My name is Maria Isabel Acosta, and this is my story.

One, two, three, four, five, six, seven, eight, nine, ten.

You're doing amazing, Samantha.

Breathe in, and let's go, back to back.

Go.

One, two, three, four, five, six...[sound of heartbeat] ♪ [dramatic and driving musical score] ♪ [faint voices] [helicopter whirring] [male voice on a radio] [wind rustling through brush] [distant sound of a train whistle] [music continues] [music fades] (Maria) In Venezuela, I used to live in a city that is called Barquisimeto.

It's the third or fourth city in importance in my country.

Venezuela is full of natural resources, the most beautiful blue beaches, falls, mountains, snow, it's the most beautiful paradise.

I grew up in a medical family.

My dad is an OB-GYN.

And he pretty much grew up in a ghetto, escaped poverty and become a successful doctor.

My dad was able to perform the first IVF cycle that was done outside of the capital city in my country.

One day, I was 14 years old and my dad knocked in my door like in the middle of the night and he asked me if I wanted to go with him to witness a delivery.

And from that day on, I just wanted to be an OB GYN.

I started medical school when I was 16 years old, and I was able to finish when I was 23 years old.

I was the only female IVF doctor in my city, and after only a few years, I had a solid practice with a significant amount of patients.

[sound of cars driving] [medical device beeping] Hello, Felicia.

Hi.

My name is Dr. Acosta.

I'm part of the high risk team of doctors.

I'm the senior resident running the high risk service.

Okay.

We got a patient here in high risk that was admitted from triage.

She's 31 weeks and six days history of a prior C-section in a prior pregnancy due to twin pregnancy and... (narrator) As the senior resident on the high risk OB unit, Maria is responsible for the most critical pregnancies in the hospital.

Hi.

Is this pharmacy?

Hi.

My name is Dr. Acosta.

I'm one of the residents working in high risk OB.

I have a patient that she has severe thrombocytopenia.

She's going to have a vaginal delivery with a platelets that are extremely low.

So, it's a potentially life-threatening situation.

(male voice) Thrombocytopenia means that there's low platelet counts.

Without enough platelets, our blood won't clot and we will bleed.

And one of the most dangerous time for a woman to not have enough platelet is during the time of delivery, because 800 CCs of blood flows through the uterus per minute at the time of delivery.

That's 10 minutes, and you lose essentially all the blood in the entire body.

So, it's a very dangerous condition in that sense.

(Maria)...starting to bleed, we're going to be doing a continuous infusion of platelets while she's in active labor, and we're going to be doing an infusion of Amicar.

But for obvious reason, I'm ordering multiple drug products to have available in case she bleeds out.

All the resources you will need, we have them.

Literally, since I left this room, I've been calling everyone.

Okay?

And you know what happened in my experience when we have this type of situation?

Nothing.

We're preparing for the worst and nothing happens.

Okay?

[Laticia speaking softly] (Maria) Well, we will take care of the situation.

Whatever comes, we will take care of the situation.

Okay?

(Laticia) Gracias.

(Dr. Yao) In this particular patient, her platelet count is around 19,000.

Normal platelet count is typically above 150,000.

Patients can start to spontaneously bleed anytime after the platelet falls below 20,000.

So, she was in that range, which is very dangerous for her.

So, the worst case scenario for this mom is that she will bleed to death at the time of delivery.

(Maria) Leticia, what we're going to be doing right now is this, we're going to transfer you to labor and delivery.

There, we're going to start Pitocin.

Constantly, since six centimeters until delivery, you're going to have constant infusion of platelets, because what we think is happening is that you're consuming your platelets right away.

Once you get ready to push, we're going to transfer you to the OR.

Okay?

And you're going to have a bunch of people there.

Okay?

Peds is going to be there to receive your baby.

Everyone is going to be there.

And if nothing happens, well, nothing happens, you're going to deliver and we're going to try to control the bleeding as fast as possible.

Worst case scenario, that we cannot control the bleeding.

