Finally the day was done; I’d been up 36 hours and could not bear the thought of doing one more thing . . . my cell phone chimed. Rita, the midwife said, “One of the Amish families is in labor at home. They usually go quickly. Meet me in the hospital parking lot; I’ll be loading my blue van.”
Twilight yielded to darkness, as Rita and I followed the four-lane asphalt road through town, merged to two-lane blacktop, then twisted through a network of gravel roads. The night was inky black; no moon, no stars, only the occasional spotlight at an “English” farm. The agreement between the Amish community and the clinic was that if an Amish woman would come into the clinic for an initial prenatal visit, then she would receive home visits from the midwives for the duration of her pregnancy and could deliver at home as long as there were no complications. Women who had several children often had an Amish lay midwife handle the delivery. “But we are the couple’s quick transportation to the hospital if something goes wrong,” Rita said. “Since Amish don’t have phones, someone has to run to a neighbor’s to call for help. Otherwise it’s horse and buggy.”
Rita turned her van into a farm and the headlights outlined a small frame house. A lantern’s golden glow lit the front window. “Watch your step,” Rita warned. I stepped cautiously over frozen piles of horse manure and jagged ruts in the driveway as we unloaded the van, stacking our tubs on the front porch.
Herman, the husband, welcomed us at the door. He was tall and muscular, his woolly beard stretched past his collar. We wiped our feet on a small dmat and entered the kitchen. The house smelled like supper, something with tomatoes and onions. A wood stove, with a pile of logs nearby, radiated a toasty warmth.
Rita introduced me to Ann, who labored in the rocking chair next to the stove. She wore a white linen gown, the typical undergarment, and a white bonnet, a kapp. Her mother was busy drawing water for tea from the pump that protruded from the corner of the cement kitchen floor. Edward, Herman and Ann’s one year-old son, hid among the folds of his grandmother’s traditional blue dress.
Rita and I accompanied Ann into the adjoining bedroom. A double bed with a rough wooden headboard, an oak dresser with an oil lamp, and the baby crib were tucked into the small space. Herman had built the crib for Edward. After checking her vitals, I helped Ann stretch out on the bed. Her uterus tightened with a contraction. Rita reassured Ann that her contractions were good. We listened for the familiar dlup, dlup, dlup . . . of the baby’s heartbeat. A rate of 140, perfect. I gloved my hand and checked Ann’s cervix. It was open to three centimeters and the length had thinned halfway. This would be a long night, but the novelty held my weariness at bay.
The bedroom was pleasantly warm. An alarm clock perched on the dresser cast a monumental shadow on the wall. Rita handed it to me and told me to set the alarm every fifteen minutes, the interval for checking the baby’s heartbeat. The clock was the old-fashioned kind with a large clock face and metal ringer on the top. The key in the back grated as I wound it, setting the time: 8:30. Its soft ticking faded into background as we set up our theater: baby pack, instrument pack, sterile gloves, oxygen—just in case. We lay a plastic sheet over the mattress, letting it drape to the floor and covered it with towels.
We settled into routine. Grandmother entertained Edward and busied herself around the kitchen where Herman rested in a rocker near the stove with Rita nearby in a straight-back chair. In between contractions Ann and I talked about our lives. We were the same age—24. Ann took off her kapp and pulled pins from her coiled hair, releasing long blonde curls much like my own. Although they spoke German at home, Ann’s English had only the hint of an accent. Born down the road, she attended school through eighth grade. Then she worked for a neighboring family as a helper, caring for children and assisting with household chores. “Are you married?” she asked me.
I shook my head. “Right now my focus is to get through medical school. Then maybe I’ll have time to think about having a family.”
The metallic bell of the alarm clock interrupted our conversation. Rita peered in while I listened for the baby’s heartbeat. It continued to be strong. With an intense contraction, Ann moved onto her hands and knees. Laboring quietly and moaning occasionally, she did not ask for pain meds. After each contraction, I wiped her forehead with a washcloth, then massaged her boney shoulders, ropey biceps, and firm back. She was smaller than I, probably stronger as well, from physical labor. She talked of doing laundry in tubs by hand and tending the garden. My world was suspended as I shared these intimate moments with her. Her world—set apart from my 21st century life of e-mail, iPods, and cell phones. Only the metronomelike click of the clock and the periodic chime of the bell marked time…
Read the version published in Family Medicine, February 2008
(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)
During her rural elective in medical school, Dr. Kroening rotated at a clinic/hospital that served the Amish community. The clinic/hospital was able to negotiate an agreement with the Amish community that worked for both. The Amish were able to continue home births with back-up for emergent problems and the medical folks were reimbursed and able to work within their malpractice/liability constraints. This is an example of serving your community—working out an agreement that respects the needs of all involved. During this birth Dr. Kroening experienced the world of someone her age, from a very different culture, who lived a very different life: doing laundry in tubs, tending a garden, caring for children, living without electricity or computers versus e-mail, iPods, and cell phones. Such experiences can be life altering for us—the opportunity to step back and examine and appreciate people who have very different lives and perspectives from our own. This is one of the gifts of medicine—the privilege of sitting on the sidelines of the lives of others. We may ask ourselves: How do we partner with them? How do we encourage them? How do we help them heal themselves? How are we touched by the interactions? Reflect on patient encounters that provided you with a bird’s eye view into a world different from the one you know. Feel free to share it, but preserve the privacy of the individuals involved.