Tag Archives: pregnancy

Paradise Lost

Obstetrics isn’t always the happy specialty. Tragedy is Death claiming one life during pregnancy. Unspeakable devastation is when both mother and baby are lost.

Linda was one of the receptionists in our OB/GYN office, and a single mother with a young daughter. She had known bad relationships and even worse situations but she rarely let them cloud her demeanor. She would smile even when she was angry, fuming over the latest frustrating phone conversation with a patient who had been unreasonable, irritated or just plain stupid. Being around her would make the worst day of work just a little better.

Linda met and later married Danny, a hard-working shop rat at GM who looked like Chuck Norris and worshiped the ground she walked on. No one had ever treated her so well and her face lit up whenever she talked about him. Maybe “happily ever after” was more than just a fairy tale.

Linda was ecstatic when she became pregnant and we were thrilled. Her ultrasound revealed her six-year-old daughter was going to have a baby brother. All of the providers took care of her during her pregnancy and we were looking forward to the new arrival. Someone arranged a baby shower; it’s what you do for family.

One cold, rainy night in October, two weeks before her due date, Linda dropped off her daughter at a Brownie meeting and headed home. On her way back, a man ran a stop sign at an intersection, slamming into her car and sending it down an embankment. The impact threw Linda out of the car which then rolled over her and her unborn baby.

When the ambulance arrived, the paramedics could feel the baby moving inside Linda’s uterus, even as she lay unconscious, but there was nothing they could do. The hospital was at least twenty minutes away and a baby deprived of oxygen has only a few minutes to live. Even if someone had delivered the baby with a scalpel, a rainy country road is no place to resuscitate a critically ill baby. They could only watch on in horror as the movement slowed and stopped.

The hospital’s obstetrics residents were waiting in the Emergency Department when the ambulance arrived. The paramedics quickly wheeled their gurney into a room which had been set up for an emergency delivery. Tthe chief resident dutifully performed a procedure he knew was futile.

I was at home that night when the resident called.

“I’m in the ER. There is a patient of yours, here. She was in an auto accident about an hour ago. We delivered the baby down here but… I’m sorry. Neither one of them made it.”

I felt sick and more than a little helpless. At first, I didn’t know what to do. I’m used to driving like a bat out of hell to the hospital to deliver a baby that’s coming quickly, but there wasn’t anything I could do that would bring them back. After the initial shock, I called Jenny, one of the nurse practitioners who had cared for Linda throughout her pregnancy. She called Hope, one of the other receptionists and a friend of Danny’s, who in turned called the factory.

An eerie silence met me when I walked into the room. The residents had gone back to the Labor unit and the nurses had moved on to other patients. The gurney was bloody; a scalpel and the placenta lay in a stainless-steel basin. Linda and son lay side by side, as if they were sleeping peacefully after a long labor. Her abdominal incision was still open but the bleeding one would expect from a fresh Cesarean was lacking. I covered her with a clean gown and a sheet. Jenny and Hope appeared a few minutes later, their faces pale and grim.

“Someone found Danny; he was working on the line. It will take him about half an hour to get here.”

When Danny arrived someone from the front desk escorted him to the room. I excused myself to make room for him and as I left, I heard the most anguished cry ever to come from a man whose heart had been shattered. The woman he cherished and her baby would never come home.

A few days later, I drove Jenny, Hope and Sarah, another receptionist, out to the funeral in a little town about half an hour away. Linda and Zach—she’d picked out the name a few months before—were in the same casket. I don’t remember anything about the service; how much can one remember after nearly twenty-five years?

After the ceremony we joined the procession out of town to a state highway, then onto one of the many rural back roads, to a small cemetery a several miles north. The cemetery drive was unpaved and rutted; we pulled off into the grass near the fresh gravesite. The afternoon was cool and sunny, not cold and rainy like the night they died. A breeze stirred the few leaves that had fallen; in a few weeks all the trees would be bare.