We can transfer you to the ICU, which we already have a bed available for you there.

But we have everything prepared.

Okay?

Do you have any question for me?

[gentle but serious piano melody] Over the — years of my training, we had to witness the installation of a communistic government in my country.

[news announcer] Venezuela has been gripped by the largest protests since Nicolas Maduro became president following the death of Hugo Chavez a year ago.

(Maria) There were several people in the streets protesting against the government.

[sound of gunfire] Several were murdered.

Many young people were killed in the streets of my country, protesting against the government.

The prices of everything was crazy.

The inflation was the highest inflations rate on earth.

We were the generation of people that saw first line the crumbling of a country.

Each day was more and more difficult to do whatever we used to do.

Pregnancies achieved by IVF tends to have higher level of complications.

In that time, the government had cut the electricities in different areas of the city, including hospitals.

So, it was very difficult for us to see how we worked so hard to achieve these pregnancies, and eventually, went up with babies dying.

And you start having this relationship with these patients that really trust you in a way and having to go with them to a cemetery to bury a baby.

It..it broke my heart completely.

This is not fair, this is not how things are supposed to be, like how this happened?

I just couldn't understand it.

(female voice) Dr. Acosta, the baby's heart rate's down.

(Maria) Samantha, baby heart rate's dropping a little bit, and we are complete... we need to start pushing.

Right?

I want you to be very brave.

I need some extra hands here.

We're going to break the bag, guys.

Samantha, this is going to be fast.

All right?

I need you to cooperate with us.

[sound of rapid heartbeat] [crowds shouting] [sound of gunfire] I was pregnant at the time, and it was a very, very stressful situation that actually end up in preterm labor.

I had to be crash into an emergency c-section and my daughter was fine, but we figured out that she had a cleft palate.

The type of surgery that she needed and the options we had.

Being my husband, an American resident, we decided, okay, we really want to go to the United States to perform the surgery.

Our initial plan was to come to Orlando and kind of have a two to three weeks stay while she got the surgery, and eventually, she'll recover.

And my plan was to go back and start coming and going while we kind of figure out what was going to happen with the country.

I remember on a specific moment, that was one of the breaking moments, I went to Costco with a friend, and we had to buy some things.

And eventually, I came into the aisle of the diapers and there were like mountains of diapers.

And the last box of diapers that I got in Venezuela, it..it was a present from one of these mommies that lost her baby.

And when we came back from the cemetery, she actually told me, "I really want you to have the diapers of my daughter because I know your daughter is going to need it".

So, when I was in that aisle, something changed inside of me that day.

I knew that day, that I had to stay.

The core reason was that I was a mom.

That was the reason— that I wanted to— provide to my daughter a safer and better environment.

I didn't want her to spend the most important years of her childhood in fear.

Staying in the United States meant so many things.

We had to say goodbye to my family, my friends, my practice, my patients— and the life that I once dreamed it was going to be.

All my medical training was pretty much nothing here.

So, I think that the first challenge was to find myself, like find my worth and what would define me if I was not a doctor anymore.

It was just starting from zero — again.

[sound of coffee percolating] (narrator) As an OB GYN resident, Maria starts most of her mornings at 5:30 to pre-round on all of her patients before the team meeting at 7:00 AM.

(Maria) So, probably one of the most challenging things about residency is the number of hours that we work.

Some days, you love it and some days, you struggle.

Especially in certain rotations, we have to do 24 hours.

So, obviously, some days, I feel the 45 years.

[chuckle] [pinging of hospital machines] [ping of door securtiy sensor] (Maria) Good morning.

I see, I see.

(clinician) Happy Thursday.

Did you see that we have three new friends?

(Maria) Yes.

I just read it.

(Clinician)Okay.

(Maria) Three or four?

(Clinician) You can take 501.

I think three.

Right?

Am I crazy?

(Maria) Leticia arrived?

(clinician) Leticia?

Yeah, she's 501.

I was going to see her.

And then, there's Clemente in 505... [commotion of a group talking] [female voice off camera] Good morning.

