Day 280
Saturday 31st July 2010
One year ago.
I come to work today, ready for a weekend of fun. Weekends are understaffed by nature. Our skeleton-staff arrive to take over from the ghostly night crew.
“How was it?”
“Awful. There was a transfer from out of town. A cord prolapse.”
A silence descends. This is never good. We wait a few minutes until the boss walks in.
“A cord prolapse arrived at 6.30am.”
“How is it?”
“Not good.” There is a silence while the story plays out. “There was loss of the fetal heart rate, the cord prolapse was recognised, and there was an emergency Caesar. The baby came out with a pH of 6.7. Required seven doses of adrenaline before a heart rate returned. Forty minutes passed between the last monitored heart rate, and getting it back.”
Fixed and dilated pupils.
On inotropes.
Ventilated.
Transferred here.
“Shit,” says my boss.
* * * * *
Intensive care is a funny place. Humans are run like machines; there are infusions, and ventilators, and machines that go ping. Blood tests are done at frequent intervals, fluids are calculated to the millilitre.
There is a lot going on with these tiny, premature babies.
But this time it’s different. Here we have a full term baby, born on time, struck by horrific happenstance. At the exact moment that the waters broke, out came the cord – ahead of the child. With the skull fitting as tightly as it does through the pelvis, there is only ever a half-centimetre leeway in any direction. The cord was squeezed between the head and the pelvis, and blood supply suddenly stopped.
Asphyxiation.
The Obstetrician did what he could, as soon as he could, immediately rushing to theatre. As they prepared, a hand urgently pushed up against the head, trying to keep it back, trying to unclamp the cord. It’s a tough job this one; arm versus uterus. The uterus wants the baby out, that’s what it’s designed to do.
The uterus usually wins.
We enter the room in Indian file, every head lowered, over to the baby. Machines beep loudly, but everyone else is silent. A group of nurses hover close. All watching over this grey child.
This just shouldn’t happen.
This, yet again, is the definition of tragedy.
* * * * *
We stand around, my boss running the questions. She has a grave look on her face. Everyone does.
“How far away is Mum?”
“Three hours. She hasn’t left yet.”
“She needs to get here,” she says urgently . “This baby’s blood pressure is unstable. I’m not sure how long we can keep her alive.” By that, she means how long we can keep the heart beating. The breaths are via machine. The pupils are fixed and dilated. Brain waves are absent; the child is brain dead. But for now, the heart is still beating. The child is grey and lifeless, but – if there is any grace given in the healing this family is going to need – this little girl is still somewhat babylike; somewhat soft and supple.
Not yet rigid, and not yet cold.
This fucking sucks.
* * * * *
There are four neonatal intensive care units in Melbourne. This is just one of them. Every day, families have their gravely sick infants transferred to these hospitals for treatment.
Today, this was so that the family has time to grieve.
The father arrives ahead of his wife. With seconds passing like hours, we wait for the ambulance to bring in the mother.
Eventually she arrives. We greet her.
“Perhaps we could go to another room to have a chat,” says my boss.
In respect of this unnamed family, I will divulge no more. Suffice to say, that my boss manages the situation flawlessly, using simple, unconfusing, compassionate language, in a way that I have not witnessed in a long time. It is far more common to see doctors fluff the breaking of bad news, than to see it done well. Here, she does so with exemplary skill.
There is no correct way for the machines to be turned off. They can in there, with their baby, or not. They can take her to their room, or she can remain in the unit. There in no rush for decision. There is no right answer here.
I sit, watching this young mother, her tummy still full. Tears stream down her face. Her stoic husband sits by her side, rubbing her back, offering his support. I feel the waterbrash rise in the back of my throat, thankful that it is not me giving the news. This last nine months has touched me in a way that I can no longer be just a doctor in these situations. Although my circumstances were nothing on the horror of this – I too, have lost a child.
I notice the wetness welling in my eyes.
Thankfully no one else does.
I’m not as impartial as I used to be.
The scene burns into my consciousness. In this instant, I appreciate all that is good, and cruel, and even loving, in these pivotal moments in life.
I feel the full privilege of being here.
Of my job.
Of being part of this.
And of how these words, imparted with genuine humanity, can help their wounds to scar a little less jagged than they may have otherwise.
* * * * *
Having kids, Pre-pregnancy Diaries
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baby, compassion, doctor, ICU, medicine, pain, privilege, support, tragedy
Themocracy
What a excruciating, yet beautifully written post. Makes me appreciate our little one all the more… and her wonderful father with the big heart. xx
Well written my friend, I just wish we had that level of compassion with Viktor. I never forget, but this was a reminder of the opposite of pure joy. Much love to you all.