Things are going all right, I guess. I got rid of a few patients. I have only three right now, and they’re pretty stable. And I got a decent night’s sleep last night. I really needed it; basically collapsed at nine-thirty after I got home totally wiped out from another all-nighter without any sleep. So right now, things are looking up.
But Sunday night was one of the worst possible nights I could imagine. I was on with Larry, the senior resident, and we were both working our butts off. I spent most of the afternoon and evening doing shitloads of scut. At about one in the morning, I finished most of my work and went up to the well-baby nursery to try to finish all the physsies. There were a lot of new babies, and I was plowing through them all. At about three A.M. I realized that the chart of the baby I had just examined was still over in labor and delivery, so I went over there to get it. Just as I got through the door, a nurse came running out of one of the labor rooms, yelling, “Get peds! Get peds stat!” She saw me and asked if I was from peds. I told her I was and she said, “There’s a little preemie just delivered right in this room.”
Great! This was just what I needed at three o’clock in the morning. I thought, Oh, my fucking God, what am I going to do? I had never been alone with a new preemie. So I turned to the unit secretary, yelled at her to call Larry stat, and then I ran into the labor room.
Lying at the foot of the bed was this little fetus. The midwife said, “I measured him. He’s twelve inches long.” The baby was tiny but he was moving and I didn’t know what the hell to do.
Last week I had gone to the delivery room with the neonatal fellow to see a micropreemie who had just been born. We knew about the baby in advance and we knew that it wasn’t going to be viable, but the fellow had taken me to teach me about what what’s viable and what’s not. That baby had no breast buds, his skin was gelatinous, his eyelids were sealed shut, and he was only ten inches long. The fellow said, “This baby is clearly not even twenty-four weeks; he’s not viable. There’s nothing to do for this baby.” So we didn’t do anything, and he died. And that had been my one experience with extreme prematurity.
Well, I checked all those things out in this kid. I measured him, and sure enough he was twelve inches long. I looked at the eyes and they were sealed and there were no beast buds and the skin was gelatinous and I thought that this kid couldn’t possibly be viable. Then I listened to his chest; he had a strong heartbeat, so I rethought the situation and I figured maybe I was wrong. I didn’t know what to think.
I decided to take the baby over to the warming table in the DR (Delivery Room) to see what I could do. Everything I knew was telling me that this baby could not possibly survive, but I just hadn’t had enough experience and I was all alone. I ran into the delivery room with the baby and I laid him down on the warming table. I realized I didn’t have any idea what to do next. I figured I’d try some oxygen: I grabbed the oxygen mask, turned the oxygen on and started to try to bag the baby, but the face mask was too big; it went over his whole head. I wasn’t having any success.
Just then the baby kicked a couple of times so I listened to the heart again with my stethoscope. It was still beating pretty strongly. I decided that weighing the kid might help decide whether he was viable or not, so I asked the nurse to get a scale. And just then, as my panic was reaching its peak, Larry came walking in. Thank fucking God! I think I had been out of the labor room for maybe a minute by that point, but it had defiantly been the worst minute of my life.
I told Larry everything that had happened. He took one look at the baby and said, “Forget it. That kid’s not viable. Don’t do anything.” I was pretty relieved I still felt bad because I didn’t have a clue about what I was supposed to do, but at least I realized I hadn’t done anything that was harmful.
Then the nurse came back with this rickety old scale; it looked like something out of the nineteenth century. We put the baby on it and it read twelve hundred grams. No way that baby weighed twelve hundred grams! She said, “Well, this is the scale we use to weigh all the babies.” Larry said, “Well, it’s wrong.”
We wrapped the baby up in a towel and brought him back into the labor room. Larry explained to the mother that the baby was too small to survive but since he had a heart rate, we were going to have to take him down to the NICU. The midwife started throwing a shit fit. She said, “You can’t take the baby downstairs! This baby belongs with his mother! You have no right to take the baby out of this room!” Larry told her that he wished he could leave the baby, but it was hospital policy that any infant with a heartbeat had to be brought to the NICU.
Then Larry and the midwife started fighting about where the baby should be kept while we waited for him to die. I stayed out of it; I agreed with the midwife, but I wasn’t going to argue with the resident who had just rescued me. Finally Larry called the hospital administrator. She showed up, heard the story and agreed with Larry. The midwife argued with her for a while but finally backed down and we took the baby downstairs.
When we got down to the NICU, we reweighed him; he really weighed only 460 grams. We put him in an isolette to keep him warm. I checked his heart rate about every ten minutes. Finally, after an hour, the heart stopped and I declared him dead. Then I went upstairs and told the mother that the baby had died. She was exceedingly sad.
Then I went downstairs and started doing more scut. At about seven o’clock all the new nurses came on, and they started yelling at me. They wanted to know why I hadn’t filled out the death certificate and gotten permission for an autopsy. They were being really hostile. I was exhausted and I’d had a horrible night; all I wanted to do was be left alone. I didn’t even know I was supposed to fill out the damned death certificate and get consent for the autopsy. Nobody told me I had to do those things.
Finally, one of the nurses came up to me, and she was really nice. She knew I hadn’t done any of this stuff before so she showed me exactly what had to be done. She gave me the death certificate and the autopsy form and the form for the burial. She told me that I should go up and talk to the mother and tell her that if she wanted a private funeral, it’d cost six hundred dollars and if she didn’t have the money the city would bury the baby free.
So I went back upstairs and talked to the mother, told her how sorry I was. I didn’t know what to say; I don’t have a lot of experience with this. I asked her if she wanted us to do an autopsy and she said no. She was so broken up. It tore tears from my eyes. This is the saddest thing I had ever encountered.
Another day I pray my heart continues to beat for me.
