are we ok?

I was an eager 2nd year resident doing work that I loved. Despite all odds, I found myself in a field of medicine that constantly amazed me. We were working the night shift at a community hospital. Along with a senior resident, we ran the labor floor and took care of all the Gyn patients. The night had been quiet and I was checking on the few laboring patients. As I exited one patient room, I saw EMS wheeling a pregnant patient on a gurney towards the registration desk.

*I am a well-trained attending. I am 37 weeks pregnant and there is a twin amniocentesis on the schedule. I consider my belly, the belly of the patient and my arm length. All seems doable. I prepare and do the procedure with ease. I see a few more patients and then I notice an intermittent pain on my right side.

As I approached the registration desk, everyone seemed to be in quiet conversation that did not include the patient. Her facial expression was one of concern. Seemingly unnoticed by the staff at the desk or EMS, I asked her what was happening. She told me that she was having pain and bleeding. I put my hand on her 32 week belly and asked if I could lift up the sheet. Upon lifting it, I see a terrifying sea of red. I grabbed the ultrasound machine and, with the fear of a 2nd year resident, begged the staff to call for help. As I put the ultrasound probe to her belly, there was a slow squeeze of the fetal heart. I counted about 80 in my head and then as I moved the probe, I would see, for the only time in my career, the fetus, then a placenta and then a large clot. I looked at her face and sounded the alarms.

*My right side keeps hurting and I am having contractions. I meet with a resident over lunch. I tell her that I am uncomfortable and am going home. She encourages me to go back to the office. Eventually, I end up on the labor floor. I walk myself to the labor room saying hello to the docs, nurses and residents that I work with daily. An epidural is placed for labor. I stop feeling the contractions and complain that this is really an elective induction. My doctor reassures me that the epidural is working and that I am contracting every 2 minutes. I wonder why I do not feel the contractions but continue to have significant right sided pain.

With the help of the nurses, we wheeled the patient into the operating room. With bravado that only comes from wanting to save a life, I told the anesthesiologist that we needed to perform an emergent C-section under general anesthesia. As everyone was moving, my chief comes running in. I give her a quick summary as she takes it all in — me, the patient, the operating room and the blood. We perform the C-section in a minute. I deliver a pale female infant and the placenta follows. I take a quick breath only to then again hold my breath as I wait for the cry. We always wait for the cry.

*I tell my doctor that I am still having pain despite not feeling contractions. I know her well and her face reveals her concern. She wants to break my water but as she does, I instinctively know it is not just amniotic fluid. She tells me the fluid is bloody, that my baby’s heart rate is good, and that she will be right back. She is gone for under a minute, but something feels so wrong. She comes back in and examines me. She looks directly at me, quietly says my name and is quiet for just a few seconds. I know. I tell her to do whatever she needs to do. The next few minutes are like a slow motion tape reel in my head. Taking off the monitors, moving the bed, calling for blood, alarms sounding.

It feels like hours but it was less than 5 minutes. Her uterus has contracted. Her vitals are stable. And the whole time, we hold our breath. And then, it happens. The cry. We hear her cry. We look across the room. We see stress wash away from the faces of our neonatology colleagues. We see her, turning pink, screaming to the world that she is here.

*The docs and nurses run me down the hallway into the smaller operating room. I hear them whispering to each other and more nurses, doctors and staff come running in. In the operating room, they call for others to move me from the hospital bed to the operating table. So many people and sounds fill the small room. I find my voice and say that I can move. Without waiting for an answer, I put all my strength into my hands and transfer myself to the operating table. As I move, I glance down at my hospital bed and see a terrifying sea of red. I must have not looked long and yet, the multiple large clumps of blood, the soaked pads, the now red colored sheets are imprinted forever on my soul.

As we hear her cry, I become lost in what could have happened, what almost happened. I am both terrified and amazed by our quick actions. I am reminded, again, of the urgency of our field. I cower in the awesome responsibility it is to be an obstetrician. I weep without fully understanding the fear that must have overcome the mother. The baby’s cord gas suggests an acute hypoxic event. For the next 4 days, I check several times a day with the pediatric team. Has she had a seizure? How is her tone? And in the most non-medical way, is she OK?

*The team hovers over my belly with knife in hand, as I lie and tell them that I do not feel them pinching the skin on my stomach. In the midst of paralyzing fear, I tell them to get her out and give me blood. I hold my breath. I feel their arms on my stomach. They call out the time of her birth. And, I wait for her cry to break the silence.

They tell me that is she is OK. She will be OK.

*I do not take a breath until she does.

*And then her cries fill the crowded room.

• And, they tell me that she is OK. She will be OK.

Michal A. Elovitz, MD