miscarriage, it’s been three times already.”

“I know it’s been a lot. Let’s see what the blood count shows. I’ll let you know as soon as I get the results.”

Gina walked back to the nurse’s station and called the lab. The white blood cell count was almost twice what it had been earlier. She called the chief resident and Dr. Driscoll who both said the only safe choice was to initiate regular contractions with Pitocin and get her delivered as quickly as possible.

Esther could tell the news was bad from Gina’s expression when she walked into the room. Before Gina could say anything, Esther said, “There’s no chance.”

“No, I’m sad to say there’s not. The white blood cell count is much higher, meaning the infection is getting worse instead of better. We need to stop the medication preventing your contractions and start one that will make you go into labor. Do you want to call Avram?”

Esther said, “I talked to him right after you left a few minutes ago. I’ll call again and tell him to get here as soon as he can.”

“That would be good. You could die from this infection if the baby stays inside for much longer. I’m worried and want to keep you safe. I know it’s going to be hard, but we need to do this now.”

Gina was practically pacing the halls by the time Avram arrived. She brought a consent form to the room and explained the procedure to both of them. Avram was quiet throughout, but when she asked for their signatures, he said, “Before I sign, I need to use a phone that’s private to call the Rebbe—our Rabbi. I need to make sure we’re doing the right thing.”

The only private phone Gina could think of was a pay phone on the first floor. She said, “I can take you to a pay phone downstairs, but this needs to be done quickly. The longer we wait, the riskier it is for Esther.”

Gina had Esther sign her part of the consent, then walked with Avram to the elevator, pushed the button and waited for it to arrive. They rode down in silence, with Avram in a corner staring nervously at the floor. She showed him the pay phone and stood a polite distance away with the consent in hand, waiting for the Rabbi’s approval. Avram greeted the Rabbi in Yiddish, then took a minute to explain the situation. He nodded several times, said his goodbyes and finally hung up.

Avram signed the consent. Gina ran up the seven flights of stairs and told the labor nurses to get everything ready. She joined Esther at her bedside. When Avram returned, Gina excused herself for two minutes to give them some time to talk and quickly checked on another patient down the hall.

By the time she returned, Esther was alone. She said Avram had gone to the stairwell to pray.

Gina said, “The Pitocin should work quickly. You’re already having some contractions, so your body knows what it needs to do. The baby will also be smaller than last time because it’s a month earlier.”

Gina gently removed the fetal heart monitor from Esther’s stomach. She sat down, reached out for her hand, and said, “The baby probably won’t live more than a few minutes. There may be a few gasps for air before the end.”

They both wiped away their tears, and Gina went back to the nurse’s station to tell them to start the Pitocin.

It was only an hour until the baby was delivered, with Avram by Esther’s side. Gina wrapped him in a blanket and gently handed him to Esther. The placenta came soon afterwards. Gina left the room so Esther and Avram could be alone with their baby for the final minutes.

Thirty minutes later, she saw Avram walking by in his long black coat and hat. Esther seemed calm when Gina returned to the room. She told Gina she would like to keep the baby with her until the morning.

It was a busy night, but Gina checked on Esther whenever she had a free moment. Esther stayed awake all night holding the baby in her arms. In the morning, she kissed him goodbye and handed him gently to Gina.

The following night, the first thing Gina did when she arrived was to go to the postpartum floor downstairs to see Esther. The nurses reported that Esther’s fever had resolved, and her white blood cell count was back to normal. The IV antibiotics were going to be continued overnight and the plan was for discharge the next morning.

Esther smiled when she saw Gina walk in the room and motioned for her to come over for a hug.

“I’m so glad you had time to come downstairs to see me again. I won’t miss being here, but I’ll miss seeing you. You helped me get through this.”

Gina replied, “I wish things could have turned out differently. I know it feels hard to think about right now, but I don’t want you to give up hope. There should be a new medicine to help you by next time.”

Esther said, “From your mouth to God’s ears. Doctor, I have something I want to give you. It belonged to my mother, and I brought it with me to the hospital. We’ll both get too emotional if you look at it now. Just take it home with you and keep it.” She handed Gina a blue velvet bag tied with a silk ribbon.

They hugged again and Gina said goodbye. She waited to look inside the bag until she returned home the next morning. She wore the beautiful, beaded necklace until she was ready to go to sleep, then found a special place to keep it.

Esther was lucky to have been treated in New York in 1987. Since the Supreme Court’s Dodds decision in 2022, 20 states have outlawed intervention when a fetal heartbeat is present, as in Esther’s case. Many more pregnant women are now facing the possibility of death from delayed treatment and worsening infection.