\u201cSee the little flicker?\u201d the doctor asked, as she tilted the ultrasound screen and pointed to the tiny movement. The patient leaned forward, squinting, trying to decipher the gray and black pixels that showed she was now a mother. \u201cThat\u2019s the heartbeat,\u201d her doctor explained. \u201cRight there,\u201d she pointed again, this time zooming in even further. The patient nodded as she tried to contain her excitement. She smiled with one of those tight-lipped grins as her eyes widened, as if joy was actually bursting out of her. Her husband chuckled at her wild expression and squeezed her hand. \u201cIt\u2019s okay,\u201d her doctor said. \u201cBe excited! This is exciting!\u201d And with that word of permission, the expecting mother squealed, just a little, and calmed herself again. \u201cIt\u2019s our first, you know, and my sister just had a girl and I wanted our kids to be able to grow up together and we just didn\u2019t know if it would happen this fast, and,\u201d she paused to catch her breath. \u201cSorry, I just can\u2019t believe we get to start buying baby stuff!\u201d<\/p>\n
I looked at the screen again, at the little flicker of light, at the little piece of white against black that would someday have a lot of \u201cbaby stuff\u201d foisted upon it. It was one of the earliest pregnancies I had seen on ultrasound \u2013 in fact, I had only seen one other scan done at the same gestational age. It was striking how identical this scan was to the first one I had seen, months earlier. The screen had looked exactly the same, with the crown-rump length of the tiny embryo measuring the same, with the same shape of black fluid around white tissue. I thought back to that day, to the tiny portable ultrasound screen so far from home. Instead of an antiseptic outpatient OB\/GYN clinic in temperate California, the first scan had been done on the dirt floor of a little hut in Central America.<\/p>\n
It was a typical clinic day in rural Panama \u2013 humid, muddy, with lines of patients waiting to be seen. Working over the summer with the non-profit organization Floating Doctors, I saw many pregnant women come to clinic for prenatal care. Traveling to indigenous island communities, where most patients have no other access to health care, we would set up makeshift clinics and see as many patients as possible. It is common for women in the Ngobe communities to have as many as ten kids; oftentimes they start having children when they are teenagers themselves. Unsurprisingly, there was a lot of prenatal ultrasound scanning to be done.<\/p>\n
When I saw this particular patient, whose ultrasound was done so early in the pregnancy, the crown-rump length was the same as the patient\u2019s I would see months later at home. This woman was 32 and had five children. Her youngest, a two-year-old girl, leaned on her mother\u2019s chest as I scanned, taking a pause in her whining to stare at the screen. She didn\u2019t understand what it was, but her mother squeezed her excitedly anyway as I pointed at the little flicker, the unmistakable heartbeat. Even though they already had a big family, even though it was miserably sweaty sitting on the floor in our little ultrasound hut, and even though the toddler was getting fussy, this woman had the unmistakable grin of sheer excitement.<\/p>\n
Talking to the pregnant women in Panama, either during the scan or translating during the physician checkup, I imagined the lives these babies would have. It was an easy thing to think about, seeing so many children running around and playing as their parents waited in line. The kids were a handful to organize; it was no easy feat keeping them far enough away from the clinic to avoid distractions, but close enough to organize whole family visits when it was their turn. They played muddy games of soccer or baseball, chasing each other around and asking us for highly coveted stickers. They were so full of energy, so happy and so free. The mothers usually didn\u2019t find these games as amusing as I did; they were exhausted, overwhelmed, and just trying to get the visits done so they could go home. I can\u2019t begin to imagine the strength and resilience it takes for those mothers to care for so many children, and oftentimes other family members, with such limited resources and support.<\/p>\n
There was a mural painted on the side of a school in one of the communities we visited. The mural was a giant world map, not particularly accurate in terms of scale or geography, but vibrantly colored and decorated. When I saw it, I thought it was quite fitting, as I was working in a team with students and doctors from all over the world, living in a country I had never been to before, speaking a foreign language every day. When I thought about its place in the community, however, I began to wonder what it meant to them. These villages are isolated, by geography and lack of transportation and resources. The children who seemed so free to me would most likely find it difficult to leave their small village, if they ever wanted to. I wondered what they thought of that colorful map on the wall, whether it was an abstract concept of the world beyond their borders, or whether they dreamed of a truly unrestricted future. The child back home in Orange County, of course, might dream of just the opposite \u2013 wishing the world were not so vast and intimidating, wishing the world stretched just to the end of the block, where everything in between was familiar and safe.<\/p>\n
These are the things I wonder about, the things that keep me thinking about certain patients long after they\u2019ve left. These are the things that connect patients, at least in my mind, despite the vast differences in their lives. Ultimately, the job in medicine is to focus on the patient, or the ultrasound image, but it\u2019s not always easy, or in the patient\u2019s best interest, to tune out the context.<\/p>\n
We are trained to look at that little flicker of a heartbeat, measure its rhythm and pace, and watch as the baby grows and the flicker gets stronger. We are trained to look at every patient, every heartbeat, the same \u2013 without bias, without judgment, without assumptions. At the same time, we can\u2019t ignore the world around us, the world that we are working in and the world that our patients live in. We can\u2019t ignore the fact that differences between two patients\u2019 cultures, communities and access to resources may make them seem worlds apart. But mostly, we can\u2019t ignore how strikingly similar we all are at the start \u2013 just little flickers of black and white, so simply alive. Maybe if we try to remember that, all the differences we see every day will become just parts of the mural \u2013 not terribly accurate, certainly open to interpretation, but mostly just a beautiful mess of color.<\/p>\n
<\/p>\n
Featured image:
\nPanama Clinic, courtesy of Leigh Goodrich<\/p>\n","protected":false},"excerpt":{"rendered":"
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