It was late in June 2020, and little was known about the worldwide pandemic. I drove to the hospital motivated by force of habit. The summer heat in Mexico City made the unusually empty streets feel like a desert.
I was on call in the COVID unit again and I knew what that meant for the next 24 hours: put the protective equipment on, check patients, take the protective equipment off. Put the protective equipment on, perform a cesarean, take the protective equipment off.
When each day is spent just as the last, time passes slowly in the moment but extremely quickly in retrospect. I gave the wall clock an envious gaze. Did its internal motor melt or did it somehow manage to stop working on Sundays? Was it even Sunday?
The television in the nursing station blared the national daily program announcing the weekly death count. The virus has killed more health care personnel in Mexico than anywhere else. However, nobody reacted anymore. Escalating tragedies had numbed the people who heard the news.
The phone rang: another positive patient. This time it was a 16-year-old with a term pregnancy, her first, and ruptured membranes. Despite having a 5 cm cervical dilation, she was sent straight from the triage to the COVID area for a cesarean.
"This would've never happened last year," I told Salvador, a keen first year resident. "So much for our years-long effort to reduce our cesarean rates."
Salvador wondered in interest, "Did we really used to do that?" I chuckled internally, for I remembered Salvador matched with this hospital roughly at the same time as the pandemic began.
"It's the first cesarean you want to prevent, you see, otherwise the morbidity rises significantly on the next pregnancies." We continued talking about abnormal placental invasion, surgical adhesions, and perinatal outcomes. Salvador listened attentively. Being isolated from the world since the COVID outbreak, neither of us had much contact with anyone outside the hospital and we had developed a singular bond.
Salvador was there for me when my parents caught the virus. I was with him when he made the decision to leave his home. We worked extra shifts together to cover for our infected colleagues. We were not only coworkers anymore; we had become family.
Cesareans had become the stopgap measure at our hospital to prevent excessive exposure to isolated patients in labor. It made me sad to operate on women who would normally have a better chance to deliver vaginally, but to think that the new generations were not learning good obstetrical practices was heartbreaking. This was one thing I would not let COVID take.
I got up from my chair and adjusted my goggles. "Hook me up an oxytocin.” The nurse gave me an excited look. "Let's talk to our patient. We are doing this the right way."
A few hours later, I personally handed the young woman her vaginally delivered baby. The nurses, the pediatrician, Salvador, and I exchanged a fraternal look. Masks cannot cover a smile when you smile with the whole face.
Francisco Javier Ruiloba Portilla, II, MD, is a resident obstetrician-gynecologist at Instituto Nacional de Perinatología in Mexico City, and the Junior Fellow Chair of ACOG’s Mexico Section.
Disclaimer: The thoughts and opinions in the Frontline Voices initiative reflect experiences of individual ACOG members and do not represent official organizational opinions of ACOG.