One day in January, I was facilitating a fourth-year elective course with eight medical students. It was a medical humanities class, and the topic that afternoon was the virtue of forgiveness. A student named David led the discussion, and I listened as they exchanged ideas. When their energy waned, I asked, “Do any of you have someone to forgive from your clinical experiences? Did anything ever happen that you need to forgive or perhaps still can’t forgive?”
I waited for an answer, but no one said a word. When a classroom becomes that quiet in response to a question, I sometimes have the strength to sit with the silence. So, I looked out the window and waited. I leaned back in my chair and waited. Finally, David said, “Something unforgiveable happened to me.”
“What happened?” I asked him
“I was scrubbed into a vaginal hysterectomy. The patient was under general anesthesia. My attending was prepping the patient’s vagina. He picked up a clamp holding sterile cotton balls and dipped them into Betadine. While he was cleansing and scrubbing her labia and inner thighs, he looked at me and said, ‘I bet she’s enjoying this.’ My attending winked at me and laughed.
Someone gasped. I stared at David. He shifted in his seat and crossed his arms on his chest. A splotchy red rash appeared on his neck. Staring down at the table, he murmured, “Man, I was just standing there trying to learn. The guy was a dirtball. It still pisses me off.”
David glanced at me. I asked, “When your attending said that and laughed, did you laugh, too?”
My question touched a nerve; perhaps my tone was accusatory. David snapped back, “Yeah, I laughed, but what was I supposed to do? Have you ever been in a situation like that?”
I looked down at the table in front of me and saw my black ballpoint pen. I focused on its gold clip for a moment. I placed my index finger and thumb beside the pen and spun it in place. It twirled and clicked as it spun around and around. I stared at the rotating pen and remembered. I felt my face flush. The spinning pen slowed, and then the clicking stopped. I looked up at David. “Yes, I have.”
“So, what happened?” David asked.
“It’s my third year of medical school and I’m on Ob/Gyn. I deliver a baby girl and put her in the mother’s arms. I can still remember the mom’s name—Mrs. Lopez. I deliver the placenta, put it in a pan, and inspect it. It’s intact. Then, I turn back to Mrs. Lopez. I see blood gushing from her vagina. It comes in waves. I’ve never seen anything like it. I yell to my resident—the guy’s name is Dr. Canby —‘Hey, something’s wrong. She’s really bleeding over here.’ He shoulders me out of the way and checks her perineum for a laceration. There is none. He puts his hand on her abdomen and aggressively massages her uterus. She keeps bleeding. Then Dr. Canby says, “She’s got uterine atony. Start oxytoxin and call anesthesia.’ A nurse lifts the baby off the patient’s chest.”
“A few moments later, the anesthesiologist walks in the room and asks, ’what do you got?’ Dr. Canby says, ‘Vaginal delivery. Uterine atony. External massage failed. Give her some ketamine.’”
“Anyway, so I hear the anesthesiologist say, ‘Ketamine is in.’ I look at Mrs. Lopez—her eyes are halfclosed and vacant. Dr. Canby instructs me to hold her knee. A fellow medical student holds her other knee. Our job is to keep her legs spread. Canby then performs an internal bimanual uterine massage. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life. I was blown away.”
“But then something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-claaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ and we stop.”
After I finish my story, I glance at the students; some gaze down at the table in front of them, while a few others look at me with blank stares. They are all quiet.
I know this is my silence to break
Note: All names in this essay are pseudonyms. (Anonymous author) Ann Intern Med. 2015;163-321.