in praise of hands-on expertise

(I don’t usually share personal stories in public fora, but in this case, and with my wife’s permission, I’m making an exception.)

“Shoulder Dystocia,” said the Obstetrician, as we neared the end of my wife’s otherwise-routine delivery of our son last week. This meant nothing to me. My wife, on the other hand, freaked out. She’s a physician and had understood something I’d missed. My child’s head, which had only just emerged, began to visibly turn blue. I froze and, not for the first time in these medical situations, felt utterly useless.

What followed is best described as a highly coordinated dance. The Doctor started a set of rough and involved maneuvers, with stern orders to the nurse to apply pressure here, apply pressure there. The nurse pushed with one hand and grabbed the phone to call for help with the other. Within 30 seconds, before the additional help even arrived, a shoulder was out, one twist, and then the other. Our son cried and his color quickly turned pink. Cord clamped, scissors handed to me, I cut, doing my best not to shake from the adrenaline. The Pediatric team evaluated our son, and, 5 minutes later, he was in my wife’s arms. His left arm was visibly sore for a few hours. By end of day, though, the pediatrician was confident he had sustained no permanent damage.

So now, a few days later, I am beginning to understand. My son’s shoulder got stuck right after his head emerged. This happens in approximately 1% of births, though oftentimes the situation resolves itself. When it doesn’t, permanent nerve damage is a not-unlikely outcome, with reduced or even no use of the impacted arm. And, because the umbilical cord is compressed, the child cannot breathe. If my son hadn’t been delivered in the 5-10 minutes that followed, he could have suffered permanent brain damage or even died.

Instead, he is a perfectly happy 1-week old baby.

We’re so accustomed to things going well, we forget how quickly things can go wrong. We don’t often enough praise the folks in our society who have deep hands-on experience, with the training to react in a highly coordinated, rehearsed, scientifically proven manner in a matter of seconds. They’re the ones ensuring things go well. Most white-collar professionals, like myself, never need this kind of precise, automatic response. We see it in athletes, but we forget that doctors, pilots, soldiers, and a few others need it too. It’s a response so well learned it’s hard to imagine it could be anything but instinct. So we thank chance, fate, or some other mystical agent. We forget the role of these hands-on experts. We figure we can do without them.

Not so. In that one moment last week, decades of accumulated medical knowledge, analyzed by dozens of researchers poring over thousands of data points, condensed and taught to a team of doctors and nurses, rehearsed through years of training and ingrained through careful checklists, came together so that my son will never need to care that this ever happened. It’s awe-some, in the true sense of the word.