Friday 5th March 2010

Gestation: 23 weeks

One year ago.

 

Over the next three minutes we establish things.  Plans were in place for the baby to be born in Melbourne at a Tertiary Centre.  Not here, on a Saturday morning, walking in off the street, ready to drop.  There is an ultrasound from a month ago, confirming a very small baby for gestation.  Due to genetic abnormality, drug use, inadequate placental nutrition, or all of the above.  The kidneys looked abnormal, the heart appeared to be structurally okay, but the lungs are underdeveloped to the point of having very little lung tissue at all.

Peg and I look at each other for a moment, reading each other’s thoughts.

This child will not breath normally, if at all.

A sense of dread washes over us simultaneously.

Peg and I do calculations, getting drugs ready.

“Where’s Matt?” she asks.

“I don’t know.”

“We really should have the Consultant here, too, shouldn’t we?”

“Absolutely,” I say.  “Just no one’s had a chance to call him.  I’ll go,” I say, as I head for the door.

Twenty seconds later I have Matt.  I give him the synopsis as quickly as possible.

“And what exactly does it say about the lungs?”

“That there is pulmonary hypoplasia.”

“And what about the kidneys?”

“That they’re abnormal.”

“But what else?”

“Nothing.  Look I don’t have it in front of me this second, Matt.”  With that, Peg is there, passing the report into my hand.

I read it to him, this month-old ultrasound.  The full stop lands after explaining, that there is ‘very little, if any lung tissue seen at all.’

I hear the rush of the road in the background.

I can hear him think.

“And what do they want to do?  Do they want Resus?”

“Honestly, Matt, we haven’t even asked.”

He pauses again.  “I just can’t believe,” he says, deliberating carefully, “that no one in Melbourne has had a discussion with the family about these results.  We need to be having a discussion with them about what their expectations are.  Because it will be a very different situation, dependent on what they want.”

“Couldn’t agree more,” I say.  “We just literally haven’t had a chance to talk about any of that yet.”

We hang up, without even saying goodbye, complicit in the urgency.

* * * * *

Peg and I re-enter the room.

We split, her to Dad’s side, me up to Mum.  Pain and exhaustion line her face, mid-contraction, well into stage two, the birth imminent.  The father sits there, holding her hand, a grave look on him.

“We just have to ask,” I yell, above the contraction, “have you been told about your babies lungs?”

Mum’s eyes remain closed, almost not hearing.  Dad nods a quiet yes.

“And you’ve been told that they are really not formed, and that your baby might not be able to breathe?  And that there is a really high chance that he or she could die?”

Again, mum keeps her eyes closed, groaning through the pain.

“Yes,” Dad says.

A human silence falls after this.  The electrical cacophony continues unabated.

“So we really need to be very clear about this.  About what is going to happen here.”  I pause for a second.  “Do you want us to try and make your baby breathe, or do you want to hold your baby in your arms, without us interfering?”

The moment holds heavy.  Thick.

“We want you to do everything you can,” he says.

“Which we can,” I say.  “But you need to know,” I add deliberately, “that your baby has very underdeveloped lungs, and could well die.”

He nods silently.  Mum’s eyes never once open.

All of the nuances and subtleties of a meaningful birth are out the window.

It doesn’t get any more medical than this.

Another contraction winds up, the babies head starting to show.

I turn and then I see Matt there, as he comes through the door.

“Where are we at?” he asks, panting;  the order of the day.   We give him the latest.  The decision to resuscitate.  His eyebrows furrow with concern.

“I’m going to say hello.  What are their names?”

Peg and I look at each other as we say, in unison, “We don’t even know.”

* * * * *

to be continued…