We're going to start.

This one's a 38-year-old G5 P3013 at 37 weeks and zero days.

This is an induced labor for di/di twins.

In room six, she's a 28-year-old D2P1, 39 weeks and 30 days, admitted for Strom.

That occurred one hour apart from the other family...patient.

(Maria) It's an induction of labor.

It's not a termination, but it's an induction of labor, because she doesn't want to continue with the pregnancy as the prognosis of the fetus is so bad.

(male voice) Oh, okay.

(Maria) She wants to hold her baby.

(male voice) Yeah, yeah.

Because likelihood of this baby demising inside is super high, so she would rather have the opportunity to hold her baby.

(male voice) And that's what I was given in turnover as well, be able to bond with the baby until the baby passes.

[Maria speaking Spanish] Uno, dos, tres, cuatro, cinco, seis... (Maria) We have a discussion with her and set expectation that this baby might pass during labor, and she have a pretty good understanding of that.

No, we're not crashing her.

(female voice) Have a great day.

[group talking all at once] [speaking in Spanish] (Maria) I found that I didn't have any identity outside of being a doctor.

I was either a doctor or mom.

But as an international medical graduate, in order to become a doctor in the United States, I will need to validate my medical degree, and pretty much, redo my residency.

So, I had to face the reality that if I was gonna redo everything, I was going to start this at 36, 37 years old, and this was going to be a project of about seven to 10 years.

That was the truth.

There were so many people that told me that this was not something doable.

I was too old, my English was not good enough.

OB GYN, it's a very difficult specialty to get in.

Don't even try it.

Maybe you can consider being a nurse.

You have no idea how many things I had to listen.

So, I had to decide if I was going to believe what some people around me was telling me, or if I was going to believe what I thought God was telling me, that He created me with a purpose and that His purpose in me was going to be fulfilled no matter if I was in Venezuela or in the United States.

So, I made that hard decision, and one day, I just decided that I was going to believe.

And I was like, okay, I'm going to do it again.

I'm going to do it.

[gentle piano melody] So, I study from 8:00 AM to 8:00 PM almost every day.

I didn't have time to cry.

I didn't have time to get depressed.

I didn't have time to mourn or to go through my loss.

I had to study the Krebs cycle and I had to study anatomy.

[sorrowful viola joins piano] I think that the 'Steps' were a lifesaver for me, 'cause somehow, gave me meaning and purpose in that moment of my life.

(narrator) After two years of dedicated studying, Maria has passed the American medical boards.

But the biggest hurdle remains matching to residency is critical to rebuilding her dreams.

(Maria) So, I applied for, I don't know — many programs.

Finally, the day arrived, and all my family was in the phone, like, as I was opening that email and the email was I didn't match.

That was really devastating.

It was a really hard moment.

I cried for a while, but then, I said like, "Okay, what I'm going to do next year?"

Because I'm going to redo this, and everybody will ask me, "What is your plan B?"

And my answer was, "Repeat the plan A".

[festive Latin music] [sizzle, sizzle] (Maria) Part of raising Julieta here in the United States is also, giving her the opportunity to know our food.

These flavors made us Venezuelans, and we want her to be able to have those recipes that my mother share with me and my grandma did many years ago.

And it's kind of the things that we want passed through generations.

It's part of our heritage.

I just asked myself how my daughter is going to remember this.

Will my daughter remember a mom that is frustrated because she needs to redo a residency that she already did, or is she going to have the memory of a mommy that, somehow, embraced this with dignity and with humbleness?

Because, what if I have something new to learn?

Maybe I can be better.

Maybe, I can do robotic surgery that I didn't do in my country, and that's pretty much what I'm trying to teach her.

Like there are always, always new things to learn.

[speaking Spanish] (Maria) Later, mami.

[speaking Spanish] (Maria) Like around 7 PM.

[speaking Spanish] (Maria) Mm-hmm.

[speaking Spanish] (Maria) I'll keep you posted.

Don't call me Maria Isabel.