The minister spoke a few words before we gathered around the casket to say our goodbyes. We drove back to the office in silence, sharing a grief that needed no words.
I sometimes look back and wonder “What if?” Linda would be fifty-two now. Maybe she’d have been a grandmother by now as her daughter is now in her thirties. Perhaps she and Danny would have had more kids.

Zach would be twenty-four. He might have been a good kid, then morphed into a sullen teenager, giving his parents many a tale with which to embarrass him when he finally matured. Maybe he would have done a stint in the military and made his parents proud.

Cherish what you have, because you never know when it may be lost forever.

© Can Stock Photo Inc. / Frankljunior

Crimson Tides

Another day in the life…

Few things in my profession are more terrifying than obstetrical hemorrhage.  Every year more than 144,000 pregnant women bleed to death, even here in the U.S. Sometimes we anticipate problems; more often we have no warning.

I aged ten years one afternoon treating one such woman.

Marylou was in labor with her third child and everything was going well.  Her cervix had dilated to 6cm and I thought she’d deliver in the next two hours or so.  Suddenly, she said, “I can’t breathe,” and the baby’s heart rate dropped to 60 beats per minute or bpm (normal baby heart rate is 110-160 bpm).  Her cervix was completely dilated but the baby wasn’t looking any better and too high in the birth canal to deliver with forceps, so we took her to the operating room.

The baby came out screaming and we were all relieved…for the moment.  We closed the uterus but the suture line slowly oozed blood.  The bleeding seemed to improve after a few minutes, so we finished.  We noticed a little bit of blood around the staples that closed her skin, but it wasn’t unusual.  The nurse pushed on her uterus to expel any remaining blood before taking Marylou to the recovery room. Everything seemed fine.

Blood started gushing from Marylou’s vagina about 30 minutes later and it wasn’t clotting. I ordered another four units of blood—we had two units already waiting from before surgery—while her nurse started a second IV.  We then wheeled her to the Intensive Care Unit (ICU) and called one of the critical care specialists.

The specialist was a man of few words who, until that day, wasn’t known for anxiety under pressure. When he pulled the sheet off Marylou, blood was visibly welling up between her thighs.  His eyes widened as he quietly said, “We need more blood.”  That’s when we knew Marylou was in trouble.

I ran to the blood bank and came back with four units, but her blood was pouring out as fast as we replaced it.  I was starting to worry she might bleed to death and took her back to the operating room. I asked a physician on the unit, who had also been my senior resident in training, for help. We tried packing her vagina with laparotomy sponges, but the blood soaked through them and ran onto the floor. He looked at me and said, “I think it’s time to give up and take it out.”  We quickly prepared her for surgery.

One of the hospital’s hematologists brought a portable refrigerator to the operating room and directed the transfusion while we took her uterus out.  We emptied the hospital blood bank of Marylou’s blood type; then we emptied out the local Red Cross. By the time Marylou was stable and out of danger, she’d received 30 units of blood and several liters of IV fluids.

Marylou suffered from the “anaphylactic syndrome of pregnancy,” something we used to call an “amniotic fluid embolism.”  Baby’s skin cells and amniotic fluid get into the mother’s circulation, causing a severe reaction in a small number of women, much like that in someone with an allergy to penicillin, peanuts or bee stings. The afflicted patient has trouble breathing and her blood pressure can fall low enough to put her into shock.

Marylou’s blood wouldn’t clot because the reaction used up most of the blood’s clotting factors, creating a potentially fatal complication called disseminated intravascular coagulation (DIC). Red blood cell packs lack those clotting factors, so we need to transfuse other blood products—fresh frozen plasma, cryoprecipitate and platelets—to treat massive hemorrhage.  Since then hospitals have developed transfusion protocols based on the military’s battlefield experience.

The survival statistics for amniotic fluid embolism have never been good.  One hundred percent of women with an amniotic fluid embolism who aren’t treated die; up to seventy percent die in spite of treatment.  Sometimes babies have been delivered by Cesarean section after the mother has gone into cardiac arrest and died.

Marylou woke up in the ICU four days later and asked me, “Did I scare you?”

More than you will ever know.

 

 

Image:© Can Stock Photo Inc. / Frankljunior