I was a “senior” resident when it happened. And by senior, I mean I’d had about 18 months of anesthesia training so when a woman came to the OR with an “emergency” C-section, my staff supervisor left me alone even before I`d topped up the epidural.
I can’t remember anything about the case. I don’t know why she needed the C-section. I do know it wasn’t one of those crash down the hall and barrel into the OR kind of emergency c-sections.
But you know what is burned into my brain? The look in the dad’s eyes just after his baby was born. The sound of his voice.
The baby came out completely flat. Floppy. I don’t remember why. I remember the OB quickly handing it off to the neonatal resuscitation team. She didn’t hold it up over the drape to show it off to the parents. There was no, “congratulations you have a _____.”
There was a glance at me and a, “we’ve got a lot of bleeding.”
There was no sound of a baby crying.
The mom was staring off into space with a glazed look in her eyes that caused icy fingers of dread to wrap around my heart. The dad had stood up and was looking at his son. I was fumbling around drawing up the oxytocin and trying to get it into the IV and wondering just how much bleeding was “a lot” and how I could possibly get to the phone on the other side of the room to call for help from my staff person if “a lot” turned out to really be “a lot.”
The circulating nurse was running around opening stuff that the OB was calling for. Sponges. Instruments.
The dad said, “What’s wrong with my son?”
I was surreptitiously looking at the mom’s arm wondering where I could slip in another, larger, IV, but I was jolted back to the present by the anguish in his voice.
I looked at the OB.
She was sewing up the uterus. She looked up at me.
And that’s when I realized it.
That everyone thought that looking after the dad was my job.
Never mind that my primary patient, the mother, might be hemorrhaging. Never mind that I’m busy with resuscitation measures…replacing blood loss with IV fluid, giving uterotonics, keeping an eye on suctions and sponges, still trying to capture the attention of the single distracted circulating nurse so that I can get some help…
Never mind that I have absolutely no idea how to distill what I know about neonatal resuscitation into non-medicalese. Never mind that I don’t know how to phrase what is happening to his son in a way that is hopeful and helpful without false optimism. Never mind that in a minute I might have to tell him his wife is bleeding badly and he needs to leave the OR now.
I took a moment to gather my thoughts while the dad angrily pleaded, “Please, someone tell me what is happening to my son!”
At exactly the same moment, the OB said, “Its firming up now, I think we’ll be okay.”
And I said to both the parents, “Your son was stressed and when he was born he wasn’t breathing. They are breathing for him and giving him oxygen. But they aren’t doing chest compressions which means his heart is beating at a good rate. In a minute or so, he’ll either start to take over and maybe even cry, or he will need more help and they will need to put in a breathing tube. They are doing a good job.”
And then I had to force my attention back to the mother. Make sure her vitals were okay. Count sponges, look at the suction canisters and estimate the blood loss. Tally up the IV fluid she’d received and think about if it was enough. Decide if she needed blood drawn…or blood given. Think about the uterotonics she’d had and the condition of her uterus. Think about her pain management.
It’s completely callous…but I had a job to do and I couldn’t get too distracted by the baby.
Both the mom and the baby were okay. Her uterus clamped down and she stopped bleeding. He started breathing then crying. I’m pretty sure his second APGAR was a 9. His parents got to hold him in the OR, even though he ended up going to the NICU for a few hours of observation.
I wasn’t okay though. I felt like a complete failure.
Still do. I’m sure the parents of that little boy have all kinds of scary memories of his birth…including one of the callous OR staff, especially the anesthesiologist, who didn’t even have the heart to explain to them what was going on. I’m sure neither the mom nor the dad caught wind of the fact that she had a significant hemorrhage during her c-section. I’m sure neither of them was cutting me any slack for having to deal with that.
No, I’m sure what they remember is their little boy…grey, floppy, not crying. Surrounded by staff working on him and surrounded by a cold silence.
Now that I’ve gone through the experience of birth myself, now that I’ve been a patient myself, I wish that I had visited them a day later to apologize and to thank them for teaching me.
Teaching me to be quicker. With words. With comfort. With multitasking. With empathy.