It's a Placenta

Jack Handey, the father of wisdom, once said, "To become a knife thrower in the circus, they probably don't let you start off throwing at a live woman. They start you out with a little girl."

I've gained a new appreciation for these words over the last month. This is because I've finally started working in the hospital, a place that -- much like the circus -- seems to defy human limits on a regular basis.

My first hospital assignment was to the Labor & Delivery floor. L&D is where childbirth, arguably the greatest show on earth, takes place. It is also where the show Boston Med takes place. Unfortunately, I had never seen Boston Med, and everything I knew about childbirth had to do with food babies. So I guess you could say I was ill prepared for what lay ahead.

This became apparent within minutes of my first day. Morning rounds, a time for the doctors to discuss all the pregnant women on the floor, had just started when news arrived of an imminent delivery. A few moments later, I found myself in an operating room. There was a woman on a table. People and metal carts were scattered all around. The woman pushed twice, and before I could even adjust my gloves, we were plus one.

If there had been time to swell with feeling, I would have. But a nurse appeared in front of me holding a cylindrical plastic container, the kind that soup gets served in if for some reason you're ordering a lot of soup to go (where are you going with that soup though?). "You're gloved," she said. "I need you to pick up the placenta and put it here."

So while the team from Pediatrics huddled in the far corner of the room fussing over the baby, and the team from L&D huddled around the operating table fussing over the mother, I stood in the back trying to fold up the placenta like a newspaper so that it would fit inside the container.

People often ask me how many babies I got to deliver during my time on L&D. Almost no one wants to know how many cups of ice chips I delivered, and even fewer inquire after the number of placentas. This is unfortunate, as the latter two are both non-zero numbers. But tales of ice chips won't get anyone's pulse racing these days. And it isn't always easy to casually broach the topic of placentas in conversation. Say the word and people instinctively grimace, or stop eating whatever they're eating, or change the subject to something less gruesome, like Pap smears.

I can't blame them. The placenta is basically a giant human wheel that awkwardly follows a baby into the world because it has nowhere else to go. Once out, it looks hapless. It doesn't move around or act adorably infuriated. Its Apgar score at forever minutes is still zero.

But perhaps because this is my first month in the hospital, I've found myself drawn to the placenta more than any other part of the childbirth process. The placenta is my version of Jack Handey's little girl, a safe place to start out before trying my hand at anything with a shot of graduating high school someday.

And there are other reasons to relate to the placenta. In a way, it captures the life and times of a medical student: we're usually following, and when we're not following, we're lurking. At rounds, we lurk in the back row and listen as acronyms fly through the air like badminton birdies. In the OR, we lurk behind the scrub techs and watch pink bowels jiggle on large overhead monitors, one of the many benefits of modern camera-assisted surgery. And on the L&D floor, when a pregnant madam gets close to the moment of truth, it often feels like we are part of an entire troupe of lurkers -- us, the midwives, the nurses, the uncomfortable boyfriend with smart phone in hand -- fixated from the safety of darkness on the illuminated empty space between her legs.

Someday, of course, we hope to be the ones in the light, the ones who lead the action. For now, we watch and follow and pray that the cord connecting us to everyone ahead of us doesn't break.

On the evening of my last day on the L&D floor, I scrubbed into one final delivery, a cesarean section. The young woman on the table had given birth before, but never by c-section, and she was nervous about how this baby was going to make the journey from her belly to her arms.

The husband appeared in the OR looking tall and goofy in a jumpsuit that one of the nurses had instructed him to wear. We proceeded with the operation. The baby was a girl, large and healthy -- "She is big," reported the husband to his wife, who couldn't see; "She is not small" -- and we began the process of closing the mother back up. Per standard protocol, the uterus was lifted out of the body and wiped down with a wet rag like the hood ornament of a fancy car. I looked over to see how the husband was taking this, but he was busy snapping photos of the baby girl with a disposable camera.

After the operation was over and we began cleaning up, the husband turned his camera on the woman, who was still lying on the operating table. She groaned in protest and held up her arms to shield her face.

"No, don't hide," said her husband as he reloaded between pictures. He was documenting everything: the johnny, the narrow table, the metal basins, the scrub cart now piled high with bloody towels. I remembered my first day in the OR and wondered if he, too, was overwhelmed with emotion and searching for a way to take it all in.

"We need these to show our kids someday," he said, "so they won't want to give birth. We don't want to be grandparents anytime soon."

He may not have been the father of wisdom, but there in the company of both a woman and a little girl, it seemed a wise father had been born.