Saturday, February 13, 2010
In my whirlwind tour of all specialties that makes up the third year of medical school, I spent the last two weeks working in Labor and Delivery. There have been many moments over those two weeks that were, by themselves, blog-worthy. But when babies are popping out, there's no time to blog. So here are some of the more notable moments on L&D. Some were joyous, some were sad, all were miraculous and humbling.

On my second day, I still didn't really have any idea how things worked. I was at a new hospital, on a new rotation, and pretty lost. My first day had been pretty uneventful. I'd written some notes (all the laboring ladies need notes every 2 hours), and seen twins delivered from across the OR, but not seen any normal deliveries. About 8 hours into my second shift, one of the residents wanderd into the room I was writing notes in and said someone had just come in and would probably deliver pretty quickly. So I scampered off to her room, and when I got to the door, one of the residents said, "do you want to deliver a baby?". Duuuuhhhhhhh. So I put on my plastic booties and gown and jumped right in! About five minutes later (these things happen fast when it's the fourth vaginal delivery a woman has had...), the resident was coaching me as I delivered the baby boy. There was much screaming (from un-medicated mom, not me!), some crying (from the baby, not me!), and a very firm grasp on a slimy baby (yeah, that was me). Those suckers are SLIPPERY!!! Moral of the story: I delivered a baby. It was pretty awesome.

A friend of mine was following a patient. She was a 19 year old girl, 24 weeks pregnant with her first baby. I never asked, but I don't think the baby's father was even as old as she was. When we came in that day, the plan was to stop her labor and send her to the antepartum unit for a long stay until her baby was old enough to deliver (probably around 34 weeks). Suddenly, my friend ran off because the girl was fully dilated and going to deliver. 24 weeks old is on the limit of viability. Sometimes they try to save them at 23. But at 24 weeks, the likelyhood of the baby living, let alone being normal and healthy, is slim. And we don't think the mother had a clue how serious the situation was. She was excited, anxious, and happy. She had no clue about the challenging journey her daughter was about to embark on. She was born weighing 1.5lbs. When my friend and I went to see her in the NICU, she was intubated, had two lines in her unbilical cord to deliver medicine and draw blood, her face was bruised from trauma, and you could see through her skin. When I left the service a week later, she was still hanging on. I don't know what the outcome will be, but I have spent a lot of time thinking about that little girl, and how far we push the limits.

Speaking of pushing limits, this last patient was probably more memorable than any. She was also 19 years old, and came to triage (pregnant lady ER as I like to call it) because she'd had fluid leaking for the last couple days. Her doctor told her he was worried her water had broken, so she was sent to see us. She was 22 weeks pregnant when she came in. After ultrasounding her belly, we found that she had virtually no fluid around her baby. Her water had broken 18 weeks early, and she was devastated. This was very much an intentional pregnancy. She wanted this baby. But rupturing at 22 weeks meant that not only was the survival of her baby in question, but whether or not they could even try to save it was unsure. Before 23 weeks, no one will attempt to resuscitate. So before she could even absorb what was going on, conversations about when to give steroids, when she wanted to set a cut off for resuscitation, whether she wanted a DNR, what to do if she got an infection were all happening.

A 23 week old baby is a remarkable, devastating miracle of modern medicine. I honestly don't know of any of them make it. They are million dollar babies, attended to continuously for the first months of their lives. Many don't survive. Most aren't "normal". But when you look at it, less than a pound, but with fingers and toes and a nose, how many parents would say, "no, don't try". Some do, and it takes strength and courage and understanding to be willing not to put their little one through what they go through. But some can't, because they know there is a chance that their little baby will be the one to turn out ok.

In the hallways of the NICU, there are pictures of many of the kids that have made it out. My favorite is of an 11 month old boy named grant, who is little for his age, but otherwise a normal baby. He was a 23 weeker. As I walked past that picture with one of the high risk maternal-fetal medicine fellows, he said "that is why we do what we do. He is why we keep pushing the limits."

So we push the limits of what we know is possible, hoping that the ones that make it can somehow live for the ones who couldn't.


Anonymous said...

Another comment: I've got a young cousin, born 23 years ago this month. She was 6 weeks early, suffering from superventricular tachacardia (I'm sure you know what that is and if I spelled it correctly.) 6 weeks isn't VERY early but it was traumatic for her family. That kid, now a young woman, just took off for her 2 year stint in the Peace Corps. Guatemala, where she'll dealing with public health. What goes around, comes around.

About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


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