The silence is what I remember most. The room had been filled with activity and noise, the sounds of labor and encouragement. Then there was a gut-wrenching, heart-pounding silence.
The baby was a mottled gray, devoid of movement and sound.
It was as if everyone in the room took a collective breath and held it, watching for the flail of an arm or the opening of a small mouth.
One Second.
Two Seconds.
Three Seconds.
Suddenly, the infant was in the hands of the neonatologist as a team encircled the child, connecting monitors and ventilating.
Outside of that huddle, the silence continued. The obstetrician delivered the placenta and assessed for bleeding. Her work seemed methodical and uncaring without the usual gushes of joy and relief from the parents. But she knew Mrs. B’s mind was somewhere else, preoccupied with the absence of a child in her arms.
Today was not my first time meeting Mrs. and Mr. B; I had been at several of their prenatal appointments. I knew that Mrs. B was reserved but always smiling; she had been waiting a long time to have a baby. Mr. B was talkative and curious about the science behind everything; he always arrived at the clinic with dozens of questions.
During her labor, I cared for Mrs. B alongside the midwife, coaching her through contractions and studying the fetal monitor. I explained the cardinal movements of labor to Mr. B and walked him through what would happen during the delivery.
As labor progressed, so did the complications. The labor was taking too long. The baby was in distress. The midwife was calling the doctor.
Mrs. B looked exhausted, and Mr. B looked concerned, "This is not going as you described. What did we do wrong?"
As more nurses and doctors entered the room, everything progressed quickly and loudly. The obstetrician donned her gown as the midwife prepared the vacuum. Today would not be my first delivery; this would be something else. Mr. B was right; this was different from what I had seen described in textbooks.
Then, there was the silence and the thickening of the air when it was unclear if the baby was alive or dead.
I looked at Mrs. B; she was staring at Mr. B, a look on her face that I will never forget — fear, confusion, and devastation. He was focused on the NICU team, his mouth silently moving as if asking questions no one could hear.
An indeterminable amount of time passed, and still no one spoke. The silence felt unbearable.
I peeled off my gloves, my hands damp with sweat from adrenaline and apprehension. I placed a shaking hand on Mrs. B's shoulder and another on Mr. B's arm.
"The beeping sound is the baby's heartbeat."
My voice was hushed and raspy, scared to break the trance created by the muffled sounds of the NICU team but desperate to make sure Mr. and Mrs. B did not feel alone.
Mr. B nodded, eyes never breaking contact with the infant warmer as tears rolled down his cheeks.
"The bag you see is helping your baby breathe."
A nod, a silent acknowledgment, followed each statement. I continued to provide short narrations of what was happening. It was as if the three of us had an unspoken agreement from our lighthearted talks about labor earlier in the day. They liked knowing what to expect, and while I did not fully understand what was wrong with their baby, I knew enough to demystify what they were seeing.
When the baby was transferred to the NICU, we all left. There were other patients to check on, other babies that needed to be delivered, but my mind stayed in that room.
Eventually, I found myself outside Mr. and Mrs. B's door again. My shift had ended, but I could not leave the hospital without seeing them.
I entered the room, unsure of what to say. Maybe I would explain what had happened or provide reassurance that the NICU team was so dedicated. As I sat in the chair beside Mr. B, all the explanations and platitudes felt meaningless. We sat beside one another, and I did not break the silence this time. We sat, my hand on Mr. B's shoulder and his lying on top of his wife's blanket as she slept.
Ten Minutes.
Fifteen Minutes.
Thirty Minutes.
As I heard their family gathering outside the door, I prepared to excuse myself. Mr. B rose from his chair as well. We stood there looking at one another with tear-stained cheeks, and he nodded with a small smile. I nodded back. An unspoken acknowledgment that for this brief time, we were present in this room, in this space, in this experience together. I left the room without saying a single word.
As I sat in my car in a darkened hospital parking lot, hunched over my steering wheel, my loud sobs punctuated the silence. I wept because a newborn child could know the feeling of wires and tubes before they knew the feeling of their mother's skin. Because doing everything right does not guarantee that things will not go wrong. Because no matter how much I study, I will not always be able to prevent my fellow human beings from experiencing unfathomable pain.
I am left with the awareness that this will be my life in medicine. I will meet my patients where they are, amidst their grief and their suffering. Sometimes, the situations we cannot fix with medical knowledge are the ones we can, and must, help the most. So, we do the only thing we can: we show up with our shared humanity — a wordless language that allows us to see and be seen, to heal and be healed. It asks us to set aside our stethoscopes and meet our patients in the depths of their emotions and experiences, to be with them without saying anything at all.
Email Natalie Pearlman, MS4
