As an obstetrician, I try to make my laboring patients comfortable. That means managing her pain from contractions as well as her emotional stress. One night I have a patient in labor. Her name is Candace. Candace has had a previous cesarean but in this pregnancy, she is going to try to deliver vaginally. Six hours into her labor Candace starts to bleed excessively from the vagina.
I tell Candace, “I know that you had hoped for a vaginal delivery but it looks like we will have to do a cesarean. We had discussed the possibility of not having a successful vaginal delivery. I hope you are okay with us proceeding on to a cesarean so that we can stop this excessive bleeding. At this point, I don’t know why you are bleeding but I believe a cesarean will stop it. Fortunately, your baby’s fetal heart rate is reassuring, that is, your baby appears to be doing well.”
Candace replies, “I am totally fine with proceeding with a cesarean. Part of me always wanted to just have a repeat cesarean anyway. My major concern is that I had a panic attack in the operating room with my last cesarean and I am concerned it will happen again.”
I then tell Candace, “The staff is now running around preparing for your urgent delivery but I am going to go into the operating room, the O.R., with you and I will be there to reassure you during the entire procedure. I will distract you with amusing stories and I may even sing to you.” Candace still has a look of concern but she squeezes my hand and says, “I trust you.”
In the O.R. Candace slides onto the operating table but then starts screaming, “I can’t do this! I can’t do this! Stop everything. I need Valium.”
I tell Candace, “I would rather not give you Valium at this point as it will go right to the baby.”
I ask the anesthesiologist to give Candace some Phenergan. Candace asks, “Is that like a cousin to Valium?”
I say, “Think of it as Valium’s cousin’s roommate.” I can see that the anesthesiologist is smiling even though her mask is on.
The anesthesiologist says in a loud voice, “The Phenergan is in.”
I ask Candace if she is feeling better. She says, “Yes, somewhat, thank you.”
Candace’s face is now behind a blue paper drape so I cannot see her but I can still talk to her. I tell Candace, “I used to tell inappropriate stories in the O.R. but I quit after taking a class on harassment. Since I quit telling those stories, my surgical assistant says she has become so bored she is thinking about retiring early.” I add, “Nevertheless, in your honor, I will tell one last inappropriate joke to distract you.” Although the nurses have masks on, I can see their eyes rolling.
I start off, “My wife asked me if I was having sex behind her back. I said, ‘Well, who did you think that was?’”
The room goes quiet except for a few chuckles. The staff does not want to chance getting into trouble for participating in an inappropriate joke if someone were to take offense and I was to get reported. Our anesthesiologist is originally from China. She often does not understand the subtlety of my American jokes. At this point, she says, “I don’t get it.”
Candace bursts out laughing causing everyone in the O.R. to laugh with her. Candace is relaxed enough for us to proceed with the surgery.
I am always circumspect with my informal banter during a cesarean as the patient is almost always awake and attended by her partner. They are listening to everything that is said in the O.R. as they await the first cry of their newborn. If I make a small error, such as cutting into a blood vessel during the surgery, I never say, “Oops.” Instead, I say, “There.”
Assisting me with the surgery tonight is a surgical Registered Nurse First Assistant (RNFA) named Suzanne. I like working with Suzanne because she politely laughs at all of my jokes.
Suzanne’s last name is Gourioux. We have another nurse that works with us in Labor and Delivery that is from France and is fluent in the French language. One day she told Suzanne that she was not pronouncing her own last name correctly. When the French nurse pronounced her name she made sounds that had never been produced by an English speaking person. It sounded like she was saying Guyere. It sounded as though she was trying to say, Goodyear, while eating a mouthful of soft cheese. None of us could pronounce the name correctly including Suzanne. We finally gave up. My last name is Matsumura. I imagine if I tried to pronounce my own last name in Japan there would be some raised eyebrows.
Whenever I see Suzanne, I always sing to her a line from a James Taylor song. I sing, “Suzanne the plans they made put an end to you.” Those of us who were listening to the radio in the 1970s can remember what was going on in our lives when that song was popular. Suzanne always found it to be a bit amusing that I would sing that one line to her.
She relates the following story to me now as she assists me in the cesarean. “I was talking to my mother on the phone yesterday and I told her, ‘There is this obstetrician that I work with. Every time he sees me, or even talks to me on the phone, I remind him of a song and he sings, Suzanne the plans they made put an end to you.’” Her mother then said, “I named you after that song.”
After hearing that I feel very nostalgic and quietly, under my mask, sing:
“Just yesterday morning, they let me know you were gone. Suzanne, the plans they made put an end to you. I walked out this morning and I wrote down this song….”
