Tuesday, November 1, 2011
99% of what happens on the Child Birth Unit (CBU) is happy and exciting.  Sometimes where are bumps along the way, but generally babies are born healthy and families are happy.  But 99% still leaves room for tragedy, and those stick with you.

While medicine continues to improve, and we are able to do increasingly more remarkable things, there are still limits on who we can save.  Never was that more evident than today.  I wasn't directly involved with this case, but not much happens on the CBU that everyone doesn't hear about. 

There are a woman who came in overnight (before my shift) who was 21 weeks pregnant and started having contractions.  This is not completely unheard of, and there are a few common things that can cause preterm contractions that are generally pretty easy to deal with (infection being the most common).  This woman was treated with fluids and terbutaline, but her contractions persisted.  Ultrasound revealed a grossly normal baby without obvious deformities.  Lab tests did not show any source of infection that could be treated.  As her contractions continued, her cervix started to dilate.  After much debate, she was started on Magnesium as a last ditch effort to stop her contractions.  It failed.  Preterm labor in itself is not uncommon, but she was only 21 weeks pregnant.  The general limit of viability for a fetus is 24 weeks.  Sometimes they will resuscitate babies born at 23 weeks. 

Nothing before 23 weeks is considered viable.

She was in rip roaring labor, and there was nothing to do to stop it.  She was delivering her baby, which was still alive, and they had to tell her that there was absolutely nothing anyone could do to save it.  The NICU doctors came to talk to her and reiterate that they could not offer her anything.  The OB docs talked to her and told her they'd done everything they could to stop it, but her body was going to have this baby.

She asked why, if her baby was perfectly healthy (from what we could tell), and was going to be born alive, we couldn't help it. 

She asked why we couldn't keep it in for just 2 more weeks until it was viable.

She asked what was causing her preterm labor.

She asked why no one was helping her.

She held her baby after it was born, as it was dying, and just asked "why?"

And there's only one answer, although not a good or satisfying one...

Because there are limits.


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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