I love my job. This is bizarre considering the fact I am scared / afraid when I meet a new patient. I am afraid of failing. I am afraid of failing to make a good diagnosis. I am afraid of being incompetent. I do not want to be responsible for the life of somebody. In the same breath, I want to be there in time of need. I want to do the treatment whatever it be, a c-section, a central line, an intubation, etc.
You can imagine then how I felt – happy, afraid, angry, excited, depressed –when the phone rang and it was the OB nurse. She said my wife was requesting my presence. It is rare for my wife to call for help, but when and if she does, it means simply one thing . . . things are not going well.
In helping my wife I have come to realize a couple of things. First she does not need my help. She is a competent, compassionate doctor. Yes we make suggestions to each other that neither of us thought of. But that is beside the point. Second, her call for help is a call for support usually because of a difficult case and or of being inundated by patients. I find my role in these cases as being someone she can pass work off to, trusting it will get done in a timely / efficient / competent manner. I am too her as she is too me in these same circumstances, a security blanket, a thing of comfort, someone to get things done and bounce ideas off of. I do not change the outcome for my wife and or her patients but I provide, as she does me, a source of comfort, a familiar face in a stressful environment.
The call came in at 7 am that morning, 30 minutes before the end of her shift and the start of my shift. Her shift was long. It started at 8 am the day before. All though we live less than 5 minutes from the hospital, I saw her for a short lunch only and then at 3 am. When she crawled in to bed, I could feel the weight of her day, the hopeless admits that had come in too late. Topping them off was a 55 plus year old man coming in with hypotension, bilateral lower extremity edema, tachycardia, urinary tract infection and pancytopenia – platelets 8 (normal 150), WBC 500 (normal greater than 5000), Hct 7 (normal >35%). We know he will die but we try to save him anyway. At 6:30 am she headed back over to the hospital to tie up loose ends. She did not want to leave me a mess.
After hanging up the phone, I pick up Noah and head to the hospital. I try to run, but cannot, I am out of shape. I walk as fast as I can. Passing the OB desk I hand Noah off to a nurse, “Please watch him” I say. I enter our four bed labor suit. There is crowd. My wife is easy to find. She is the white person leaning over, what appears to be, a young pregnant person, doing CPR. Our eyes meet. I know my role. I ask her what she needs. “We need to intubate her, Fred, and I need a line.” I call for the nurse anesthetists, search out equipment and request a central line kit. She is intubated by the nurse anesthetists, and I place a subclavian central line. We hook her up to the monitor and attempt to resuscitate her. Her story is strange. Did she throw a clot? She came in this morning at 7 am complaining of abdominal pain which started the night before. She had not felt the baby move for 16 hours. My wife had just determined there were no fetal heart tones when she stopped breathing and went into cardiac arrest. Forty-five minutes later we stop. We are unsuccessful. Mom, 14 years old, and baby, 39 week gestation age, are both dead.
I am angry. I am hungry. I missed breakfast. My shift has started. I cannot go home now. My wife will clean up the OB deck. I will start rounding on the medicine patients. Midway through rounds my wife informs me that Togo culture dictates that mom cannot be buried with a baby and that family is requesting we do a c-section for the baby. We comply. We deliver a normal looking infant with a normal placenta. The only odd thing we notice is the smell. I think the baby has been dead for a while.
This is not the way to finish and or start a shift.
After proof reading this blog my wife asked a question, for me, what is the learning? I think it is clear but now am unsure. It is the title, it is HELP, but I am unsure. Maybe it is just a story of events past and my random thoughts there of.