Stories from thirty years of being a physician.  This is one.

José was a Certified Surgical Assistant (CSA) who helped me with Cesarean sections. He was a big guy with a little white in the scruffy black stubble on his face, and a man of few words.  I usually had to ask him to repeat the occasional amusing quip because, unlike the nurses whose hearing was far more acute, all I heard was a low rumble.  José always thought I should sew the abdominal muscles back together after we did a Cesarean.  I didn’t see any reason—sewing muscle is like sticking a needle through a stick of butter—but I didn’t see any harm. I’d give him the needle holder after I’d closed the peritoneum. He would neatly bring the pyramidalis and rectus muscles together with the same care one would use embroidering a shirt.

One evening Maria came to the hospital from the office. Her doctor couldn’t find the baby’s heartbeat, and an ultrasound confirmed the baby had died. Her first baby, a girl, had died from a brain hemorrhage when she was 11 months old. She had two boys at home, both delivered by Cesarean section. Sadly, this turned out to be another girl.

She insisted she’d felt the baby moving on her way to the hospital and repeatedly asked if there was some mistake.  We checked again with a bedside ultrasound exam, found no movement and no heartbeat, and her tears finally began to flow. I felt a little useless because she spoke no English (and I only know a little German), but her nurse, Molly, spoke fluent Spanish and gently consoled Maria.

I explained another Cesarean section would be the best way to deliver. We gave her the option of waiting until the morning but she didn’t want the baby inside her any longer than necessary.  We waited for her family arrive and gave everyone time to grieve, and then took her to the operating room. The anesthetist made her comfortable with a spinal and we prepped her for surgery.

It took about 5 minutes to open the uterus. The odor coming from the amniotic fluid indicated the baby had died a few days earlier.  We found a large clot in the umbilical cord where it entered the baby and a very tight constriction in the cord farther down near the placenta.

She began sobbing again as she felt the baby leave her body.  José leaned over the drape talked to her in the low, quiet voice.  I couldn’t follow what he was saying, but I caught “Dios”, Spanish for God.  We finished the operation in near silence.  We moved her to a regular bed after dressing the incision and took her back to her room.  I sat on a stool in the hallway because my back was aching; José came out of the operating room a moment later.

I asked, “So, what did you say to her?”

He replied, “Sometimes God wants angels, too.”  He paused, weary.  “This is tough for us; I can’t imagine what they go through.  Even when your kids are grown, you worry about them and don’t want them to die before you do.”

I thought I saw a faint glimmer of tears in his eyes, but my own tears obscured my vision.