Mullberry Whine

poured out before bed

Spontaneous

Baby Bill in Cap and Shift, 1889, Mary Cassatt

“Have you seen a spontaneous vaginal delivery yet?” a resident barks as she books by me, motioning with her head for me to follow.  I pend my post-op note and log off the E-chart to run after her.

“No, only emergent C-sections,” I answer, grateful she’s thought to include me.  “I’ll be happy to see something normal – something not high-risk.”

She snorts.  “Umm, do they have you following room 3?  Oh, no, I guess you’re on the back ward…  So, this may be a normal delivery, but this is a very abnormal baby.”

She stops a moment before we reach the door.  “This is a 26-weeker with [insert extensive list of congenital defects].”  She softens a minute and blinks slowly as she searches my eyes.  “I just want to prepare you that this will be a very abnormal looking baby, OK? Once he comes out, I’ll have you follow the NICU team with him and watch them do their thing.  It’s a good thing to experience if you’re interested in peds or critical care or OB.  But it may be pretty disturbing to watch, so if you have to step out, it’s OK, don’t worry about it.  You should know he has less than a 5% chance of survival, but the family is requesting that everything be done… Are you going to be OK with all that?”

I nod.  But, really, is anyone OK with that?

Mom is already pushing when we slip in, surrounded by a slew of stone-faced family and a veritable crowd of specialists, from anesthesiology to neonatal intensivists to maternal fetal medicine fellows.  Her affect is completely flat as she quietly follows the resident’s instructions.  The baby is born a handful of silent pushes later, and I am struck by mom’s unchanged expression as they whisk the blue, malformed child away. Dad immediately wanders off, retreating to the corner where he chortles a bit at the Adam Sandler movie that was blaring all through the delivery.  Grandma sits on the couch and opens a dogeared book.  I tear myself from the surreal scene and follow the NICU folks to a sterile room, where APGARs of 0, 0, and 2 are called, and every touch to the fragile newborn’s skin results in a bloody rent.  A tiny heart stops and starts, stops and starts over and over; a tiny pair of lungs fills repeatedly, but not of it’s own accord. Injections and IVs slip in and out. Equipment is tossed every which way as every last ditch effort at resuscitation is utilized, commands flying fast and furious at every person attendant.

Nearly an hour passes before they call it.

A nurse makes a few notes before laying aside her clip board, and everyone stands motionless, staring at the tiny form on the little blue table.

Finally, the attending neonatologist clears his throat. He thanks everyone for their efforts, and the bustle of clean up follows. I kneel to pick up some rubbish, and feel the welling about my eyes spill over onto the floor. I disguise a dab, a sobby grimace with a fake cough as I toss the used packaging.

The neonatologist is not fooled.

“That was hard,” he says quietly, his hand on my shoulder blade. “Do you want to help me bundle him?”

“I’d think Id like that,” I say. He hands me a little blue hat and together we wrap him in a fuzzy flannel blanket.

.

Step 2 CK Throw BackFrom Obstetrics

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4 comments on “Spontaneous

  1. Amy
    October 10, 2012

    Wow…I can’t imagine just how hard that must’ve been…=(

    • mullberrywhine
      October 12, 2012

      No kidding. A tough day – and certainly not my favorite delivery… 😦

  2. kindredspirit23
    October 11, 2012

    I am so glad there are people who can do that without emotion and glad that there are people like you there who have them.
    Scott

    • mullberrywhine
      October 12, 2012

      We need the highly skilled workers who have learned to distance themselves. We also sometimes need those who haven’t quite got the hang of the whole distancing bag…

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Nothing under the table.
***
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
***
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
***
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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