Doctors' Writing Contest 2011 New Doctor Award: Saving Grace

February 25, 2011

This physician recounts his days during residency where a delivery, usually a joyful occasion, turned terribly tragic in the case of the mother.

That morning, the sun had painted a beautiful array of colors over the town, but they fell behind me as I drove into the cavernous gray hospital parking garage. By the time my shift was over, I would be yearning to be outside again to get some warmth on my face, soak in the colors, and heal the coldness in my hands and my heart.

Thankfully, everything was going well at first, but the routine seemed colorless. No two days are the same when you're a resident, but as the time ticks away, you realize if there were 25 hours in a day, more would be demanded of you. It's not easy being at the beck and call of a nurse or attending physician. Even janitors seemed to have more clout and direction than a resident.

When the delivery was completed, the attending, Dr. Lane* and I discussed how well it had gone. He left the hospital, while I finished up some paperwork, grabbed a much-needed coffee, and found myself in the hallway talking to the family. We proceeded into the room to make sure everything was going well with postpartum care and the newborn baby.

Suddenly, I was paged overhead and urgently ushered to the room next door, where I found the polar opposite of a happy birth. Upon entering the room, I immediately noted panic on the face of the head nurse, Diane.

As I looked over to the bed, I saw a 29-year-old first-time expectant mother in what appeared to be a full tonic-clonic seizure. I looked at her vitals on the monitor, assessed the conditions, and knew the situation was not good. Her skin was pale, and her face was blue even though oxygen had been initiated. I asked Diane what had happened. She said the mother, Beth, had been doing fine, when she had suddenly rolled her eyes back, gasped, and then appeared to be having a seizure.

CODE BLUE

My mind rapidly made decisions, while outwardly I tried to remain calm. In what seemed like a slow- motion blur, but was really only a few seconds, I called a full code blue. (Later on I would find out that many colleagues responding to the code were not sure if it was accurate, because codes aren't supposed to be called on the labor and delivery floor.) The nurses phoned the patient's attending physician, but he was 15 minutes out, far too long to help.

I had the clarity of mind to call Dr. Lane back to the hospital, even though he had not been involved in the care of this mother. The nurses and I began initial CPR with oxygen and chest compressions, which seemed especially complex because the pregnant abdomen and muscular uterus were pushing back.

There was a cold and surreal feeling about the whole situation. Faceless bodies flooded the room to offer help. I had never seen anything like this before. Dr. Lane arrived, and I updated him. It had been only four minutes since the code had been called. Oxygen, IV epinephrine, lidocaine, and CPR were in full swing, but we needed to make a radical decision. Should we try to save the baby, the mom, or both?

It became obvious the patient was deteriorating. The cardiac monitor flat-lined, and we administered more alternating shocks, followed by more medications. Dr. Lane took off his dress shirt and threw a green scrub top over his T-shirt. He reached for the gloves and scalpel and we started a cesarean delivery right there in the room on a standard hospital bed.