Wednesday, March 24, 2010

She May Be The Reason You Are Alive Today

Ada Lovelace Day, March 24, is an international day of blogging to celebrate the achievements of women in technology and science.

Do it right and do it now-Virginia Apgar


If you have had a child in the past half century, you have probably heard of the APGAR test and, if you are anything like me, you probably still know your child's scores as it is offers us overachievers the first of many opportunities to feel inadequate or superior with regards to our parenting skills (and it doesn't matter that at the time the test is administered, one has had virtually no opportunity to actually be a parent because the child was inside of you all this time so clearly the APGAR score can be seen as a womb rating, right?).

If you haven't had a child or if you who can't remember anything that was said to you in the delivery room because you had other things on your mind like the fact that a baby just came out of your body, fear not, I shall explain. The APGAR test is given to newborn babies at one minute and five minutes after birth. There are five signs scored, each one is given 0-2 points. The signs are Appearance (skin color), Pulse, Grimace (reflex irritability), Activity, and Respiration. You, like me, may look at the list and think that whoever came up with this test seemed to choose some odd words for the anagram. Why not just say color? Was CAPRRI too difficult to remember? Was the McDonald's Corporation in any way involved as part of their ongoing campaign to capture the hearts and minds of our children?

The truth is that when A Proposal for a New Method of Evaluation of the Newborn Infant was published in 1953, there was no anagram. The anagram came ten years later as a teaching tool and a means of honoring the woman who invented it, Dr. Virginia Apgar.

There are many articles about Virginia Apgar which discuss her life and career. All of them speak of her brilliance and her determination, how she made her own instruments and carried a scalpel in her purse in case her services were required at a moments notice. She was fourth in her class when she graduated, but became an anesthesiologist at the encouragement of her superiors who believed that a female surgeon would not be viewed as credible and anesthesiology had a need for competent physicians (at the time, anesthesiology was administered by nurses and there was the concern that surgery could not progress if the field of anesthesiology did not improve). She moved into the field of obstetric anesthesiology in 1949 when she did not become head of her department at Columbia. Obstetric anesthesiology was a neglected field at the time and as the first woman to become a full professor at Columbia she developed a training program. Aiding in the delivery of babies became the work she loved the most. It was in the delivery rooms where she saw the poor care that many newborns received. After a remark a medical student made regarding the inability to evaluate a newborn, she scrawled five signs to look for on a piece of paper and rushed to a delivery room to test out her idea. And the APGAR test was born.

What strikes me about the life of Virginia Apgar is how her story is one we encounter often in history. She was a brilliant woman who was told she could not do the work she wanted to because of her gender, so she does the work she can do and she revolutionizes the field. While I am tempted to ask what strides may have been made in surgery had she been allowed to practice, I must admit that it is unlikely she could have made a greater contribution than the one she did. Previous to the APGAR test, babies who were sickly and unresponsive at birth were left to die and their mothers were told they were stillborn. The APGAR test gave doctors a means of measuring newborns and, when it was learned that medical intervention could improve a score (hence the measurements at one and five minutes) it gave doctors a goal (while I may joke the score is a womb rating, doctors see it as a rating of their abilities and they all want their patients to be perfect 10s). The truth is that Dr. Apgar saved more lives as an anesthesiologist, a field which at the time had been written off as "women's work", than she ever could have as a surgeon. Babies who would have been left for dead were given the medical attention they needed because of her test, a test that just required paying attention and then taking action. And she continues to save lives today, nearly twenty-six years since her death. (And while the APGAR test is perhaps her most famous contribution to the field of obstetrics and neonatal care, it was not the only lifesaving measure she discovered in her career).
I am not sure there is anything more to say that tops that. But her grand-nephew gave a speech at the ceremony inducting Dr. Virginia Apgar into the National Women's Hall of Fame in 1995 and he said no tribute to her would be complete without repeating one of her favorite jokes. He obviously knows more about the topic than I do and it happens to be a really good joke:

How do you tell the sex of a chromosome? You pull down it's genes!

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