Call me mommy.

(Maria) I have to go to a delivery, mami.

Goodbye.

(Maria) Ciao.Te amo.

This is being a mom while you're doing residency.

Okay, let's go.

Hey, girl.

Is it getting real now?

Yeah?

May I check you?

With your permission, mommy.

[beep, beep, beep] [Laticia] It might have gone away.

It was painful... (Maria) Yeah, yeah, yeah.

She's complete, actually.

She's probably... here at minimum.

Let's go.

(clinician)Wonderful.

Let's go have a baby.

Okay.

(narrator) Because of her extremely low platelet count, if Leticia has any lacerations or tears during delivery, she could easily bleed out in minutes.

A smooth delivery is critical to her survival.

(Maria) Okay.

When you get to be pushing, I want you to listen to my voice.

There are going to be a lot of people, but I want you to listen to my voice.

We're going to do a nice, controlled delivery.

I don't want the baby to pop up.

Okay.

We're going to do nice and slow so you don't tear.

All right?

(Maria) Most of the time, everything is fine, but when things are wrong, they are really wrong.

Things can get complicated in minutes.

Remember what I told you?

Nice controlled delivery.

Okay?

Breathe in and push.

Go, mommy.

Go.

One, two, three, four, five... [many voices] Eight, nine, 10.

Beautiful.

All right.

Perfect.

Leticia, you're doing an excellent job.

This is completely normal.

You're doing it excellent.

Everything's going perfectly.

Okay.

Breathe in and push.

Go, go, go, go, go.

Good, good, good, good, good.

Harder, harder, harder.

[VO] I think that probably one of the things that I love the most about OB-GYN is the fact that you never know what is going to happen.

Like that adrenaline of things changing very quickly, it's really exciting, and I'm totally passionate about it.

(clinician) Six, seven, eight.

(Maria) Give me some gel.

Go.

Go, go, go.

Here.

Good, good, good.

It's coming, mommy.

It's coming.

Go for it.

(clinician) And one, two... Push.

Beautiful.

... three, four... Good job.

... five, six, seven, eight.

It's so good.

Very good, baby.

Good job.

[excited congratulations] [baby crying] [intense and triumphant violin] Guess what, no lacerations.

No lacerations.

You didn't cut yourself.

You have no lacerations.

Yeah.

Yeah.

Leticia, you did it.

It was perfect.

It was perfect, mommy.

Are you happy?

You did amazing!

I lost many things, but I never lost the ultimate freedom, which was to choose my attitude no matter the circumstances.

So, that year, we heard about the transitional year medicine program internship that Loma Linda University has, and I got the interview for Loma Linda.

It was a completely different interview.

The questions he made, he was able to see me, and I realized that, probably, five minutes into the interview, he was just so kind, and at that point, it was Loma Linda or nothing for me.

I just wanted to be here, and I wanted, probably to be part of this family.

[beautiful, haunting vocal melody] And the next year, I matched as an OB GYN resident.

This was the place where I felt that I could embody this concept of service, this concept of ministry that I have through medicine.

There is a Bible verse that comes to my mind very often when I kind of understand what happened in my story, and in Spanish it says, [speaking Spanish] and it's basically, "I cry out to the Lord and He heard my prayers," and that is exactly what happened to me.

[song cont.]

♪♪ And with every change we'll always be ♪ ♪ where hope's not lost but found ♪ ♪ it is all in our hands, it is all in our hands.

♪ [baby crying] [music swells triumphantly] I have embraced this new life as an opportunity.

And sometimes, what we think it's our biggest loss is that exact opportunity that God has to show himself to us.

♪ It is all in our hands.

It is all in our hands.

♪♪ [music cont.]

(narrator) Next time on Life on the Line.

[news caster] Ukraine under fire.

A full scale Russian invasion of Ukraine.

[newscaster] The battle for the capital city of Kyiv appears to be underway.

(announcer) This program was made possible by the Ralph & Carolyn Thompson Charitable Foundation and Ed and Ann Zinke.