It's a Boy!

One morning I did a repeated low-transverse cesarean section and delivered a healthy, 8-pound 13-ounce, male infant. Although deliveries are always exciting, this one had a deeper, more personal meaning. Three years before this cesarean section, few anticipated my ability to ever do surgery again.

My problems started abruptly, on 14 December 1985, with a sweet unpleasant odor. I thought it was from the infant I was examining during a neonatology internship rotation, a requirement at that time for obstetric and gynecology residents. The nurse assured me that there was no foul odor, but I knew better. Rather than debate such a fine point in the early hours of the morning, I decided the night had been long and it was time to go home.

Christmas had always been a favorite time of year for me. While driving home, I ran through my long gift list. The pungent odor streamed back into my consciousness, then quickly disappeared. I walked into the house with post-call fatigue and a severe headache; I barely noticed my husband at the tree. Migraine, I thought and headed for pillow and sleep. But the pain! This was the worst migraine I'd ever had and those rank smells made everything worse. It was too much.

I lay on the bathroom floor, vomiting. I called for my father. Hours passed. Or did they? A minute later, my husband appeared at my side. I recognized him but couldn't remember his name!

We got to the emergency room in 20 minutes. Phlebotomies. IVs. A neurologic examination. I couldn't remember the names for things. I couldn't remember the simplest objects. Who was the president? What was my address? My serial sevens were 100, 93, 83, and 86. The initial CT scan was normal. But I continued to smell the foul odors and there was the possibility of temporal lobe seizures. The neurologists began intravenous Zovirax and Decadron for the presumed diagnosis of herpes encephalitis.

The days passed, not easily, I assure you. Roger, a concerned, thoughtful neurologist, talked with us daily. Repeated head CTs showed abnormalities in the left temporal lobe. Roger remained confident. He could even make the lumbar punctures tolerable. Christmas came and went. Roger kept us posted. Questions about my future—as wife, mother, and surgeon—haunted everyone.

The 2-week hospitalization ended and I was discharged home—that is, to my parents' home. I was unable to care for myself. Speech therapy continued. The anomia was horrifying. I could only identify 5 of the 60 objects tested. The days dragged by.

I began to take self-improvement steps and gradually recovered. It was one thing, after all, to identify a pair of scissors, but identifying complicated instruments, such as the Brewster retractor or the Kelly clamp, was a whole different story. I rehearsed daily.

One hundred thirty-seven days passed. At last I was ready to resume my residency. I was taking Tegretol. I continually practiced my instrument names. My plan was to resume my residency part time but I was told this was not an option … it was full-time or not at all.

They had me on call my first day back. As midnight approached, I began to wonder about residency. The slightest stress magnified my relentless fatigue. Under pressure, I could no longer find the words. I called Roger. Was I returning too soon? Should I quit, give up my dream of surgery? “Your anxiety is normal,” he said. “Be patient”. He wouldn't give up. How could I?

Time, with its frustrations, passed. I began to feel normal! One day I looked at the morning surgery schedule—a repeated cesarean section. As I picked up the chart and entered the room, Roger was standing by his pregnant wife. She would be my first patient that day. I froze. Could I do this? I was of two minds. On the one hand, here was a man who had seen me at my worst, now watching as I prepared to do surgery on his wife. Yet an opportunity had appeared for me to give something back to Roger; I could prove that his medical knowledge and patient care were superb. I thrilled at the chance to share in the joy of bringing new life into his world.

The operating room lights flashed on. Gown. Gloves. Drapes. It was magic! Two miracles! Two! Knife, pickups, Mayo scissors. My pulse stepped in time with the baby's. Metzenbaums, bladder blade, knife, bandage scissors … The membranes bulged. Allis forcepts … suction …

“Roger, it's a boy!”

• Copyright ©2004 by the American College of Physicians