Potential Energy

In physics, an object possesses potential energy as a product of its position or condition. The energy is not a force––not yet––not until it is set into motion. But once released, in the right circumstance, that energy has the power to impart profound devastation. 

When I trained as an obstetrician, I learned how to pull a scalpel across skin, like a cellist glides a bow over strings, creating the perfect note––the perfect cut. I learned which medications quiet a postpartum hemorrhage––when blood is spilling from a woman’s body so fast it is audible. I learned how to interpret black-and-white sonographic images of a fetus to identify a congenital misstep––an absent cardiac ventricle, a hole in a skull, cysts in a kidney, a missing hand, dilated bowel, no heartbeat. Often, my job is joyful––trite but miraculous. Yet when the work is sad, it is awful. And now, standing outside Lindsay’s exam-room, I am mired in the awful. 

I raise my hand and prepare to knock. I notice the stillness of my arm before it moves toward the door. Over decades of medical education, training, then practice, I have garnered complex skills. But I still do not know how to gently wield the unrealized force of untold bad news––potential energy. 

I know a truth Lindsay doesn’t––not yet. The baby wiggling inside of her body is going to die soon. I am the doctor who read her ultrasound, found the anomaly, and now, I have to tell her. After my hand is set in motion to knock on the door, I will share information that will shatter the hope Lindsay and her husband have gathered over the last five months––I will erase the dreams that drifted into her consciousness when her pregnancy test had two lines instead of one. What I know but she doesn’t is there will be no first birthday party. There will be no sparkly bike with ribbons on the handlebars. There will be no first dates, prom dates, or wedding dates––not for this baby. I stand outside of her door about to knock full of potential energy because of my position and her baby’s condition.  

Obstetrics harbors problems that cannot be repaired. Most people fail to consider babies die and sometimes such a fate is unavoidable. There is a conspicuous absence of fetal and neonatal death in television shows and lay media. Sweet, perfect, well-grown babies are what the world wants to witness. The alternative feels implausible––medicine’s secret. I am still working to understand my role when the potential to heal a broken body is gone. 

To maintain board certification, I read articles outlining the best treatment for COVID-19, the best suture to repair a perineum, the best technique to dislodge a shoulder dystocia, but my required reading does not instruct me on how best to break a heart. For Lindsay, what I will carry into her room has the power to divide her life into a before and after––a force that will split her in two. I wish I knew how to best manage that responsibility. 

As I stand outside her room, I anticipate her trembles, heaves, and sobs––a scene I know well but dread. I prepare to accept my limitations and remind myself pain needs a witness. But my mind runs through options to offer ease. I will want to lie. I always want to lie: “Your baby could be just fine.” “Maybe the condition won’t be as bad as we think.” “We should look again, I might be wrong.” Denying reality would ease my discomfort but deception delays Lindsay’s inevitable pain. So, instead, I decide how I will map the steps down a path Lindsay does not know waits. 

Hand sanitizer evaporates from my skin leaving my palms cold and sterile. The air smells like rubbing alcohol and my daughter’s shampoo I used earlier that morning. I hate this part of my job. I hate the knock. I stand with my arm raised, then pause, take in a breath, pray to a God I rejected long ago because I cannot believe a greater power would force me to deliver this news––to devastate a mother. “Help me do this well,” I whisper to no one but myself. Then, I put energy into motion and knock on Lindsay’s door.