At this point, those in the room familiar with the song start singing along. Even the scrub tech, who is younger than my children, sings along as she passes instruments.
“…I just can’t remember who to send it to. I’ve seen fire and I’ve seen rain. I’ve seen sunny days that I thought would never end. I’ve seen lonely times when I could not find a friend but I always thought that I’d see you again.”
It is very quiet after singing. I ask my patient, “Candace, are you okay with us singing at your delivery?”
She replies, “I was quite anxious when the surgery started but then I got caught up in the story. I then thought, well, things must be going pretty smoothly if they can sing during my surgery.”
I laugh, “Well, you’d be surprised. I also sing when the surgery is not going well. I do that to stay calm.”
A baby girl comes out of the uterus with a lusty cry, which is always a relief to the parents. Actually, it is not just the parents that welcome the newborn’s first cry. The entire operating room gives an inaudible sigh of relief at that point. The rest of the cesarean is the more relaxed, anticlimactic part of the surgery. At this point, Candace’s anxiety appears to be completely gone. This happens with every cesarean. Even though the surgery is far from over, all anxiety has left the room. I start to sew the uterus closed.
Now that the stressful part of the case is over, I engage my assistant in light banter. I ask Suzanne if she can name the four Beatles. Suzanne is much younger than me but I think she can name them all.
Suzanne asks, “Is one of them, James Taylor? The room goes dead quiet. I carefully put down my suture not believing what I have just heard. I feel as though I am about to wake up from a dream. The patient’s voice from behind the drape breaks the silence, “Are you f***ing kidding me?” Suddenly everyone starts laughing including the patient and Suzanne. I ask our Chinese anesthesiologist is she can name the four Beatles. She names them all, ending with Paul McCarthy. I say, “Close enough.”
At patient Candace’s post-partum visit six weeks later, she tells me that she had not been familiar with James Taylor but that song now means a lot to her and her husband as it was introduced to them at the most memorable moment of their lives. They purchased the music and plan to play the song for their daughter as she grows up.
I remember in 1970 thinking that the lyrics were quite sad. I later learned that the Suzanne mentioned in the song was a friend of James Taylor and she had died unexpectedly. Carole King had played piano for the recording. There is a line in the song that says: “I’ve seen lonely times when I could not find a friend….” Carole King was moved by that sad thought. She could not imagine not being able to find a single friend. She decided to write a song in response. Her song is called You’ve Got a Friend.
The song Fire and Rain meant a lot to me as a struggling pre-med student in Southern California in the 1970’s. I was very discouraged as I had received rejection letters from all of the medical schools I had applied to and did not have a backup plan. The song spoke to me and my generation. It will speak to future generations.
Candace replies, “I am totally fine with proceeding with a cesarean. Part of me always wanted to just have a repeat cesarean anyway. My major concern is that I had a panic attack in the operating room with my last cesarean and I am concerned it will happen again.”
I then tell Candace, “The staff is now running around preparing for your urgent delivery but I am going to go into the operating room, the O.R., with you and I will be there to reassure you during the entire procedure. I will distract you with amusing stories and I may even sing to you.” Candace still has a look of concern but she squeezes my hand and says, “I trust you.”
In the O.R. Candace slides onto the operating table but then starts screaming, “I can’t do this! I can’t do this! Stop everything. I need Valium.”
I tell Candace, “I would rather not give you Valium at this point as it will go right to the baby.”
I ask the anesthesiologist to give Candace some Phenergan. Candace asks, “Is that like a cousin to Valium?”
I say, “Think of it as Valium’s cousin’s roommate.” I can see that the anesthesiologist is smiling even though her mask is on.
The anesthesiologist says in a loud voice, “The Phenergan is in.”
I ask Candace if she is feeling better. She says, “Yes, somewhat, thank you.”
Candace’s face is now behind a blue paper drape so I cannot see her but I can still talk to her. I tell Candace, “I used to tell inappropriate stories in the O.R. but I quit after taking a class on harassment. Since I quit telling those stories, my surgical assistant says she has become so bored she is thinking about retiring early.” I add, “Nevertheless, in your honor, I will tell one last inappropriate joke to distract you.” Although the nurses have masks on, I can see their eyes rolling.
I start off, “My wife asked me if I was having sex behind her back. I said, ‘Well, who did you think that was?’”
The room goes quiet except for a few chuckles. The staff does not want to chance getting into trouble for participating in an inappropriate joke if someone were to take offense and I was to get reported. Our anesthesiologist is originally from China. She often does not understand the subtlety of my American jokes. At this point, she says, “I don’t get it.”
