Abruption
It was all setting up to be a very manageable day. The first case was all pre-opped and ready for surgery - nobody in triage. I was able to revel in my good fortune only long enough to look down the long triage hallway to see our OB tech wheeling the face of death down the hallway. The woman in the wheel chair was black, not obese and sat with her eyes closed and head slung backwards, face to the ceiling. The nursing staff and I looked at one another while the OB tech put this lady in a room. This one, I would see quickly, I decided.
She was bleeding, of course. "What brought you in today?"
The large, African American man who came along answered for her, "she's bleeding." With a few rapid fire questions I learned that this lady had a gush of blood in the toilet before coming (in addition to the puddle she was making on the floor in her room) had no prenatal care but thought she was "about 5 months pregnant," this was her 12th pregnancy and she had 11 children at home and she was clearly in significant pain. No time to put her on the monitor, a quick bedside ultrasound of the belly showed the baby to have a heart rate in the 60's or 70's, indicating fetal distress. The only question left to be answered was, "is this a viable baby." If the patient is really 5 months pregnant (about 20 wks) there's no sense in rushing her to the operating room for an emergency c-section, the baby won't survive regardless. But what if she's really more like 25 or 26 wks? 24 wks in utero is considered to be about the limit of viabilty. I called my senior who quickly measured the baby's femur length by ultrasound. The baby's femur lenght was consistent with about 29 wks gestation!
We moved her fast. I scrubbed into the case, but I let my senior and the attending do most of the cutting. From the time she rolled up to the floor to the time the baby was out was about 10 minutes. We opened the uterus to find the baby with it's placenta completely detached. Infant delevered still inside the bag along with it's placenta. It still had a heartbeat. The pediatricians worked on him for ~20 minutes but he didn't make it. Baby was pronounced dead in the OR.
We had some time to relax at this point. With baby out - albeit dead - thing were no longer an emergency. Since nobody had taken much of a history, conversation turned to speculation.
"Well, there's another cocaine related abruption." "Man, having kids at the taxpayer's expense, no prenatal care, how irresponsible." "12 kids! How many baby daddies, I wonder. Probably 12!"
As we finished closing her up, the nurse came in. "The father of the baby made a point of letting us all know that they were high school sweet hearts and have been together for 20 years. He is the father of all 12 kids. He was a small business owner and recently lost his business which is why she hadn't gotten any prenatal care yet.
How quickly we judge. Not that it made any difference to me. My job was to assess the situation and act accordingly - which, I think I did. In retrospect, we might have been able to get that baby out 3-4 minutes earlier, at best. But I doubt it would've made any difference. She most likely abrupted at home. The kid was severely anemic and probably without oxygen since she left home. But, we had to try. All, in all, I felt pretty good about the it.
I am sick of always being called here and called there and everything being an emergency. I haven't blogged in a long time, so here's the rundown with my life.
1. Leaving my current position and applying to ER residency
2. moving to California with my girlfriend in January.
Good thoughts of leaving are what sustain me through some of these miserable days. I can't wait for the opportunity to take control of my life again!
