First, Do No Harm

by Ann Calandro

Most of our courses were in the sciences, but all students were required to take a history of medicine course. Many students complained about it, because they wanted to dissect cadavers or practice their clinical skills on patients, but I loved that history of medicine course. Maybe I loved it because my grandmother lived with my father, mother, and me for six months when I was a child, before she died, and I enjoyed listening to her talk about her childhood and young adulthood. I didn’t need her to tell me that the world was different then, and she didn’t tell me that it was or wasn’t. She only told me her memories as we sat on the front lawn during those summer evenings, in the last slow drips of honey-colored sun, she in a green metal chair and me in a red one, while I absorbed her words like vitamin D. I learned in the course that vitamin D was considered important back then. My grandmother told me she chewed a tablet of it every morning. “They tasted good,” she remembered. “They were sweet, like candy.” 

Today was an ordinary day at work. I work four days a week as a solo practitioner. Some physicians can request and obtain licensure to be part of small group practices, but at this point in my life, when I am young and have lots of energy, I prefer to work alone. Everyone feels comfortable asking for and receiving help if needed. Two patients were assigned to me today: a sow and a woman. In the morning I delivered the sow’s third litter of piglets, a birth that occurred without any problems, and in the afternoon I delivered the woman’s first child—a healthy, eight-pound boy, a delivery that also went smoothly. As required, the woman’s husband, parents, siblings, and grandparents attended the birth, which took place at the couple’s home. A great-grandmother was also present. I noticed that she flinched when I reached into my bag at one point during the labor, but when I took out  additional clean cloths and a small bottle of massaging oil, she relaxed. 

Once the baby was nestled against his mother and the placenta expelled, I wrote  the required verification that the birth was normal and natural and that no instruments, techniques, or medicines were used to induce, hasten, slow, or otherwise interfere with labor and delivery. Had my patient required more intervention that I was qualified to give, I would have called for transport to the clinic and served as her advocate during whatever processes and procedures a specialist deemed necessary, as long as I agreed. It is not rational to expect women and their spouses to make informed decisions during the process of childbirth, even if they have received information on labor and delivery during pregnancy. While I signed and dated the form and affixed my official seal, the great-grandmother walked over to me slowly. She was very old and leaned heavily on a cane, but her eyes were clear and her voice was strong. 

“I was one of the last women to undergo birth the old way,” she told me, after introducing herself. “It was shortly before the Great Pandemic.” I nodded. I had read about the pandemic during my training, and my great-grandmother had also given birth to my grandmother in a hospital. It was incomprehensible to me that each pregnant woman then was not treated as an individual but was instead subjected to the assembly-line rules, regulations, and whims of insurance companies, hospital executives, and government bureaucrats. I explained that my grandmother had lived with us when I was a child and had told me this information, because she had been a forceps delivery in a large, well-ranked, corporate hospital and her mother, my great-grandmother, had sustained serious tears and an severe infection during the birth. I added, “I have read that in 1954, formula was all the rage, and in 2018, formula was considered evil and breast-feeding was pushed on all women. Is that so?” The old woman chuckled. “Yes. That was one of many areas in which corporate greed, hospital ratings, and the indifference of health care professionals combined to make women nothing more cogs in a for-profit system. I also underwent serious tearing and a severe infection during childbirth, and I was not even examined before I was shunted out of the hospital in fewer than 48 hours. I was lucky. I survived. My child survived. Many women didn’t, or they sustained lifelong injuries. There was no legal recourse unless the baby was harmed. It’s good that the system has changed. It’s a shame that it took so long for change to occur, and it’s a shame that a pandemic that could perhaps have been avoided was the catalyst for this change.” 

One of the changes involved how doctors were trained. When the insurance companies were finally overthrown; when health care was considered a necessity of life like food and water; when health care professionals went back to seeing people as humans needing care and explanation and not as checkboxes to mark and move along, the training of all medical professionals changed, too. Now obstetricians deliver humans and animals, using best techniques from both specialities.  

I agreed, and we smiled at each other. As I turned to leave, I said, “I feel honored to meet and speak with a survivor from those terrible times,” and she thanked me. I checked the mother and her baby boy one final time, noted in writing that everything was well, explained to the family that the district nurse would arrive in the evening to take over from me, and asked if anyone had any questions. No one did, and so I bid the family farewell, tired but thankful that I had done no harm on this ordinary day.

Ann Calandro is a mixed media collage artist, classical piano student and composer, and writer of fiction, poetry, creative nonfiction, and children's books.

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