Almost Makes
You Believe
by Mike Litrel, M.D.

had noticed that the supervision of a good upper level resident made all the difference. So I'd promised myself that when I was finally an upper level, I would be the model teacher and supervisor.

But now I was the first upper level to make one of the new interns cry. I didn't appreciate the distinction. I wasn't the biggest jerk in the residency program - just the season's first.

Mary delivered the placenta, her shoulders still heaving with sobs. My sympathy became tinged with resentment. I'd hardly raised my voice at her. On the Grady Scale of Intra-Resident Abuse, this incident barely rated a 2. This was only her first week at Grady. She had two hundred and one to go. In my estimation, she needed to toughen up - preferably instantly. She had a laceration to fix, and the patients were piling up.

I scrubbed out of surgery to round on the other patients, six of whom were in labor. As I waded through the work, I worried some about Mary. You had to learn quickly to survive Grady - it was sink or swim. Mary didn't seem too tough. One delivery with minor complications and she was blubbering like a baby.

I checked on Mary later and found her at the nurses' station, finishing her paperwork. She didn't look upset - in fact, she was smiling. I ventured an apology. "I'm sorry for yelling, I didn't mean to make you cry."

She looked at me with surprise and laughed. "You didn't make me cry, Mike," Mary said. "You were fine."

I looked at her in disbelief, and she laughed. She comfortably grabbed my arm and pulled me into the patient's room. She gestured at the baby, now lying comfortably in the Ohio bed.

"Seeing a baby being born," she said. "It was just so beautiful." She shook her head in wonder and bemusement. Tears twinkled again in the corners of her eyes.

Mary went back to her work and I stood in momentary confusion, looking at the newborn. It had been four years since I had delivered my first baby. I'd been a third year student in medical school, and my life-long desire to be a doctor had culminated in the moment I helped that first tiny patient into the world. As I held her in my hands, a tidal wave of wonder and joy had washed over me. In delivering babies, I'd found my destiny.

But now, after so many long hours of work, so many days of simply counting the hours until I could sleep again, so many patients and so much suffering - my thoughts and feelings had changed. I had changed.

I was an expert, well versed in handling the unfortunate and dangerous circumstances that sometimes occur with deliveries. But like the doorman at the Waldorf Astoria, jaded from years in New York City, I had lost my first day's enthusiasm. Now I was merely doing my job - opening doors, closing doors - and tipping my hat.

The baby looked around at his new surroundings, seeing light for the very first time. Ten fingers, ten toes, no concerns - serenity incarnate. Was it only two hundred and eighty days ago that this human being was conceived? Was it less than a year ago that the fertilized ovum, a mere particle of dust, had blasted off in an explosion of remarkable transformation?

He, too, had changed.

The nurses in the delivery room were bustling around the young parents, tidying things up. The new father, his jaw still agape, rubbed his wife's shoulder and held her hand. The exhausted mother looked over at her newborn child, her relief and gratitude almost palpable, and her love most certainly so.

A sudden realization made me smile: Life is wondrous, if you hadn't noticed lately.

Sometimes, in fact, it almost makes you believe in God.

Dr. Litrel is in practice at Cherokee Women's OB/GYN in Woodstock and Canton and is a Clinical Assistant Professor at Emory University School of Medicine. He lives in Towne Lake with his wife Ann and their two sons Tyler and Joseph. (mikelitrel@attbi.com)

After a doctor delivers a hundred babies or so, he or she begins to see the obvious - delivering a baby is not that hard. For the doctor, I mean. The mother still has it rough.

To the mother falls the heroic work of labor - many long hours marked with blood and pain, of forcing the baby's head from her body. Once she has reached that point, she has left the doctor with only two small tasks, first, pull the baby's head down; then, pull it up. That's obstetrics in a nutshell. Down, up. Always been that way, always will.

Every year a few new doctors try to innovate. One July at Grady Hospital, the intern I was supervising as a third year resident insisted on doing things a new way - the Up First Method. Not only is this impossible, it gives the baby quite a headache.

As I watched the intern fumble, I felt myself the epitome of patience. Many of my fellow residents had come from Emory's Medical School, where the students deliver Grady babies long before graduation. But this freshly promoted doctor had come from a medical school affiliated with a hoity-toity hospital, chock full of private patients. As a student, she had been allowed to draw blood, maybe, but had never come close to delivering a baby. Her first deliveries couldn't be as casually under-managed as those of the Emory graduates traditionally were.

"Pull down, Mary, down," I repeatedly whispered in her ear. But Mary kept pulling up. Finally, the baby's head turned purple - not a good sign - and I lost my temper.

I don't remember exactly what I said to Mary as I took over the delivery, placing my hands over hers to direct them downwards and deliver the baby - now floppy. But in a moment of high stress, I think I may have conveyed my complete disgust with her as a physician and a human being.

Out of the corner of my eye, I watched the pediatricians resuscitate the baby, as Mary and I waited for the placenta to deliver. They were urgently pumping oxygen into the baby's lungs, as it lay ominously still. With each silent second, I kicked myself for not taking over sooner. However, after what seemed endless minutes, the reassuring sound of the baby's cry finally broke the tension. I was happy.

But Mary was not. As she watched the baby come to life, her lower lip began to quiver. Her eyes filled with tears. And she began to sob.

Crying is a summer tradition among the new interns at Grady Hospital. One moment you're walking tall, a June medical school graduate with a diploma and the title of Doctor. The next moment you're July's lowly intern - thrown into the ravenous jaws of the thousand-bed indigent teaching hospital like a juicy piece of meat. It's not a question, really, of whether you'll break down. It's just a question of when.

Grady Memorial Hospital draws its patients from the inner city intern. As I'd struggled through my own internship, I