The Window on the Seventh Floor: On Delivery During a Pandemic
Authors: Elizabeth S. McDonald
Journal: Annals of Internal Medicine (2020)

On Being a Patient15 December 2020The Window on the Seventh Floor: On Delivery During a PandemicFREEElizabeth S. McDonald, MD, PhDElizabeth S. McDonald, MD, PhDPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (E.S.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4998 Audio Reading - “The Window on the Seventh Floor: On Delivery During a Pandemic” Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads “The Window on the Seventh Floor: On Delivery During a Pandemic” by Elizabeth S. McDonald, MD, PhD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail It must have been quite a sight—a 40 weeks' pregnant woman walking into the front entrance of a busy city hospital, struggling to balance a large duffle bag on one shoulder, a full bookbag on the other, her lower face fully covered with a mask. I was that woman, and I work at the hospital. However, this time I was reporting not to provide patient care but to receive it and so did not take out my badge. Just past the door, a security guard immediately stopped me.“Put on some hand sanitizer.”I complied, then was ushered into a new line ending with someone pointing a light at my forehead.“I need to take your temperature.”Then to another long and crowded line. As the weight of the bags started to turn my stomach, finally, an interview.“Why are you here?”“They are expecting me on the labor floor.”“All pregnant women go to the emergency room first for evaluation.”The emergency room in our level 1 trauma center was always alive with activity, especially in the middle of the COVID-19 pandemic. I would likely be there for hours, as I was not visibly ill. The gentleman in a booth protected by Plexiglas directed urgently to the left, to the emergency room. I glanced to the right—another long line; another interview; and, finally, a large book. Every patient or visitor signed in with the same pen soaking in a bowl of antiseptic. I had not even made it past the hospital entrance, with the oppressive summer heat circulating through the ever-revolving doors, and I was alone.Earlier in the day, there had been a routine obstetric ultrasound and the radiologist looked at me with a frown.“I am very concerned,” she began. This is never what one wants to hear, I thought. “The baby has turned from cephalic to breech. Also, there have been multiple changes since the last study that are worrisome. You need to deliver within the next 12 hours.”As a result, the labor floor was expecting me for a procedure to turn the baby, followed by delivery. Still, my labor partner would not be allowed past the lobby until the procedure was finished, possibly for many hours. COVID-19 had replaced free patient and visitor movement in and out of the hospital with new and ever-evolving restrictions.Finally, up on the labor floor, I waited in a small room with other pregnant patients. No one had a support person. The exigencies created by the pandemic had led to unprecedented policies impacting emotional support and shared decision making for all of us. We looked out the windows, our masks and social distancing stifling normal conversation as the day passed into night and an eerie calm settled on the usually bustling city. Philadelphia had a citywide curfew from 8:00 p.m. to 6:00 a.m., limiting travel in “all public spaces … such as sidewalks.” Many local businesses were already closed because of the pandemic; now, streets were largely deserted as storm clouds passed through. We listened to the thunder, quietly waiting, watching the lightning and hearing rain pound the windows—our collective stories of navigating drastic changes in health care delivery, months-long stay-at-home orders, and citywide curfews, all while expecting, remained untold.A nurse entered the room.“I need to test you for COVID. All asymptomatic patients are tested before delivery.”The dreaded test, feared not for the procedure but because hospital policy required immediate infant separation if the results were positive. And what of the implications of a positive result for having a partner in attendance? For even touching the newborn? A short while later, the results of the COVID-19 test were negative and the procedure was successful. I was put in a different room—it was 2:00 a.m. The empty city, under lockdown and curfew, had settled for the night. The storm continued, 563 000 experienced power outages, trees were down, and sirens blared outside.As night turned to day, suffering gave way to joy—new birth. Outside, something had changed. The deserted and wet streets were now filled with crowds of people, many wearing white coats. They were walking, and some held signs: Silence Is Not an Option, No Lives Matter Until Black Lives Matter, and White Coats for Black Lives. My colleagues, seen from the window, were gathering at Franklin Field, marking the beginning of a newly announced “Year of Civic Engagement.” Hundreds would kneel there in silence for 8 minutes, 46 seconds.I wanted to join them but was not yet allowed out of bed. A nurse came in.“Time for vitals.”“That can wait. Can you go outside?”“I would like to, but I have to stay on the labor floor.”I, too, settled for looking out the window, watching my colleagues take a knee. Now from that window I saw hope that, in the future, my baby could live in a fairer, more equitable, and just country. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (E.S.M.)Corresponding Author: Elizabeth S. McDonald, MD, PhD, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA 19104; e-mail, Elizabeth.[email protected]upenn.edu.This article was published at Annals.org on 18 August 2020. PreviousarticleNextarticle Advertisement Audio Reading - “The Window on the Seventh Floor: On Delivery During a Pandemic” Audio. Virginia L. Hood, MD, a physician from the University of Vermont, reads “The Window on the Seventh Floor: On Delivery During a Pandemic” by Elizabeth S. McDonald, MD, PhD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 15 December 2020Volume 173, Issue 12Page: 1024KeywordsCOVID-19Emergency departmentNursesPatientsPregnancySocial distancingStormsTemperatureUltrasound imagingWalking ePublished: 18 August 2020 Issue Published: 15 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...