Near life experience

Wow, what a night huh?
Seriously. Tell me that you at least got to be in one happy delivery today.
Yeah, but I was still preoccupied the whole time.
I feel you. Tonight was rough.
For real. It was sandpaper-your-face-and-let-it-weep-with-blood rough.
Yeah.
Yeah.
Sigh.

On my last night on night float, I saw the other side. The unhappy side of L&D.

I should have known. I walked into the hospital at 6pm, into a very sober sign-out, where the day team was debriefing about a mom who delivered twins, knowing that one of them was a trisomy 21, had been leaking amniotic fluid, and probably wouldn't survive for more than a couple of minutes. The mom didn't want anything done for that baby. She had come to terms with it, and she made it clear that she wanted at least one healthy baby. So when they did the emergent c-section, they delivered the first twin, and with Apgars of 1 and 1, there was no intervention. Yet, looking at the baby later, the first twin didn't have any of the classic features or facial abnormalities associated with trisomy 21. Did we make a mistake not trying to resuscitate? Had we misdiagnosed the trisomy? And if so - should we have performed a c-section weeks ago, when the first twin might have had a better chance at survival? Would any of it had made any difference?

As we grappled with those questions, we got a heads-up from an outside hospital - they were sending us a patient who hadn't felt fetal movement in 2 days and had finally decided to come in to the ED to get it checked out. The baby had died. And now it was our job to counsel the mom and perform a c-section. It was the worst hour of my life. Knowing in advance that you're delivering a dead baby doesn't make it better. If anything, it makes it worse. Way worse. We made the incision and tried to push the baby out, but because there was no tone, it was so difficult. And very sobering. The mom cried the whole time. All I wanted to do was walk over to the other side of the drape and hold her hand, but I was stuck there, holding her bladder out of harms way, watching my resident and attending try to wrestle that baby out of the uterus. And when it was all over, my resident and I walked back to the conference room, and we both broke down too.

You would think that it couldn't get any worse. But bad things always seem to happen in 3's and at 4am in the morning. That night wasn't any different.

At what seemed like 4am exactly, we got a call from our own triage team. A 23-week first time mom had rushed to the hospital because of lots of vaginal bleeding and fluid. Chaos reigned. The senior resident tried to put on the fetal monitor and figure out a pattern to all the decelerations we were seeing. Another resident was trying to pull up past notes on the computer but the entire system was freezing, for some odd reason. The intern kept paging the patient's attending, and got no answer. The nurse kept taking vitals every 15 minutes. The anesthesiologist kept trying to place an epidural, but the patient was in so much pain she couldn't sit still. The students ran in and out of the room, fetching things. Ultrasound machine. Boluses. Steroids. Booties. A different attending ran into the room to help. And the husband sat there, bewildered, silently putting on scrubs that we handed him, as we prepped his wife for emergent surgery. And none of us knew what was really going on.

They had just gotten into the operating room when the baby's heartbeat flat-lined. The students were sent away, so we instead waited anxiously in the conference room, pretending to write notes and do work, but all of us preoccupied with what was going on in the OR.

The baby didn't make it.

It was 6am by that time, and my fellow M3 teammate and I were sent home. Normally we rush home, trying to beat the sunrise, trying to get in bed while it's still semi-dark. But that morning we didn't rush anywhere. Instead, we sat in the locker room, in our blood and amniotic fluid-stained scrubs, trying to digest everything that had happened. Trying to figure out rhyme from reason. But there was none. There was no meaning in all the madness. No karmic explanation. We eventually fell silent and ended up sitting there with our backs against our still-unopened lockers, numb from all the pain we'd seen that night.

It was a rough end to L&D. And a rude reminder that bad things always seem to happen to the nicest people.

My pulse is racing, I can't catch my breath.
This near-life experience scared me to death.
Is this where I end, or is this where we begin?
Or is this where we begin?
- Lifehouse