Candace bursts out laughing causing everyone in the O.R. to laugh with her. Candace is relaxed enough for us to proceed with the surgery.
I am always circumspect with my informal banter during a cesarean as the patient is almost always awake and attended by her partner. They are listening to everything that is said in the O.R. as they await the first cry of their newborn. If I make a small error, such as cutting into a blood vessel during the surgery, I never say, “Oops.” Instead, I say, “There.”
Assisting me with the surgery tonight is a surgical Registered Nurse First Assistant (RNFA) named Suzanne. I like working with Suzanne because she politely laughs at all of my jokes.
Suzanne’s last name is Gourioux. We have another nurse that works with us in Labor and Delivery that is from France and is fluent in the French language. One day she told Suzanne that she was not pronouncing her own last name correctly. When the French nurse pronounced her name she made sounds that had never been produced by an English speaking person. It sounded like she was saying Guyere. It sounded as though she was trying to say, Goodyear, while eating a mouthful of soft cheese. None of us could pronounce the name correctly including Suzanne. We finally gave up. My last name is Matsumura. I imagine if I tried to pronounce my own last name in Japan there would be some raised eyebrows.
Whenever I see Suzanne, I always sing to her a line from a James Taylor song. I sing, “Suzanne the plans they made put an end to you.” Those of us who were listening to the radio in the 1970s can remember what was going on in our lives when that song was popular. Suzanne always found it to be a bit amusing that I would sing that one line to her.
She relates the following story to me now as she assists me in the cesarean. “I was talking to my mother on the phone yesterday and I told her, ‘There is this obstetrician that I work with. Every time he sees me, or even talks to me on the phone, I remind him of a song and he sings, Suzanne the plans they made put an end to you.’” Her mother then said, “I named you after that song.”
After hearing that I feel very nostalgic and quietly, under my mask, sing:
“Just yesterday morning, they let me know you were gone. Suzanne, the plans they made put an end to you. I walked out this morning and I wrote down this song….”
At this point, those in the room familiar with the song start singing along. Even the scrub tech, who is younger than my children, sings along as she passes instruments.
“…I just can’t remember who to send it to. I’ve seen fire and I’ve seen rain. I’ve seen sunny days that I thought would never end. I’ve seen lonely times when I could not find a friend but I always thought that I’d see you again.”
It is very quiet after singing. I ask my patient, “Candace, are you okay with us singing at your delivery?”
She replies, “I was quite anxious when the surgery started but then I got caught up in the story. I then thought, well, things must be going pretty smoothly if they can sing during my surgery.”
I laugh, “Well, you’d be surprised. I also sing when the surgery is not going well. I do that to stay calm.”
A baby girl comes out of the uterus with a lusty cry, which is always a relief to the parents. Actually, it is not just the parents that welcome the newborn’s first cry. The entire operating room gives an inaudible sigh of relief at that point. The rest of the cesarean is the more relaxed, anticlimactic part of the surgery. At this point, Candace’s anxiety appears to be completely gone. This happens with every cesarean. Even though the surgery is far from over, all anxiety has left the room. I start to sew the uterus closed.
Now that the stressful part of the case is over, I engage my assistant in light banter. I ask Suzanne if she can name the four Beatles. Suzanne is much younger than me but I think she can name them all.
Suzanne asks, “Is one of them, James Taylor? The room goes dead quiet. I carefully put down my suture not believing what I have just heard. I feel as though I am about to wake up from a dream. The patient’s voice from behind the drape breaks the silence, “Are you f***ing kidding me?” Suddenly everyone starts laughing including the patient and Suzanne. I ask our Chinese anesthesiologist is she can name the four Beatles. She names them all, ending with Paul McCarthy. I say, “Close enough.”
At patient Candace’s post-partum visit six weeks later, she tells me that she had not been familiar with James Taylor but that song now means a lot to her and her husband as it was introduced to them at the most memorable moment of their lives. They purchased the music and plan to play the song for their daughter as she grows up.
I remember in 1970 thinking that the lyrics were quite sad. I later learned that the Suzanne mentioned in the song was a friend of James Taylor and she had died unexpectedly. Carole King had played piano for the recording. There is a line in the song that says: “I’ve seen lonely times when I could not find a friend….” Carole King was moved by that sad thought. She could not imagine not being able to find a single friend. She decided to write a song in response. Her song is called You’ve Got a Friend.
The song Fire and Rain meant a lot to me as a struggling pre-med student in Southern California in the 1970’s. I was very discouraged as I had received rejection letters from all of the medical schools I had applied to and did not have a backup plan. The song spoke to me and my generation. It will speak to future generations.
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