Tuesday, April 18, 2006

Crash section

Seeing more than one worried face hurrying into a patient's room is never a good sign. But for a medical student, it usually signals a learning opportunity. So today, when I noticed a much greater than usual bustle around a laboring woman's room, I slipped in with one of the techs and made myself useful.

The patient's unborn child was experiencing "late decels." This is when the baby's heart rate drops after the mother's uterus starts contracting. This means the blood supply to the placenta is being cut off, which obviously isn't good for the kid. It also means the mother has to deliver the baby as quickly as possible. So I assisted setting up the warmer, where the newborn would be placed, as the obstetricians tried their best to get the kid out.

No luck with normal technique, so they started using forceps. Not a pleasant image, and is is almost shocking to realize that essentially the same design has been in use since the 1700s. This usually works pretty well, but even here, the OB docs weren't having any luck. The nurses were getting a little worried, because the real pediatrician hadn't shown up yet, and they are definitely necessary in this situation.

This is when the OB staff doc made a frighteningly calm pronouncement. He simply said "all right, let's go to crash c-section" and the entire room emptied, except me (who didn't know what to do), the nurse midwife, and the doc himself. Every other soul sprinted down the hallway, joining the pediatrician who had just walked in, to prep an operating room. I followed them, and donned a mask and gloves with the rest of the crowd. It was then my job to stick my head out of the OR and call out when, far down the hallway, I could see the patient being wheeled out of her room.

From the time we left the patient's room, until the whole OR was prepped and ready to go, was about five minutes. I saw the patient being wheeled out of her room on her bed, and from that point until the time she was on the table, with anesthesia putting her under, was another minute. I've never seen an OR move that fast. Surgeons, for all their skills, are normally cautious and deliberate, which only makes sense when someone's life is in question.

Now once the patient is unconscious and the OB/Gyn doc is ready to cut, it is "standard of care," meaning the absolute minumum required, for the baby to be in the pediatrician's hands one minute later. If anything, this was better than that. Three cuts with the scalpel, and the surgeon was pulling the baby's head out of the abdomen. Seconds later, a massive resuscitation of a very blue, very motionless baby was underway.

I was pretty worried at this point. I've seen and been part of close to 100 deliveries now, and this was the worst looking kid I've seen yet. But modern medicine is surpassingly capable. According to the delivery note, it took 3 minutes to get the baby girl breathing. I would have guessed half an hour. But she hasn't looked back since, and when I left this evening, was indistinguishable from any other healthy infant on the ward. She didn't even spend time in the NICU.



Thainamu said...

:-) I like stories with happy endings.

Aiming at Proverbs 31 said...

I came across a link to your blog from my daughter Colleen's blog. God designed babies to be so resilient despite thier seeming fragility. I was also glad for the happy ending. Blessings.

Nathan said...

Aiming, thanks for stopping by, and to both of you, I like happy endings too. :)

MrStandfast said...

I figured it out. Zorro was an obstetrician. He was also Tyrone Power, but maybe Tyrone Power was an obstetrician.

Alex said...

That was an amazing account. I loved reading it. It makes life seems like a succession of little mercies and miracles.

medstudentitis said...

That's why I LOVE ob-gyn!

Nathan said...

Glad somebody does... ;)

Actually, I loved it as well, and I would probably view surgery in general in a different light if I hadn't sustained three (yes, three) needlestick injuries in three months on it. And only one was my fault. Maybe I should make that story into a new post sometime.

tmm said...

This is an amazing story

Macri Family... said...

This is a very true and real story - something very similar happened to when my daughter was born 8 months ago. It's amazing how well prepped this team was, and that both mommy and baby today are healthy.
So glad for my miracles and well-trained nurses, and glad to hear there are other miracle workers out there.