I’m in the back of an ambulance rig driving 110 miles an hour down the highway with the lights and sirens blaring.   The knuckles of my right hand are crushed every four minutes as my patient has contractions.  She cries only a bit.  She’s sixteen and her last period was nine-months ago but she hasn’t seen any other physician before me.

This last contraction was an intense one—my bruised hand can tell—after it abates she turns away; my hand is still in hers and I absent-mindedly start to move it but she stops me with a firm squeeze. So I follow her lead and I stay in the silence.  I notice how each pothole accentuates a rattling in the back of the emergency truck and how the sirens sound distant. I reflect on how moments ago I checked her 8cm cervix, took her medical history, and saw inside of her pregnant body with an ultrasound.

Watching her in this experience has been stunning.  She has been stoic, almost wise.  Politely answering my questions between contractions. No drama. It’s a strange rhythm: during contractions there’s intensity and I have the right affirming words, and even the knowledge to move forward and deliver this baby (if need be). But when the contraction subsides and the baby has not come, there’s awkward silence.

I’m accompanied by an EMT and an ex-OB nurse. The EMT has been helpful and efficient and is now engrossed in forms. Regular conversation with my other colleague seems a out of place now. So the silence continues.  After all, my, “you’re going to be alright…we’re almost to the hospital…we’ve got you…your mom is on the way…” seem empty by the third time.

My hand begins to feel pressure once more.  I turn to the EMT, “If I need to deliver her, I want to pull over.” He nods.

I examine her again and see that she is not crowning.  

I have a child who is pregnant with a child who has received no prenatal care.  The odds are against her: the rates of maternal mortality in this geographic location are devastating.  I still tell her that she will be all right.  These are hopes but I say them as absolutes.

 I check-in, “what are you thinking about?”


She says with more weight than her 100lbs.  And words fail me again.

We make it to the OB floor of the hospital.  The team is well choreographed and she’s situated and hooked up to monitors almost immediately.  I give report to the next physician.  I go to her to say goodbye and take her hand in mine once more—not a handshake but palm-to-palm with thumbs crossed.  She looks into my eyes and holds my gaze for longer than a moment: fear and courage mixed.  I turn to leave.